<Review>Experience in hepatic, biliary and pancreatic surgery using the ultrasonic surgical scalpel

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Since November 1983,a total of 33 patients with hepatic, biliary or pancreatic diseases underwent 36 operations using the so-called ultrasonic surgical scalpel in our clinic. The utilized device was the CUSA^<[○!R]> system (Cavitron ultrasonic surgical aspirator, Cooper Lasersonic Co.). A characteristic effect of CUSA occurs in that the higher the water content of the target tissue is, the more easily the tissue is fragmented. Thus, blood vessels, bile ducts and the main pancreatic duct are relatively easily spared and skeletonized because of their high collagen contents. CUSA-using surgery to the liver was made in 21 patients, among whom 10 patients underwent surgery for the primary hepatocellular carcinoma (HCC) and 2 patients were operated on suspicion of HCC, whose postoperative histology revealed the benign regenerated cirrhotic nodule. In the surgery for HCC, CUSA is considered to be a valuable device because of its reasonable exposure of vessels and bile ducts. This character of CUSA was evidenced in cases of present survey. Although CUSA has been expected to lessen the intraoperative blood loss and to shorten the operation time, the results of HCC surgery in the present survey were unsatisfactory regarding these viewpoints. CUSA-using surgery to the biliary tract was mainly aimed at the dissection of pericholedochal or pericholecystic adhesion or malignant infiltration. In 7 out of 9 patients of pancreaticoduodenectomy, CUSA was useful to expose the main pancreatic duct long enough for the pancreaticojejunostomy. As an exceptional utilization, CUSA was applied to fragment the duct-occluding pancreatolith with successful removal in 2 patients. No postoperative direct death was noted in the CUSA-surgery.
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<Review>Experience in hepatic, biliary and pancreatic surgery using the ultrasonic surgical scalpel

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