Background: Excessive intraoperative blood loss and the possible requirement for blood transfusion are major problems in hepatic resection for liver tumors. Reduction of blood loss is a goal in liver surgery, and several technical developments have been introduced for this purpose. The aim of this prospective randomized study was to compare the use of the Cavitron Ultrasonic Surgical Aspirator (CUSA) with a radiofrequency-based bipolar hemostatic sealer versus CUSA with standard bipolar cautery (BC) in patients undergoing hepatic resection. Methods: One hundred nine patients with liver tumors were randomized to undergo hepatic transection using CUSA with a bipolar sealer (Aquamantys 2.3 Bipolar Sealer) (n = 55) or BC (n = 54). Blood loss during parenchymal transection and speed of transection were the primary endpoints, whereas the degree of postoperative liver injury and morbidity were secondary endpoints. Results: Compared with the BC group, the bipolar sealer showed signifcantly lower blood loss during transection and blood loss divided by resection area (P = 0.0079 and 0.0008, respectively); signifcantly shorter transection time (P = 0.0025); signifcantly faster speed of transection (P < 0.0001); signifcantly fewer ties and ties divided by resection area required during transection (P < 0.0001); and, although not signifcant, less postoperative morbidity and a shorter hospital stay. Conclusion: CUSA with a bipolar sealer is superior to CUSA with standard BC for various hepatectomy in terms of less blood loss and faster speed of transection, with no increase in morbidity.
The aim of the study is to evaluate the safety and effectiveness of microwave endometrial ablation (MEA) in women with submucous myomas for office-based gynecology. Thirty outpatients (average age : 44.6 years) who hoped to avoid hysterectomy received MEA for treatment of menorrhagia due to submucous myomas. The patients were divided into two groups according to the maximal myoma size. Group A (21 cases) in which node is less than 3 centimeters treated by MEA. Group B (9 cases) in which node is over 3 centimeters was treated by MEA with transcervical microwave myolysis (TCMM).
The mean operation time were in Group A; 17.7 and in Group B; 18.5 min. The blood loss during a monthly menstrual period decreased in Group A; seventeen (80.9%) and Group B; eight (88.8%) patients to less than 20%, Group A; three (14.2%) and Group B; one (11.1%) patient to less than 50%. Menorrhagia remained in Group A; one (4.7%) and in Group B; no patient after treatment. Three patients (14.2%) of Group A and one (11.1%) of Group B had mild endometritis within a month after treatment. The average VAS score regarding feelings of satisfaction for MEA were 8.8 (Group A) and 9.2 (Group B)(full score=10). MEA with TCMM is feasible for treatment of menorrhagia due to submucous myomas in various size and it may be useful for a office day surgical procedure that is minimally invasive for who hoped to avoid hysterectomy.
Of the 1635 patients with hepatocellular carcinoma receiving initial treatment at our hospital, 297 received local ablation therapy and 592 underwent hepatectomy. The prognosis and background factors of these patients were compared in this study. No significant difference was noted in the cumulative survival rate between the local ablation therapy and hepatectomy groups. However, with regard to background factors, the local ablation therapy group had significantly poorer hepatic functional reserve, smaller tumor size, and a lower proportion of patients with progressive stage disease. Accordingly, further investigation was conducted in a similar manner to correct for these differences in background factors. We limited the target hepatocellular carcinoma patients to those with liver damage grade A and a single tumor of ≤2 cm. Although no difference was found in the cumulative survival rate between the local ablation therapy and hepatectomy groups, the cumulative non-recurrence survival rate was significantly more favorable in the latter. However, serum albumin levels were significantly lower and tumor size was smaller in patients who received local ablation therapy than in those who underwent hepatectomy, despite the inclusion of only those patients who met the aforementioned conditions of liver damage grade and tumor size. Similarly, the results of specific local ablation therapies, including percutaneous ethanol injection therapy, percutaneous microwave coagulation therapy, and percutaneous radiofrequency ablation, were compared with those of hepatectomy in patients with liver damage grade A and a single tumor of ≤2 cm in size. However, the results indicated no difference in the cumulative survival rate. In conclusion, the cumulative survival rate did not differ between patients who received local ablation therapy and those who underwent hepatectomy, even on limiting the subjects to patients with liver damage grade A and a single tumor of ≤2 cm.