Biomedical subjects

E Buttler

Publications and source records attributed to E Buttler.

6 recordsLinked to original sources

PubMed2001

[Surgical techniques in hepatic resections: Ultrasonic aspirator versus Jet-Cutter. A prospective randomized clinical trial].

AIM OF THE STUDY: For all resection-techniques of liver tissue intra- and post-operative blood-loss remains an important problem. Two novel resection-techniques the ultrasound-aspirator (CUSA) and the water-jet dissector (Jet-Cutter) appear to offer significant advantages regarding this problem. Aim of the present prospective clinical study was the comparison of these dissection techniques. MATERIAL AND METHODS: Prospective randomized study with the end points blood-loss, length of surgery, tissue trauma and long-term survival. FINDINGS: Significant differences between both procedures with Jet-Cutter (n = 31) versus ultrasonic surgical aspirator CUSA (n = 30) were observed regarding length of resection and complete liver ischemia time (Pringle-time). Here significant advantages of the jet-cutter-technique were observed with 28 +/- 11 minutes length of resection versus 46 +/- 19 minutes and 29 +/- 12 minutes Pringle-time versus 39 +/- 16 minutes. Furthermore, significant fewer blood transfusions were required following jet-cutter-resection with a mean of 1.5 blood units vs. 2.5 blood units using the CUSA. No differences were observed regarding postoperative long-term survival. CONCLUSIONS: The jet-cutter-technique is a fast and safe surgical procedure for liver resections and offers an attractive therapeutic alternative for various indications in liver surgery.

Blood Loss, Surgical↗

PubMed2000

Impact of virtual reality imaging on hepatic liver tumor resection: calculation of risk.

The risk involved in partial liver resections depends mainly on tumor localization, invasion of central vascular structures, and parenchymal function. The imaging techniques available today (computed tomography, magnetic resonance imaging) allow us to detect precisely the extent of tumor invasion and their relationship to central vessels. The various three-dimensional reconstruction techniques are helpful with regard to a virtual planning of liver resections. The calculation of remaining liver volumes subsequent to partial hepatectomies are considered to be an essential predictive parameter in terms for the development of postoperative liver failure. In a retrospective and a later consecutive, prospective clinical study we analyzed the postoperative risk in a series of 570 patients. In an univariate analysis 13 of 31 parameters showed significant values. In multivariate analysis only three parameters (partial hepatic resection rate, PHRR), gamma-glutamyltranspeptidase, and prothrombin activity) were independent parameters for predicting liver failure, generating the most significant values for the PHRR. In our experience the most comfortable and precise technique for evaluating PHRR is the b-spline technique.

Female↗

PubMed1997

Preoperative risk assessment of hepatic resection for malignant disease.

Clinical, laboratory, functional, and volumetric data of 340 consecutive patients undergoing hepatic resection for malignant disease between November 1990 and June 1995 were analyzed. The operative mortality was 3.3% (8/244 patients). Among 178 patients with liver metastases and 66 with primary hepatobiliary tumors the hospital mortality was 4.1% (10/244 patients) and morbidity 22.0% (54/244 patients). Survival after hepatectomy was strongly influenced by the extent of resection quantified by the parenchymal hepatic resection rate. The prediction of fatal postoperative complications can be improved for patients with hepatic metastases by calculating the liver resection index (sensitivity 75%, specificity 83%).

Adult↗

PubMed1996

[Liver resection with the water jet: conventional and laparoscopic surgery].

In a prospective study 60 patients underwent liver resection. Two different resection techniques, ultrasonic aspirator (CUSA, n = 30) and Jet-Cutter (n = 30), were compared, Speed of resection, blood loss, transfusion rate, liver hilus clamping time and tissue damage were evaluated on the basis of the area of transsected liver. Liver resection with the Jet-Cutter was significantly faster with a resection time of 0.35 min/cm2 in comparison to the CUSA (0.77 min/cm2, p < 0.001) and associated with less blood loss of 18.4 ml/cm2 (p < 0.05) than the CUSA technique (34.4 ml/cm2). Tissue damage in respect to levels of transaminases SGOT and SGPT was comparable with both techniques. The Jet-Cutter is a promising new instrument in liver surgery, and challenged by these results we used the Jet-Cutter in 7 patients performing laparoscopic liver resections.

Adult↗

PubMed1995

A comparison of different techniques for liver resection: blunt dissection, ultrasonic aspirator and jet-cutter.

In a prospective study 116 patients underwent liver resection. Three different resection techniques, blunt dissection (n = 61), ultrasonic aspirator (CUSA) (n = 27) and jet-cutter (n = 28) were compared. Speed of resection, blood loss, transfusion rate, liver hilus clamping time and tissue damage were evaluated on the basis of area of transected liver surface. Liver resection with the jet-cutter was significantly faster with a resection time of 0.33 min/cm2 in comparison to blunt dissection (0.57 min/cm2) and CUSA (0.50 min/cm2) (P < 0.01) and associated with lower blood loss of 17.7 ml/cm2 (P < 0.01) than the other techniques (blunt dissection 32.5 ml/cm2, CUSA 24.3 ml/cm2). Tissue damage with respect to transaminases SGOT and SGPT was comparable to the other techniques. The jet-cutter is a promising new instrument in liver surgery.

Adult↗

PubMedDate not supplied

Laparoscopic liver resection compared with conventional partial hepatectomy--a prospective analysis.

BACKGROUND/AIMS: Tumor size and location are the major influences on the practicality of a laparoscopic operation. Visual control of the operating field is important for isolation and ligation of blood vessels and bile ducts after selective liver dissection by suitable techniques such as the water-jet dissector. METHODOLOGY: We carried out laparoscopic liver resections with the Jet-Cutter in 17 patients. The results were compared to a control group of 17 closely matched patients undergoing conventional hepatic resection during the period of the study. In 1 patient, conversion of laparoscopic to an open operation was required. RESULTS: Early in our learning curve, the duration of operation and time for resection were significantly longer in the laparoscopic group. Following laparoscopic operation, patients were discharged from the hospital after a mean of 7.8+/-8.2 days; patients having undergone conventional operation were discharged after a mean of 11.6+/-12.8 days. CONCLUSIONS: Laparoscopic liver resection is technically feasible, but, at present, careful patient selection is required.

Adult↗