الفهرس 
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Abstract
The mode of parenchymal transection in hepatic resection has been a topic of great debate for decades. Excess blood loss and intraoperative blood transfusions have been shown to be associated with increased perioperative mortality and morbidity. Myriads of techniques have been developed to help in decreasing intraoperative blood loss thus decreasing morbidity & mortality with many devices are now available to surgeons for division of the liver parenchyma. Improvement in the techniques of liver transection is one of the most important factors for improved safety of hepatectomy in recent years.
The choice of transection techniques is a matter of preference of surgeons, as there are few data from prospective randomized trials that compared different techniques.
This study aims to evaluate the effectiveness and safety of using the CUSA in combination with the Harmonic Scalpel for the division of the hepatic parenchyma in liver resection in order to improve perioperative outcomes.
The main results of our study revealed that:
The mean amount of total operative blood loss was 374 ml (SD 74.9 ml with range 270 ml to 620 ml) and the mean blood loss during parenchymal transection was 132.5 ml (SD 33.3 ml with range 80 ml to 230 ml).
The median total operative time was 216 min (SD 40.8 min with range 145 min to 300 min) and the mean parenchymal transection time was 42.5 min (SD 8.95. min with range 25 min to 65 min)
The rate of blood transfusions was (5%) and the mean post-operative hospital stay was 5.25 days (SD 2.17 days with range 3 days to 12 days).
complications occurred in one case (5%).
In conclusion, combined technique of ultrasonic aspiration and harmonic scalpel for liver resection is a safe method for both major and minor liver resections. This method is associated with decreased blood loss, reduced postoperative morbidity, and minimal mortality rates. We believe that this combined technique is comparable to other techniques and should be considered as an alternative.
This data supports that our technique can synergize the advantages of different hepatectomy tools, improve hepatic transection efficiency, and optimize surgical procedures by reducing blood loss and decreasing operative time. We strongly recommend this emerging technique to be applied in other hepatectomy institutes.