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Use of a cortical screw to aid single piece excision of the trapezium: a simple technique.

TECHNIQUE Eight cirrhotic patients underwent 12 liver segmentectomies. No vascular control was applied. The activation of the Atlas LigaSure device started with the clamp open on the liver parenchyma (Fig. 1). Then, gradually, the clamp was closed and the parenchyma was crushed between the limbs and divided using the incorporated blade at the same time. Anytime that a major vessel was identified, the liver parenchyma surrounding the vessel was crushed so that the vessel could easily be incorporated between the instrument’s limbs, and safely ligated and divided at the same time (Fig. 2). No patient required any blood transfusion intra-operatively and none of them had biliary leak. DISCUSSION The Atlas LigaSure device is a bipolar electrocautery; therefore, the charring effect and the collateral thermal damage is minimised up to 2–3 mm.4 The incorporated blade allows the simultaneous division of the tissue saving operative time. There is ambiguous information in the literature regarding the safety of major bile ducts and vessels ligation using the LigaSure energy.5 However, all our cases were minor resections and we cannot comment on that further. One of the tips of this technique is the slow, gradual closure and the frequent cleaning of the clamp.