Comparison of Hydro-dissection Versus Ultrasonic Aspirator in Division of Liver Parenchyma in Laparoscopic Resection

Inclusion criteria

• Patients with benign lesions (hemangioma, focal nodular hyperplasia [FNH], hepatocellular adenoma, biliary cystadenoma, hydatid echinococcosis [only with total pericystectomy]) and malignant tumors (colorectal cancer metastases in the liver [CRLM], hepatocellular carcinoma [HCC], intrahepatic cholangiocellular carcinoma, gallbladder cancer T1b-3NxMo without invasion into bile ducts and adjacent organs), which involves laparoscopic segmental or major resection of the liver.
• Gender: both, male and female
• Minimum age 18 years
• Maximum age: 80 years
• ASA physical status I-IV
• BMI up to 40 kg/m2
• No simultaneous extrahepatic intra-abdominal procedures (bile duct resection, colon resection, partial duodenum resection)
• Total bilirubin up to 100mmol/l if jaundice presents in non-cirrhotic patients
• If cirrhosis is present, class A and B according to CTP score

Exclusion criteria

• • Difficulty index > 12 points (see below)

• Tumor invasion of IVC or portal trunk (necessity of vascular reconstruction)
• Repeated liver resection before laparoscopic resection (the single resection before is not a contraindication)
• Simultaneous extra-hepatic intra-abdominal procedures (bile duct resection, colon resection etc.)
• Age under 18 years
• Age above 80 years
• ASA physical status >IV
• BMI > 40 kg/m2
• Total bilirubin >100mmol/l if jaundice presents in non-cirrhotic patients
• If cirrhosis is present, class C according to CTP score
• Persons who are incapable of giving consent
• Pregnant or breast-feeding women
• Patients enlisted in other studies