Clinical Study Debakey Forceps Crushing Technique for Hepatic Parenchymal Transection in Liver Surgery: A Review of 100 Cases and Ergonomic Advantages Sundeep Jain, 1 Bharat Sharma, 2 Mitesh Kaushik, 1 and Lokendra Jain 1 1 Department of Gastrointestinal Hepatopancreatobiliary Minimal Access & Bariatric Surgery, Fortis Escorts Hospital, Jawahar Lal Nehru Marg, Malviya Nagar, Jaipur, Rajasthan 302017, India 2 Department of General & Minimal Access Surgery, Soni Manipal Hospital, Sikar Road, Vidhyadhar Nagar, Jaipur, Rajasthan 302013, India Correspondence should be addressed to Sundeep Jain; drsundeepjain@yahoo.co.in Received 27 February 2014; Accepted 22 May 2014; Published 9 June 2014 Academic Editor: Christos G. Dervenis Copyright © 2014 Sundeep Jain et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction and Objective. Bleeding is an important complication in liver transections. To determine the safety and eicacy of Debakey forceps for liver parenchymal transection and its ergonomic advantages over clamp crushing method we analysed our data. Methods. We used Debakey crushing technique in 100 liver resections and analysed data for transection time, transfusion rate, morbidity, mortality, hospital stay, inluence of diferent types of liver conditions, and ergonomi features of Debakey forceps. Results. Mean age, transection time and hospital stay of 100 patients were 52.38 ± 17.44 years, 63.36 ± 33.4 minutes, and 10.27 ± 5.7 days. Transection time, and hospital stay in patients with cirrhotic liver (130.4 ± 44.4 mins, 14.6 ± 5.5 days) and cholestatic liver (75.8 ± 19.7 mins, 16.5 ± 5.1 days) were signiicantly greater than in patients with normal liver (48.1 ± 20.1 mins, 6.7 ± 1.8 days) ( < 0.01). Transection time improved signiicantly with experience (irst ity versus second ity cases—70.2 ± 31.1 mins versus 56.5 ± 34.5 mins,  < 0.04). Qualitative evaluation revealed that Debakey forceps had ergonomic advantages over Kelly clamp. Conclusions. Debakey forceps crushing technique is safe and efective for liver parenchymal transection in all kinds of liver. Transection time improves with surgeon’s experience. It has ergonomic advantages over Kelly clamp and is a better choice for liver transection. 1. Introduction Prevention of blood loss is a major concern during liver resec- tions as it is the major determinant of operative outcome. Bleeding along with bile leak and hepatic failure is one of the major postoperative complications following liver resec- tion [1–3]. Most blood loss occurs during the parenchymal transection of liver. Many methods have been introduced to achieve safe parenchymal transection. In 1958 Lin et al. introduced the inger fracture technique which involves crushing of liver parenchyma by surgeon’s inger under inlow occlusion so as to isolate vessels and bile ducts for ligation [4]. his technique was subsequently improved through the use of small Kelly clamp for blunt dissection which gives better control, namely, clamp crushing or Kellyclasia [5–7]. People have also used iner versions of clamps similar to Kelly like Pean, Halstead, Heiss, or Bengolea clamps [6, 8]. Recently, many devices have been introduced for parenchymal transection. hese include ultrasonic dissector, harmonic scalpel, LigaSure, dissecting sealer using radiofrequency, and staplers [9–11]. However, the clamp crushing technique is the most widely used method [3, 9, 12– 14] and has multiple advantages over other more advanced methods including safety, speed, and cost-efectiveness [9]. humb forceps including Debakey forceps has signiicant advantages in terms of its design and ergonomics over Kelly clamp which were reported previously when compared for their usage for diathermy [15]. But so far its use in liver parenchymal transection has not been tried or reported in literature. Hindawi Publishing Corporation HPB Surgery Volume 2014, Article ID 861829, 9 pages http://dx.doi.org/10.1155/2014/861829