This is an acoustic vibrator, perfused with saline, which disrupts the liver parenchyma by producing a cavitational force. Diathermy is also in-built into the tip. This has been shown to be very effective for division of parenchyma, with low blood losses.23,24,36,37 It consists of a hollow titanium tube that vibrates in a longitudinal plane causing selective liver parenchymal destruction. The amplitude of vibration is 100 ¡m and at a frequency of 23 kHz. Physiological NaCl is used as a coolant. Following division of the parenchyma, any form of vascular occlusion is released. Any residual bleeding vessel on the divided liver surface is controlled. The limitations of CUSA and jet cutting are that after the vessels are isolated, conventional ligation or clipping is still required and is time-consuming (Fig. 2).
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