الفهرس 
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Abstract
Minimization of blood loss during liver resection remains a major concern for hepatic surgeons due to the correlations among excessive hemorrhage, requirement of blood transfusions, higher morbidity and mortality rates and poor long-term outcomes(Yang et al. 2011).
Since the clamp crushing technique was introduced in the 1980s ,numerous high-tech equipment has been developed to improve parenchymal transection(Rahbari et al. 2014).
Randomized clinical trials and a recent meta-analysis have shown that these modern devices result in similar blood loss and transfusion requirements compared to the clamp crushing technique, but with a higher cost due cost of the device and disposable medical apparatus(Li et al. 2013).
This study included 30 patients from March 2016 to March 2019 indicated for liver resection in our department. The patients were divided into 3 groups, which are:
group A: Clamp Crush mediated Liver resection
group B: Harmonic scalpel mediated Liver resection
group C: Ligasure mediated liver resection.
The aim of the study is to assess and evaluate these different methods as regard the total operative time, transection time, total operative bleeding, hospital stay, post-operative complications, liver enzymes, the need for blood transfusion, ischemia time and inhospital &30day mortality.
For every Patient, the following data were recorded:
Pre-operative laboratory investigations were liver function, CBC, renal function, Alfa feto-protein in special cases.
Radiological was tumor location by `CT scan.
Child-Pugh Classification and status of liver parenchyma.
Total Operative Time, transection time, Operative bleeding, and ischemia time, the need for blood transfusion. Post-operative outcome, complications, hospital stay and inhospital&30 day mortality.
Our results showed that clamp crush has the longest total operative time and transection time, ligasure has the shortest, while harmonic comes in between.
Clamp crush has long ischemia time, while ligasure is shorter and harmonic has zero ischemia time.
Clamp crush has no significant difference in the total blood loss with the other techniques.
No significant difference in the need for blood transfusion between the three methods.
There is no significant difference as regard the complications, hospital stay and postoperative mortality.
No significant difference in the liver enzymes by the end of 7th postoperative day.