Hepatectomy using an ultrasonically activated scalpel for hepatocellular carcinoma. 
The first retrospective studies were performed to compare the efficacy of the ultrasonic cavitational aspirator (aspirator group) and the ultrasonically activated scalpel (scalpel group) for hepatic resection in patients with hepatocellular carcinoma.  The aspirator group consisted of 8 patients (6 with liver cirrhosis and 2 with chronic hepatitis in the nontumorous liver), and the scalpel group of 7 patients (6 with liver cirrhosis and 1 with chronic hepatitis).  All patients underwent limited hepatic resection, and the intermittent Pringle maneuver was applied during hepatic transection.  There were no significant differences in preoperative hepatic function, type of hepatectomy, tumor size and maximum cross-sectional area of the resected specimen between the 2 groups.  The amount of intraoperative blood loss was significantly less in the scalpel group than in the aspirator group (684 versus 1,859 ml, p < 0.05).  The operation time was significanly shorter in the scalpel group than in the aspirator group (176 versus 262 min, p < 0.05).  There were no significant differences in postoperative liver function and morbidity between the 2 groups.  The ultrasonically activated scalpel is effective in reducing blood loss and in shortening the time of operation, and can be employed during limited resection of the liver with cirrhosis or chronic hepatitis.