Practical usefulness of bipolar scissors in hepatectomy.
OBJECTIVE
Because less surgical stress might preserve quality of life of patients, it is more desirable to decrease both intraoperative blood loss and liver injury especially in hepatectomy. For the patients with hepatocellular carcinoma based on chronic liver dysfunction, it is more essential to control bleeding and reduce liver injury in hepatectomy than in other diseases. In the present study, a retrospective comparison about usefulness was made in hepatectomy between using bipolar scissors and using conventional procedure. Before 1997, in our hospital, we had dissected the liver by using the crushing clamp method in combination with cauterization by microwave coagulator for the purpose of reducing intraoperative blood loss. Since 1998, bipolar scissors have been introduced toward hepatectomy as a new, simple and easy device to use.


METHODS
Fifty-three consecutive patients with primary hepatocellular carcinoma at TNM stage I/II who underwent partial hepatectomy between 1996 and 1999 were enrolled in the study. Thirty-two patients (1996-1997) were treated by using a conventional method (group CM) and 21 patients (1998-1999) were treated by using bipolar scissors (group BS). The factors related to surgical stress were compared between the two groups.


RESULTS
The amounts of blood loss/transfusion were lower in group BS (641/100 mL) than in group CM (1112/450 mL). The percentages of patients who lost more than 1000 mL of blood were lower in group BS (19%) than in group CM (47%) (P = 0.04). An intraabdominal drainage was needed for 9.0 +/- 6.6 days in group BS, and the drainage period was shorter than that in group CM (15.0 +/- 8.7 days) (P = 0.01).


CONCLUSIONS
These results indicated the superiority of bipolar scissors in decreasing blood loss and liver injury to the conventional method, suggesting the worth of performing the prospective randomized study.
Yamada
Terumasa
T
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. yamada-te@mc.pref.osaka.jp
Sasaki
Yo
Y
Yokoyama
Shigekazu
S
Miyashiro
Isao
I
Murata
Kohei
K
Doki
Yuichiro
Y
Kameyama
Masao
M
Ohigashi
Hiroaki
H
Hiratsuka
Masahiro
M
Ishikawa
Osamu
O
Imaoka
Shingi
S
D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D003250:Constriction; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008872:Microwaves / Q000627:therapeutic use; D008875:Middle Aged