title: Bloodless liver resection using the monopolar floating ball plus ligasure diathermy: preliminary results of 16 liver resections.
abstract: Blood loss during liver transection and ischemia-reperfusion injury associated with hepatic inflow occlusion are significant drawbacks during liver surgery. Sixteen patients underwent liver resection using the Monopolar Floating Ball (FB) plus LigaSure (LS) diathermy without occlusion of the hepatoduodenal ligament (group FB-LS). The liver parenchyma was precoagulated using the FB, and the uncovered tiny vessels were sealed using LS. Surgical outcomes were retrospectively compared with 16 well matched patients who underwent liver resection using the conventional clamp crushing method with Pringle's maneuver (group CC). The amount of blood loss during liver transection was significantly less in group FB-LS than in group CC [200 ml (0-990 ml) vs. 480 ml (120-1800 ml); p = 0.006]. The median time it took to complete the liver transection was significantly longer in group FB-LS than in group CC [144 minutes (43-335 minutes) vs. 58 minutes (18-94 minutes); p < 0.0001]. Hepatic inflow occlusion was temporally used in five patients in group FB-LS to achieve hemostasis in hepatic venous tributaries for 6, 10, 19, 26, and 61 minutes, respectively. Using these two electronic devices allows liver resection to be safely performed, with the advantage of minimal blood loss and a reduced inflow occlusion period compared to the conventional method. The major disadvantage may be a slower transection speed. A prospective randomized trial is needed to clarify the clinical benefits of liver resections performed using this novel technique.
authors.affiliation: Department of Gastrointestinal Surgery, Cancer Institute Hospital, 1-37-1 Kami-Ikebukuro, Toshima-ku, 170-8455 Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Junji
authors.initials: J
authors.lastname: Yamamoto
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.forename: Makoto
authors.initials: M
authors.lastname: Seki
authors.forename: Tomoo
authors.initials: T
authors.lastname: Kosuge
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Tetsuichiro
authors.initials: T
authors.lastname: Muto
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006528:Carcinoma, Hepatocellular / Q000556:secondary / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery*; D003131:Combined Modality Therapy; D004564:Electrocoagulation / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000295:instrumentation*; D006801:Humans; D006979:Hyperthermia, Induced / Q000295:instrumentation*; D019194:Ischemic Preconditioning / Q000295:instrumentation; D008099:Liver / Q000098:blood supply*; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000517:prevention & control*; D015427:Reperfusion Injury / Q000517:prevention & control*; D013525:Surgical Instruments