title: Hepatic surgery using the Ligasure vessel sealing system.
abstract: Blood loss, a well-known risk factor for morbidity and mortality during liver resection, occurs during parenchymal transection, so many approaches and devices have been developed to limit bleeding. Surgical technique is an important factor in preventing intraoperative and postoperative complications. The aim of the present study was to determine whether the bipolar vessel sealing device allows a safe and careful liver transection, achieving a satisfactory hemostasis thus reducing blood loss and related complications.A total of 30 consecutive patients (18 male, 12 female with a mean age of 63 years) underwent major and minor hepatic resection in which the bipolar vessel sealing device was used without routine inflow occlusion. A crush technique followed by energy application was used to perform the parenchymal transection. No other devices were applied to achieve hemostasis. The bipolar vessel sealing device was effective in 27 cases of hepatic resection. It failed to achieve hemostasis in three patients, all of whom had a cirrhotic liver. Median blood loss was 250 ml (range: 100-1600 ml), and intraoperative blood transfusions were required in five patients (17%). Mean operative time was 200 minutes (range: 140-360 minutes). There was no clinical evidence of postoperative hemorrhage, bile leak, or intraabdominal abscess. The postoperative complication rate was 17%. The bipolar vessel sealing device is a useful tool in standard liver resection in patients with a normal liver parenchyma, but its use should be avoided in cirrhotic livers.
authors.affiliation: Department of Surgery, San Gerardo Hospital, II University of Milan-Bicocca, Via Donizetti 106, 20052 Monza, Italy. fabriziorom@hotmail.com
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Romano
authors.forename: Claudio
authors.initials: C
authors.lastname: Franciosi
authors.forename: Roberto
authors.initials: R
authors.lastname: Caprotti
authors.forename: Fabio
authors.initials: F
authors.lastname: Uggeri
authors.forename: Franco
authors.initials: F
authors.lastname: Uggeri
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies