Precoagulation minimizes blood loss during standardized hepatic resection in an experimental model.
BACKGROUND
Precoagulation of liver tissue before transection is a novel concept in hepatic surgery. Comparative data with conventional techniques are lacking. This study tested the hypothesis that precoagulation results in reduced blood loss during hepatic transection.


METHODS
Precoagulation was performed with two different devices, the TissueLink floating ball (group 1) and a dissecting sealer (group 2), and compared with ultrasonic dissection (group 3). For each technique 12 partial liver resections were performed in six pigs. Blood loss per dissection surface area was the main outcome parameter.


RESULTS
The transected surface area was similar in all groups. Animals in groups 1 and 2 had significantly less blood loss than those in group 3 (3.6 and 1.3 versus 11.9 ml/cm2 respectively; P = 0.009 and P = 0.002). One pig in group 1 died as a result of wound dehiscence. In one animal in group 2 a gastric perforation was observed after death. In group 3 bile leakage occurred in two animals, and a large haematoma was observed on the transection surface in one animal after death.


CONCLUSIONS
Precoagulation of liver tissue before transection is associated with less blood loss compared with ultrasonic dissection.
Fioole
B
B
Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands. I.H.M.BorelRinkes@umcutrecht.nl
van der Bilt
J D W
JD
Elias
S G
SG
de Hoog
J
J
Borel Rinkes
I H M
IH
D000818:Animals; D001706:Biopsy / Q000379:methods; D001777:Blood Coagulation; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004210:Dissection / Q000379:methods; D004867:Equipment Design; D008099:Liver / Q000033:anatomy & histology / Q000601:surgery*; D011897:Random Allocation; D013529:Surgical Wound Dehiscence; D013552:Swine