Results of major hepatectomy without vascular clamping using radiofrequency-assisted technique compared with total vascular exclusion.
OBJECTIVE
To improve major hepatectomy results, various techniques with or without vascular clamping have been developed. We report the results of major hepatectomies performed with radiofrequency-assisted technique (RF) without vascular clamping and compare these results to total vascular exclusion (TVE).


METHODS
All patients who underwent a major hepatectomy between 1994 and 2004 were identified. Outcome of liver resection with these two techniques was compared. Data including blood transfusion requirement, intensive care admission, postoperative liver function, morbidity and mortality were collected.


RESULTS
Seventy-eight patients underwent a major hepatectomy including resection using TVE (n = 51) and RF (n = 27). Blood transfusion rate was lower in RF group (26% vs. 53%, P = 0.04). Postoperative morbidity rate was similar in both groups, but there was a reduction in postoperative liver failure in RF group (0 vs. 9, p = 0.05). One patient developed biliary leak postoperatively in the RF group. No patients developed postoperative hemorrhage. In RF group, there was a reduction in both ICU admission (6% vs. 92%, P < 0.0001) and postoperative stay (10 vs. 17 days, P < 0.004). A substantial saving of pound 5185 per-patient could be achieved in RF patients.


CONCLUSIONS
Major hepatectomy using RF decreases the rates of blood transfusion, postoperative liver failure, ICU admission, postoperative stay and the price, when compared to TVE.
Ayav
Ahmet
A
Department of Surgical Oncology and Technology, Imperial College School of Medicine, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK.
Navarra
Giuseppe
G
Basaglia
Ernesto
E
Tierris
John
J
Healey
Andrew
A
Spalding
Duncan
D
Canelo
Ruben
R
Habib
Nagy A
NA
Jiao
Long R
LR
D000328:Adult; D000368:Aged; D001808:Blood Vessels; D003250:Constriction; D005260:Female; D006498:Hepatectomy / Q000191:economics* / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome