title: Perioperative outcome of laparoscopic left lateral liver resection is improved by using a bioabsorbable staple line reinforcement material in a porcine model.
abstract: OBJECTIVE
  Laparoscopic liver surgery is significantly limited by the technical difficulty encountered during transection of substantial liver parenchyma, with intraoperative bleeding and bile leaks. This study tested whether the use of a bioabsorble staple line reinforcement material would improve outcome during stapled laparoscopic left lateral liver resection in a porcine model.
  
  
  METHODS
  A total of 20 female pigs underwent stapled laparoscopic left lateral liver resection. In group A (n = 10), the stapling devices were buttressed with a bioabsorbable staple line reinforcement material. In group B (n = 10), standard laparoscopic staplers were used. Operative data and perioperative complications were recorded. Necropsy studies and histopathological analysis were performed at 6 weeks. Data were compared between groups with the Student's t-test or the chi-square test.
  
  
  RESULTS
  Operating time was similar in the two groups (64 +/- 11 min in group A versus 68 +/- 9 min in group B, p = ns). Intraoperative blood loss was significantly higher in group B (185 +/- 9 mL versus 25 +/- 5 mL, p < 0.05). There was no mortality. There was no morbidity in the 6-week follow-up period; however, two animals in group B had subphrenic bilomas (20%) at necropsy. At necropsy, methylene blue injection via the main bile duct revealed leakage from the biliary tree in four animals in group B and none in group A (p < 0.05). Histopathological examination of the resection site revealed minor abnormalities in group A while animals in group B demonstrated marked fibrotic changes and damaged vascular and biliary endothelium.
  
  
  CONCLUSIONS
  Use of a bioabsorbable staple line reinforcement material reduces intraoperative bleeding and perioperative bile leaks during stapled laparoscopic left lateral liver resection in a porcine model.
authors.affiliation: Department of Surgery, Meander Medical Center, Teaching Hospital affiliated to the University Medical Center Utrecht, Utrechtseweg 160, Amersfoort, JB, 3816, The Netherlands. ECJ.Consten@meandermc.nl
authors.forename: Esther C J
authors.initials: EC
authors.lastname: Consten
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Dakin
authors.forename: Jan-Lukas
authors.initials: JL
authors.lastname: Robertus
authors.forename: Sergio
authors.initials: S
authors.lastname: Bardaro
authors.forename: Luca
authors.initials: L
authors.lastname: Milone
authors.forename: Michel
authors.initials: M
authors.lastname: Gagner
mesh_terms: D020341:Absorbable Implants; D000818:Animals; D001646:Bile; D001652:Bile Ducts / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D007431:Intraoperative Complications; D007432:Intraoperative Period; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008099:Liver / Q000601:surgery; D023421:Models, Animal; D011108:Polymers / Q000627:therapeutic use; D011183:Postoperative Complications; D011446:Prospective Studies; D013526:Surgical Mesh; D017792:Surgical Stapling / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D016019:Survival Analysis; D013552:Swine; D016896:Treatment Outcome
chemical_list: D011108:Polymers