title: The Ligasure vessel sealer in liver resection: a pilot study.
abstract: OBJECTIVE
  The major complication for liver resection is hemorrhage. Energy sources other than electrosurgery have become popular with the promise of quick and effective vascular control. This study evaluates alternative energy sources in sealing ductal structures for use in liver resection with minimal blood loss.
  
  
  METHODS
  Between June 1994 and December 2003, a consecutive 116 patients (59 male; 57 female; mean age: 60 +/- 11 years; range: 27-79 years) underwent surgery for primary (n = 30), metastatic liver cancer (n = 79), or benign lesions (n = 7). The extent of hepatic parenchymal division is marked on the surface with a diathermy-scored line. The arteries, veins, and bile ducts crossing the line of division are grasped, singly or in groups, by the Ligasure (Autosuture, United States Surgical Corp., Norwalk, CT) electrocautery device.
  
  
  RESULTS
  Fifty-eight formal hepatic resections, and 58 non-anatomical wedge resection were performed. The blood loss ranged from 100 mL to 3000 mL (median: 430 mL). Only 32 patients received preoperative blood transfusions. Perioperative mortality was nil (within 30 days following surgery), and postoperative major complications were seen in 14 patients (12%).
  
  
  CONCLUSIONS
  The Ligasure device uses bipolar electrothermal energy to coagulate the opposing walls of the target vessels. A feedback-control mechanism ensures that tissues are not charred by overcoagulation. This results in a high-burst strength vessel seal. Sealing is effective in vessels up to 7mm in diameter. Larger vessels require formal suture or stapling. This described technique is simple, rapid, safe for parenchymal division during hepatectomy, resulting in minimal blood loss.
authors.affiliation: Department of General Surgery, European Institute of Oncology, Milano, Italy. antonio.chiappa@unimi.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Chiappa
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Zbar
authors.forename: Emilio
authors.initials: E
authors.lastname: Bertani
authors.forename: Ugo
authors.initials: U
authors.lastname: Pace
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Viale
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Pruneri
authors.forename: Marco
authors.initials: M
authors.lastname: Venturino
authors.forename: MariaGiulia
authors.initials: M
authors.lastname: Zampino
authors.forename: Nicola
authors.initials: N
authors.lastname: Fazio
authors.forename: Guido
authors.initials: G
authors.lastname: Bonomo
authors.forename: Pasquale
authors.initials: P
authors.lastname: Misitano
authors.forename: Bruno
authors.initials: B
authors.lastname: Andreoni
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D004564:Electrocoagulation / Q000295:instrumentation*; D005260:Female; D006498:Hepatectomy / Q000295:instrumentation*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects