Laparoscopic blood-saving liver resection using a new radiofrequency-assisted device: preliminary report of an in vivo study with pig liver.
BACKGROUND
The aim of any device designed for liver resection is to allow blood saving and quick resections. This may be optimized using a minimally invasive approach. A radiofrequency-assisted device is described that combines a cooled blunt-tip electrode with a sharp blade on one side in an in vivo preliminary study using hand-assisted laparoscopy to perform partial hepatectomies.


METHODS
Eight partial hepatectomies were performed on pigs with hand-assisted laparoscopy using the radiofrequency-assisted device as the only method for transection and hemostasis. The main outcome measures were transection time, blood loss, transection area, transection speed, blood loss per transection area, and tissue coagulation depth. The risk for biliary leak also was assessed using the methylene blue test.


RESULTS
The transection time was 13 +/- 7 min for a mean transected area of 34 +/- 11 cm(2). The mean total blood loss was 26 +/- 34 ml. The mean transection speed was 3 +/- 1 cm(2)/min, and the blood loss per transection area was 1 +/- 1 ml/cm(2). Abdominal examination showed no complications in nearby organs. One biliary leak was identified in one case using the methylene blue test. The transection surface was 34 +/- 11 cm(2), and the mean tissue coagulation depth was 9 +/- 2 mm. The inviability of the coagulated surface was assessed by adenine dinucleotide (NADH) staining.


CONCLUSIONS
The radiofrequency-assisted device has shown with a laparoscopic approach that it can perform liver resections faster and with less blood loss using a single device in a minimally invasive manner without vascular control than other commercial devices. The results show no significant differences with the same device used in an open procedure.
Navarro
Ana
A
Department of Surgery, Hospital Clínico Universitario Lozano Blesa, San Blas 104 3 degrees C, 50003, Zaragoza, Spain. anavarrog2001@hotmail.com
Burdio
Fernando
F
Berjano
Enrique J
EJ
Güemes
Antonio
A
Sousa
Ramón
R
Rufas
Maria
M
Subirá
Jorge
J
Gonzalez
Ana
A
Burdío
Jose M
JM
Castiella
Tomás
T
Tejero
Eloy
E
De Gregorio
Miguel A
MA
Grande
Luis
L
Lozano
Ricardo
R
D000818:Animals; D001646:Bile; D016063:Blood Loss, Surgical; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design / Q000295:instrumentation / Q000379:methods; D005240:Feasibility Studies; D006489:Hemostatic Techniques / Q000009:adverse effects / Q000295:instrumentation; D006498:Hepatectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008099:Liver / Q000473:pathology / Q000601:surgery*; D023421:Models, Animal; D011183:Postoperative Complications; D000078702:Radiofrequency Therapy; D013552:Swine; D016896:Treatment Outcome