title: Comparison between staple and vessel sealing device for parynchemal transection in laparoscopic liver surgery in a swine model.
abstract: BACKGROUND
  Advancements in technology have allowed laparoscopic surgery to expand into advanced procedures such as liver resection; however, the transection method is debatable. This study was designed to evaluate the feasibility and outcome of laparoscopic liver resection comparing the vessel sealing device (VSD) versus endomechanical stapling devices for parenchymal transection in a swine model.
  
  
  METHODS
  Laparoscopic left hepatectomy was performed in two groups (n=7 in each group) comparing the stapler device with the VSD. The cut surfaces of the liver were evaluated for bleeding and biliary leakage at the time of the operation and 1 week later. The animals were sacrificed 1 week after the operation to determine hemorrhage and bile leakage, and to allow histological evaluation of the liver. Serum liver enzymes were checked before, after, and 1 week postoperatively.
  
  
  RESULTS
  No evidence of biliary leakage or hemorrhage was noted at the time of the operation and 1 week later for both groups. There was a trend toward an increase in blood loss in the stapled group compared with LigaSure (40+/-16.4 cc vs 17+/-3.7 cc, p>0.05). There was also a trend toward shorter transection time in the stapled group compared with the LigaSure group (15+/-4.1 min vs 21.8+/-5.3, p>0.05). The instrument cost was significantly higher in the stapled group (720+/-110 vs 400+/-50; p<0.05). There was no difference in serial liver enzymes and liver histopathology in the two groups.
  
  
  CONCLUSIONS
  The VSD and endomechanical stapler can be safely and effectively used for parenchymal transection during laparoscopic liver resection. However, using endomechanical staplers is associated with an increase in cost.
authors.affiliation: Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI, USA.
authors.forename: Reza F
authors.initials: RF
authors.lastname: Saidi
authors.forename: Ahmad
authors.initials: A
authors.lastname: Ahad
authors.forename: Rossini
authors.initials: R
authors.lastname: Escobar
authors.forename: Ilke
authors.initials: I
authors.lastname: Nalbantoglu
authors.forename: Volkan
authors.initials: V
authors.lastname: Adsay
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Jacobs