title: Monopolar floating ball versus bipolar forceps for hepatic resection: a prospective randomized clinical trial.
abstract: BACKGROUND
  Hepatic transection by Pean-clasia is the mainstream technique that can be used with different coagulators. Monopolar floating ball (MFB) is proposed for liver transection. Whether its value for liver transection is unclear, its efficiency as a coagulator only seems high. We compared in a prospective randomized study the standard Pean-clasia with bipolar forceps (BF) versus Pean-clasia with MFB in patients undergoing hepatic resection.
  
  
  METHODS
  Seventy-six patients scheduled for hepatectomy were randomized in two groups, according to the coagulator device: group A (MFB, n = 38) and group B (BF, n = 38). The two groups were homogeneous in terms of tumor presentation and background liver features. Blood loss, blood transfusions, transection time, number of ligatures, drain discharge, drain bilirubin levels at third, fifth, and seventh postoperative day, and postoperative morbidity and mortality were prospectively evaluated.
  
  
  RESULTS
  No significant differences between groups A and B were seen in terms of blood transfusions (11.5% versus 16.5%; p = 0.450), blood loss/cm(2) (mean 7.2 versus 7.6 ml; p = 0.450), transection time/cm(2) (mean 2.1 versus 2.3; p = 0.070), number of ligatures/cm(2) (mean 0.7 versus 0.7; p = 1), drain discharge (mean 55 versus 66.7 ml; p = 0.451), and drain bilirubin levels (mean 1.9 versus 2.1 mg/dl; p = 0.664). No mortality or major morbidity was recorded in both groups.
  
  
  CONCLUSIONS
  This study showed that association of Pean-clasia with MFB was safe and minimized the blood loss during hepatic resection. However, MFB did not offer significant benefits over BF, while its cost is not negligible.
authors.affiliation: Third Department of Surgery, University of Milan, School of Medicine, IRCCS Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milan, Italy. guido.torzilli@unimi.it
authors.forename: Guido
authors.initials: G
authors.lastname: Torzilli
authors.forename: Matteo
authors.initials: M
authors.lastname: Donadon
authors.forename: Matteo
authors.initials: M
authors.lastname: Marconi
authors.forename: Fabio
authors.initials: F
authors.lastname: Procopio
authors.forename: Angela
authors.initials: A
authors.lastname: Palmisano
authors.forename: Daniele
authors.initials: D
authors.lastname: Del Fabbro
authors.forename: Florin
authors.initials: F
authors.lastname: Botea
authors.forename: Antonino
authors.initials: A
authors.lastname: Spinelli
authors.forename: Marco
authors.initials: M
authors.lastname: Montorsi