Laparoscopic left lobe liver resection in a porcine model: a study of the efficacy and safety of different surgical techniques.
BACKGROUND
Laparoscopic liver surgery is evolving and the best technique for dividing the liver parenchyma is currently under debate. The aim of this study was to study different techniques during a full laparoscopic lobe resection, and determine the efficacy and risks of bleeding and gas embolism.


METHODS
Sixteen pigs were randomized to two groups: group US underwent an operation with Ultracision shears (AutoSonix) and ultrasonic dissector (CUSA) and group VS with a vessel sealing system (Ligasure) and ultrasonic dissector. A left lobe resection was performed. Transesophageal endoscopic echocardiography (TEE) was used to detect gas emboli in the right side of the heart and pulmonary artery. The operations and TEE were recorded for later assessment.


RESULTS
Compared with group VS, group US exhibited significantly more intraoperative bleeding (p = 0.02), a trend towards a longer operation time (p = 0.08), and a trend towards more embolization for grade I emboli. In total, 10 of 15 animals had emboli during the operation.


CONCLUSIONS
This study showed that a laparoscopic left lobe resection can be performed with a combination of AutoSonix and CUSA as well as with Ligasure and CUSA instrumentation. In our hands, less bleeding was incurred with Ligasure than with AutoSonix.
Eiriksson
Kristinn
K
Department of Surgery, Stavanger University Hospital, Stavanger, Norway. kristinn.e@bigfoot.com
Kristinn
Eiriksson
E
Fors
Diddi
D
Diddi
Fors
F
Rubertsson
Sten
S
Sten
Rubertsson
R
Arvidsson
Dag
D
Dag
Arvidsson
A
D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control; D004618:Embolism, Air / Q000209:etiology; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy; D008099:Liver / Q000601:surgery; D023421:Models, Animal; D013552:Swine; D016896:Treatment Outcome