title: Laparoscopic left lobe liver resection in a porcine model: a study of the efficacy and safety of different surgical techniques.
abstract: 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.
authors.affiliation: Department of Surgery, Stavanger University Hospital, Stavanger, Norway. kristinn.e@bigfoot.com
authors.forename: Kristinn
authors.initials: K
authors.lastname: Eiriksson
authors.forename: Eiriksson
authors.initials: E
authors.lastname: Kristinn
authors.forename: Diddi
authors.initials: D
authors.lastname: Fors
authors.forename: Fors
authors.initials: F
authors.lastname: Diddi
authors.forename: Sten
authors.initials: S
authors.lastname: Rubertsson
authors.forename: Rubertsson
authors.initials: R
authors.lastname: Sten
authors.forename: Dag
authors.initials: D
authors.lastname: Arvidsson
authors.forename: Arvidsson
authors.initials: A
authors.lastname: Dag
mesh_terms: 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