title: Bipolar vessel sealing system vs. clamp crushing technique for liver parenchyma transection.
abstract: OBJECTIVE
  To evaluate the impact of the traditional clamp-crush technique and a radiofrequency bipolar vessel sealing device (BVSD) for liver resection on operative blood loss, transfusion rate, duration of operation, length of hospitalization and morbidity.
  
  
  METHODS
  From a database, 100 patients who underwent elective liver resection were retrospectively selected. In 40 patients parenchyma transection was performed by BSVD (LigaSure system) and 60 patients were operated using traditional clamp-crush technique (CC group).
  
  
  RESULTS
  The two groups were well-matched for baseline and surgical characteristics. Peak of transaminases was significantly higher in the BSVD on postoperative days 1, 3 and 5 (minimum p = 0.02 vs. CC). There was no significant difference between CC group and BVSD group in median operation time (180 vs. 190 min), blood loss (600 vs. 700 mL), transfusion rate (48.0% vs. 60.5%), hepatic failure (3.2% vs. 2.5%), morbidity rate (26.6% vs. 27.5%), and hospital stay (13 vs. 12 days).
  
  
  CONCLUSIONS
  Increased tissue damage in the BSVD group did not seem to correlate with organ dysfunction or postoperative morbidity. The two techniques appear equivalent in term of outcome and thus the choice of transection strategy remains according to the surgeon preference and experience.
authors.affiliation: Department of Surgery, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy. mattia_garancini@yahoo.it
authors.forename: Mattia
authors.initials: M
authors.lastname: Garancini
authors.forename: Luca
authors.initials: L
authors.lastname: Gianotti
authors.forename: Ilaria
authors.initials: I
authors.lastname: Mattavelli
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Romano
authors.forename: Luca
authors.initials: L
authors.lastname: Degrate
authors.forename: Roberto
authors.initials: R
authors.lastname: Caprotti
authors.forename: Angelo
authors.initials: A
authors.lastname: Nespoli
authors.forename: Franco
authors.initials: F
authors.lastname: Uggeri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006498:Hepatectomy / Q000295:instrumentation*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008026:Ligation / Q000295:instrumentation; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors