title: Comparison of two different transection techniques in liver surgery-an experimental study in a porcine model.
abstract: OBJECTIVE
  Postoperative morbidity and mortality after liver resection is closely related to the degree of intraoperative blood loss; the majority of which occurs during transection of the liver parenchyma. Many approaches and devices have therefore been developed to limit bleeding, but none has yet achieved perfect results up to now. The aim of this standardized chronic animal study was to compare the safety and efficacy of the LigaSure™ Vessel Sealing System (LVSS) with the stapler technique, which is one of the modern techniques for transecting the parenchyma in liver surgery.
  
  
  METHODS
  Sixteen pigs underwent a left liver resection (LLR). Eight pigs received a LLR by means of an Endo GIA, whereas the other eight pigs underwent liver parenchymal transection followed by simultaneous sealing by the LVSS. The operating time, transection time, blood loss during transection, and time of hemostasis were measured on the day of LLR (postoperative day 0/POD 0). Animals were re-explored on postoperative day 7 (POD 7) and the transection surface of remnant liver was observed for fluid collection (hematoma, biloma, and abscess), necrosis, and other pathologies. A biopsy was taken from the area of transection for histopathological examination.
  
  
  RESULTS
  All animals survived until POD 7. Operating time and transection time of the liver parenchyma on POD 0 was significantly shorter in the stapler group. There was no significant difference between the two groups in terms of blood loss during transection, time of hemostasis and number of sutures for hemostasis on POD 0, morbidity rate, as well as the histopathological examination on POD 7. Furthermore, the material costs were significantly higher in the stapler group than in the LVSS group.
  
  
  CONCLUSIONS
  In this standardized chronic animal study concerning transection of the parenchyma in liver surgery, LVSS seems not only to be safe, but also comparable with the stapler technique in terms of morbidity and mortality. Additionally, LVSS significantly reduces material costs. However, the transection time is significantly longer for LVSS than for the stapler resection technique.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. tobias.gehrig@med.uni-heidelberg.de
authors.forename: T
authors.initials: T
authors.lastname: Gehrig
authors.forename: G
authors.initials: G
authors.lastname: Manzini
authors.forename: H
authors.initials: H
authors.lastname: Fonouni
authors.forename: M
authors.initials: M
authors.lastname: Golriz
authors.forename: R
authors.initials: R
authors.lastname: Hafezi
authors.forename: N
authors.initials: N
authors.lastname: Rahbari
authors.forename: K
authors.initials: K
authors.lastname: Brand
authors.forename: U
authors.initials: U
authors.lastname: Hinz
authors.forename: B P
authors.initials: BP
authors.lastname: Müller-Stich
authors.forename: C N
authors.initials: CN
authors.lastname: Gutt
authors.forename: A
authors.initials: A
authors.lastname: Mehrabi
mesh_terms: D000818:Animals; D016063:Blood Loss, Surgical / Q000401:mortality / Q000517:prevention & control*; D004195:Disease Models, Animal; D006488:Hemostasis, Surgical / Q000295:instrumentation* / Q000379:methods; D006490:Hemostatics / Q000627:therapeutic use; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D011897:Random Allocation; D018570:Risk Assessment; D017792:Surgical Stapling / Q000379:methods; D013552:Swine; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics