title: The superficial precoagulation, sealing, and transection method: a "bloodless" and "ecofriendly" laparoscopic liver transection technique.
abstract: BACKGROUND
  Minimizing blood loss is an important aspect of laparoscopic liver resection. Liver transection is the most challenging part of liver resection, but no standard method is available for this step at present. Herein, we have introduced the superficial precoagulation, sealing, and transection (SPST) method, a potentially "bloodless" and "ecofriendly" laparoscopic liver transection technique involving reusable devices: the VIO soft-coagulation system; VIO BiClamp (bipolar electrosurgical coagulation); Olympus SonoSurg (ultrasonic surgical system); and CUSA (ultrasonic aspirator). Furthermore, we have reported the short-term outcomes of laparoscopic liver transection with the SPST method.
  
  
  METHODS
  The study included 14 consecutive patients who underwent laparoscopic partial liver resection with the SPST method at a single institution between August 2008 and June 2010.
  
  
  RESULTS
  The median operative time was 201 minutes (range, 97 to 332 min) and the median blood loss was 5 mL (range, 5 to 250 mL). There was no requirement for blood transfusion, no intraoperative complications, and no cases of conversion to open laparotomy. There were no liver transection-related complications such as postoperative bile leakage, bleeding, or infection. All surgical margins were negative, with a mean margin of 4.6 mm, and no local recurrence was observed at an average follow-up of 37.6 months.
  
  
  CONCLUSIONS
  The SPST method is a simple, efficient, and cost-effective surgical technique for laparoscopic liver resection. It is associated with low intraoperative blood loss and good short-term outcomes. We recommend that the SPST method should be used as a standard technique for laparoscopic liver transection (Supplemental Digital Content 1, http://links.lww.com/SLE/A103).
authors.affiliation: Department of Surgery, School of Medicine, Keio University Endoscopic Surgery Center, Eiju General Hospital, Tokyo, Japan Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX Department of Pathology and Genetic Medicine, The Methodist Hospital, Houston, TX.
authors.forename: Osamu
authors.initials: O
authors.lastname: Itano
authors.forename: Naruhiko
authors.initials: N
authors.lastname: Ikoma
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Takei
authors.forename: Go
authors.initials: G
authors.lastname: Oshima
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D015331:Cohort Studies; D004564:Electrocoagulation / Q000295:instrumentation*; D004598:Electrosurgery / Q000295:instrumentation*; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D016896:Treatment Outcome; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation*
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