title: Safety and Efficacy of a New Bipolar Energy Device for Parenchymal Dissection in Laparoscopic Liver Resection.
abstract: BACKGROUND
  Despite emerging technologies, parenchymal transection still remains challenging in liver resection. The aim of this study is to assess the safety and efficacy of a new articulating vessel sealer for laparoscopic hepatectomy. Our hypothesis was that this new device would facilitate parenchymal transection and reduce intraoperative costs in laparoscopic hepatectomy.
  
  
  METHODS
  Within 18 months, a 5 cm bipolar articulating vessel sealer was used in 32 laparoscopic liver resections (LLR). By excluding 4 patients who underwent concomitant colorectal resections, the outcomes of the remaining 28 patients (group 1) were compared with 28 patients who underwent LLR by the same surgical group using other energy devices (group 2).
  
  
  RESULTS
  Tumor type was malignant in 71% of patients (n=20) in group 1 and 89% of the patients (n=25) in group 2 (P=0.360). The number and size of tumors were similar in both groups, as well as the type of resections performed. In group 1, there was a less number of adjunctive devices (ie, energy, clip appliers, staplers) used (median 2) compared with group 2 (median 3, P=0.032). Parenchymal transection time (mean±SEM 28.2±3.5 vs. 55.2±4.1 min, respectively, P<0.001) and total operative time (200.1±13.7 vs. 242.7±14.4 min, respectively, P=0.036) were shorter for group 1 versus group 2. Estimated blood loss, transfusion rate, margin status, and length of stay were similar between the groups. There was no mortality. Morbidity was 11% (n=3) in group 1 and 18% (n=5) in group 2 (P=NS). The overall intraoperative costs were an average of $3000 less in group 1 (95% confidence interval, $1090-$4930, P=0.0029) compared with group 2.
  
  
  CONCLUSIONS
  This study demonstrates the safety and efficacy of a new energy device for LLR. Our experience suggested that this new device provided the functionality of both a vessel sealer and a stapler with its large jaw and articulation.
authors.affiliation: Department of General Surgery, Cleveland Clinic, Cleveland, OH.
authors.forename: Cem
authors.initials: C
authors.lastname: Dural
authors.forename: Muhammet
authors.initials: M
authors.lastname: Akyuz
authors.forename: Pinar
authors.initials: P
authors.lastname: Yazici
authors.forename: Erol
authors.initials: E
authors.lastname: Aksoy
authors.forename: Federico
authors.initials: F
authors.lastname: Aucejo
authors.forename: Cristiano
authors.initials: C
authors.lastname: Quintini
authors.forename: Charles
authors.initials: C
authors.lastname: Miller
authors.forename: John
authors.initials: J
authors.lastname: Fung
authors.forename: Eren
authors.initials: E
authors.lastname: Berber
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D004210:Dissection / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006498:Hepatectomy / Q000295:instrumentation*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation*; D007902:Length of Stay / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D065506:Vascular Closure Devices