title: Reducing inflow occlusion, occlusion duration and blood loss during hepatic resections.
abstract: BACKGROUND
  To assess the changes in blood loss during hepatic resection with improved haemostatic devices such as a bipolar sealing device and a topical haemostatic agent.
  
  
  METHODS
  This retrospective clinical study of prospectively collected data will assess hepatic resections performed by a single surgeon between 2005 and 2013, with the introduction of the two haemostatic techniques in 2009.
  
  
  RESULTS
  A total of 371 hepatic resections (214 from 2005 to 2008 and 157 from 2009 to 2013) were included in this study. Compared with the conventional hepatic resection (2005-2008), the use of haemostatic techniques (2009-2013) significantly reduced the need for inflow occlusion (OR: 0.37, 95% CI: 0.24-0.57, P < 0.001), overall occlusion time (20.8 min versus 25.9 min, P = 0.04) and transfusion requirement (4.6% versus 12%, OR: 0.35, 95% CI: 0.14-0.90, P = 0.02). Mean overall blood loss was reduced post-2009; however, the decrease was not statistically different (401.3 mL versus 470.8 mL, P = 0.27). Subgroup analysis revealed that blood loss was more than halved post-2009 compared with pre-2009 for patients who received pre-operative chemotherapy (324.6 mL versus 738.5 mL, P = 0.005).
  
  
  CONCLUSIONS
  The use of a bipolar sealing device and a topical haemostatic agent reduces the need for inflow occlusion, overall occlusion time and transfusions in all patients compared with conventional hepatic resections.
authors: Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.
authors: Ya Ruth
authors: YR
authors: Huo
authors: Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.
authors: Tim
authors: T
authors: Shiraev
authors: Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.
authors: Nayef
authors: N
authors: Alzahrani
authors: Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.
authors: Francis
authors: F
authors: Chu
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006490:Hemostatics / Q000627:therapeutic use*; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: C411004:FloSeal Matrix; D006490:Hemostatics
keywords: 
  FloSeal
  ; 
  LigaSure
  ; bipolar sealing device; haemostatic matrix; hepatectomy; hepatic resection; inflow occlusion