title: Extended hepatectomy using the bipolar tissue sealer: an experimental model of small-for-size syndrome in pigs.
abstract: OBJECTIVE
  After liver transplantation with a small-for-size liver graft or after extensive hepatectomy for liver malignancies or other non malignant conditions with an insufficient liver volume, the survival of patients depends on liver regeneration. This study was carried out in order to create a new porcine model for the study of small-for-size syndrome (SFSS) after extensive hepatectomy.
  
  
  METHODS
  In the present study we used 23 domestic Landrace pigs weighing 28.3±3 kg and aged 19-21 weeks. We describe our detailed surgical procedure for 75% partial hepatectomy a in porcine model, using the saline-coupled bipolar sealing device (Aquamantys®) for hepatectomy.
  
  
  RESULTS
  The Aquamantis 2.3 bipolar sealer was connected to the Aquamantis generator and was adjusted to produce 150 watts at a medium flow rate of 20 ml/min. The device temperature was programmed to remain at approximately 100° C and, as a consequence, it produced a tissue ablation without charring. The mean operating time was 153.8 min and the mean blood loss 81.9 ml. The estimated residual liver weight (ERL) was 177 g, whereas the mean proportion of ERL was 24.5%. There was no perioperative mortality.
  
  
  CONCLUSIONS
  A large animal model, such as pig, is extremely useful in order to reproduce and understand the SFSS. Our simple technique for successful resection of 75% of the liver in pigs, using the Aquamantys system, achieves effective and safe liver parenchymal transection with significant decrease of intraoperative blood loss and can provide useful information for researchers.
authors.affiliation: 1st Department of Surgery, University of Athens, School of Medicine, Greece.
authors.forename: Antonios
authors.initials: A
authors.lastname: Athanasiou
authors.forename: Michael
authors.initials: M
authors.lastname: Kontos
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Pikoulis
authors.forename: John
authors.initials: J
authors.lastname: Griniatsos
authors.forename: Apostolos
authors.initials: A
authors.lastname: Papalois
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Spartalis
authors.forename: Demetrios
authors.initials: D
authors.lastname: Moris
authors.forename: Evangelos
authors.initials: E
authors.lastname: Felekouras
authors.forename: Theodoros
authors.initials: T
authors.lastname: Liakakos
mesh_terms: D000818:Animals; D016063:Blood Loss, Surgical; D004564:Electrocoagulation / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D006498:Hepatectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D008099:Liver / Q000473:pathology / Q000601:surgery*; D008115:Liver Regeneration; D023421:Models, Animal; D061646:Operative Time; D034421:Sus scrofa; D013997:Time Factors