Laparoscopic blood-saving liver resection using a new radiofrequency-assisted device: preliminary report of an in vivo study with pig liver

• Published in: Surgical endoscopy Vol. 22; no. 5; pp. 1384 - 1391
• Main Authors: Navarro, Ana, Burdio, Fernando, Berjano, Enrique J., Güemes, Antonio, Sousa, Ramón, Rufas, Maria, Subirá, Jorge, Gonzalez, Ana, Burdío, Jose M., Castiella, Tomás, Tejero, Eloy, De Gregorio, Miguel A., Grande, Luis, Lozano, Ricardo
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.05.2008; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Animals; Bile; Biological and medical sciences; Blood Loss, Surgical; Blood transfusions; Catheter Ablation - adverse effects; Catheter Ablation - instrumentation; Catheter Ablation - methods; Digestive system. Abdomen; Endoscopy; Equipment Design - instrumentation; Equipment Design - methods; Feasibility Studies; Gastroenterology; General aspects; Gynecology; Hemostatic Techniques - adverse effects; Hemostatic Techniques - instrumentation; Hepatectomy; Hepatectomy - adverse effects; Hepatectomy - instrumentation; Hepatectomy - methods; Hepatology; Hospitals; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - methods; Liver; Liver - pathology; Liver - surgery; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Medicine; Medicine & Public Health; Models, Animal; New Technology; Postoperative Complications; Proctology; Radio Waves - therapeutic use; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Swine; Treatment Outcome; United States > US; Spain; Radiofrequency; Laparoscopic liver surgery; Liver resection; Endoscopic surgery; Device; Liver; Laparoscopic surgery; Laparoscopy; Blood; Hepatectomy; Pig; Medicine; In vivo; Vertebrata; Mammalia; Treatment; Animal; Artiodactyla; Endoscopy; Ungulata
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-008-9793-3

Background The aim of any device designed for liver resection is to allow blood saving and quick resections. This may be optimized using a minimally invasive approach. A radiofrequency-assisted device is described that combines a cooled blunt-tip electrode with a sharp blade on one side in an in vivo preliminary study using hand-assisted laparoscopy to perform partial hepatectomies. Methods Eight partial hepatectomies were performed on pigs with hand-assisted laparoscopy using the radiofrequency-assisted device as the only method for transection and hemostasis. The main outcome measures were transection time, blood loss, transection area, transection speed, blood loss per transection area, and tissue coagulation depth. The risk for biliary leak also was assessed using the methylene blue test. Results The transection time was 13 ± 7 min for a mean transected area of 34 ± 11 cm 2 . The mean total blood loss was 26 ± 34 ml. The mean transection speed was 3 ± 1 cm 2 /min, and the blood loss per transection area was 1 ± 1 ml/cm 2 . Abdominal examination showed no complications in nearby organs. One biliary leak was identified in one case using the methylene blue test. The transection surface was 34 ± 11 cm 2 , and the mean tissue coagulation depth was 9 ± 2 mm. The inviability of the coagulated surface was assessed by adenine dinucleotide (NADH) staining. Conclusions The radiofrequency-assisted device has shown with a laparoscopic approach that it can perform liver resections faster and with less blood loss using a single device in a minimally invasive manner without vascular control than other commercial devices. The results show no significant differences with the same device used in an open procedure.