A Systematic Review and Meta-Analysis Comparing Liver Resection with the Rf-Based Device Habib™-4X with the Clamp-Crush Technique

Abstract

Liver cancer is the sixth most common cancer and third most common cause of cancer-related mortality. Presently, indications for liver resections for liver cancers are widening, but the response is varied owing to the multitude of factors including excess intraoperative bleeding, increased blood transfusion requirement, post-hepatectomy liver failure and morbidity. The advent of the radiofrequency energy-based bipolar device Habib™-4X has made bloodless hepatic resection possible. The radiofrequency-generated coagulative necrosis on normal liver parenchyma provides a firm underpinning for the bloodless liver resection. This meta-analysis was undertaken to analyse the available data on the clinical effectiveness or outcomes of liver resection with Habib™-4X in comparison to the clamp-crush technique. The RF-assisted device Habib™-4X is considered a safe and feasible modality for liver resection compared to the clamp-crush technique owing to the multitude of benefits and mounting clinical evidence supporting its role as a superior liver resection device. The most intriguing advantage of the RF-device is its ability to induce systemic and local immunomodulatory changes that further expand the boundaries of survival outcomes following liver resection.

Efficiency of a radiofrequency sealer (Aquamantys) for parenchymal transection during laparoscopic hepatectomy

“…20,21 Interestingly, it has also been reported that liver transections using radiofrequency energy may improve the survival rate in cases of hepatocellular carcinoma by reducing blood loss and transfusion rate. 22,23 A number of randomized controlled trials (RCTs) have been reported on the methods of liver parenchymal transection using various devices. [1][2][3][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Although the results varied, none of the devices used for transection showed significant advantages over the classical crushing clamp method.…”

Vertical interval between hepatic segment of inferior vena cava and right atrium predicts intraoperative blood loss during hemi‐hepatectomy

“…Intraoperative bleeding from the hepatic vein is a major issue for surgeons during anatomical hepatectomy when the vein is longitudinally exposed within the section being transected . Thick Glissonean branches rarely appear in the liver transection plane during hemi‐hepatectomy, and bleeds from such branches are usually small.…”

“…Intraoperative bleeding is a major issue for hepatic surgeons not only because a large volume of intraoperative blood loss is a major cause of postoperative complications, but also because blood transfusions compromise oncological outcomes . During hemi‐hepatectomy, thick Glissonean vessels rarely appear at the site of parenchymal transection, but bleeding from these vessels is controllable using hepatic pedicle occlusion .…”

Immunological Basis of Genesis of Hepatocellular Carcinoma: Unique Challenges and Potential Opportunities through Immunomodulation

“…According to meta-analysis performed by Ding et al, increased density of tumour infiltrating lymphocytes (TILs) have been significantly associated with improved survival [78]. Additionally, studies have outlined positive immunomodulatory change following the application of RF in terms of Tregs, CD8+ T-cells, TGF-β, IFNγ, IL-10, IL-17, respectively [79][80][81][82].…”

“…immunomodulatory change following the application of RF in terms of Tregs, CD8+ T-cells, TGF-β, IFNγ, IL-10, IL-17, respectively [79][80][81][82].…”