Argon ion beam hemostasis with albumin after liver resection

Wolf, Ronald; Xie, Hua; Petty, John K.; Teach, Jeff S.; Prahl, Scott A.

doi:10.1016/s0002-9610(02)00844-9

Cited by 17 publications

(23 citation statements)

References 9 publications

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“…ABC power was limited to 60 W in vitro because the tissue samples were significantly smaller than the ABC grounding pad. In vivo, powers may be higher than 60 W, 8 thereby decreasing the time it takes to coagulate the albumin. Even so, ABC repair time was roughly twice as fast as the 12 Ϯ 5 s/cm 2 for the laser welds achieved by Wadia et al 9 ABC use has been reported to cause fatal and near-fatal venous emboli.…”

Section: Discussionmentioning

confidence: 99%

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Mechanical properties of coagulated albumin and failure mechanisms of liver repaired with the use of an argon‐beam coagulator with albumin

Moffitt

Baker

Kirkpatrick

et al. 2002

J. Biomed. Mater. Res.

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Hemostasis in the traumatized liver has been achieved by thermally denaturing topically applied albumin. In this article, the mechanical properties of liver and denatured albumin (solder) were measured, and the failure methods of liver repaired with albumin were identified. The ultimate tensile strength and Young's modulus were measured for healthy liver (N = 20) and thermally damaged liver (N = 20). The ultimate tensile strength and Young's modulus were measured for three concentrations of coagulated albumin (25, 38, and 53%) in a single layer and for two layers of denatured 38% albumin. Failure under tension of argon-beam coagulator soldered liver on the parenchymal surface (N = 30) with 38% albumin in two layers had a 70% occurrence for tearing at a mean stress of 39 kPa and a 23% occurrence for shearing at a mean stress of 7 kPa. Liver repaired on the interior surface (N = 11) failed in tension by tearing (64%) at a mean stress of 34 kPa and by shearing (36%) at a mean stress of 6 kPa. Argon-beam coagulator soldering with 38% albumin took 6 s/cm(2) for two layers of solder and gave the best balance of usability, strength, and matching of mechanical properties with those of the liver.

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Section: Discussionmentioning

confidence: 99%

“…The gas is often used to clear blood from the field. Albumin used in conjunction with ABC could potentially minimize the risk of emboli; surgeons would need to clear the surgical field (with gauze) before applying the albumin, 8 eliminating the associated risk of using the argon gas to clear blood from the field.…”

Section: Discussionmentioning

confidence: 99%

Mechanical properties of coagulated albumin and failure mechanisms of liver repaired with the use of an argon‐beam coagulator with albumin

Moffitt

Baker

Kirkpatrick

et al. 2002

J. Biomed. Mater. Res.

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“…This greater detachment has facilitated the technical domination of liver transplantation, and vice versa 1,5,11 . Several measures have been adopted over the years in order to minimize intraoperative bleeding and the hepatic insufficiency usually due to small liver remnants or to the hepatocellular suffering of livers previously involved by changes that worsen during partial liver resection 5,7,9,10 . Regarding intraoperative bleeding, hepatic pedicle clamping for LPVE is the oldest method of hepatic vascular control in order to avoid or minimize bleeding originating from the liver parenchyma, especially during liver resection.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, bleeding, together with the subsequent blood transfusions, increases postoperative morbidity and mortality. Today, with the improved technical training of surgical teams and with the development of new generations of ultrasound, harmonic and water-jet scalpels and the argon cautery , the level of hemorrhage has been reduced during hepatectomy, although bleeding continues to be a factor of intra-and postoperative complications in liver resection 7,8,9 . Strategies to reduce intraoperative bleeding during hepatectomy include temporary occlusion of blood inflow with or without outflow control, of the whole liver or part of it during parenchymal transection, a method called hepatic vascular occlusion or control 5,6,10 .…”

Section: Introductionmentioning

confidence: 99%

Biochemical liver function after partial hepatic resection with or without partial hepatic vascular exclusion

Silva¹,

Mente²,

Sankarankutty³

et al. 2011

Acta Cir. Bras.

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PURPOSE:The aim of the present study was to assess the advantages and disadvantages of liver vascular partial exclusion (LVPE) (liver dysfunction due to ischemia) during liver resection in patients submitted to partial hepatectomy. METHODS: A total of 114 patients were submitted to partial hepatectomy (minor versus major resections) with LPVE being used in 57 of them but not in the remaining 57. Patient age ranged from 35 to 73 years and 57 % were women. Mitochondrial function was assessed 30 minutes after liver resection in the remnant liver and serum aminotransferases were determined before surgery and for seven days postoperatively. LPVE time ranged from 30 to 60 minutes. Data were analyzed statistically by the Student T test (5 % level of significance). RESULTS: Mitochondrial function was similar in the minor and major liver resections. The maximum postoperative aminotransferase peak was similar in the groups with and without LPVE. CONCLUSION: LPVE did not induce mitochondrial changes in hepatic tissue in either type of surgery, and aminotransferase levels were similar for patients with and without LPVE. Thus, the results show that LPVE is a safe procedure that does not induce the significant changes typical of ischemia and reperfusion in the liver remnant. Key words: Hepatectomy. Mitochondria. Ischemia. RESUMO OBJETIVO:Avaliar as vantagens e desvantagens da oclusão vascular parcial do fígado durante ressecções hepáticas parciais. MÉTODOS: Cento e quatorze pacientes foram submetidos a hepatectomia parcial(ressecção maior versus ressecção menor) com liver partial vascular exclusion (LPVE) sendo utilizada em 57 deles. A idade dos pacientes variou entre 35 e 73 anos e 57% deles eram mulheres. A função mitocondrial foi avaliada por método polarografico avaliada 30 minutos após a ressecção hepática no fígado remanescente, e o perfil das aminotransferase foi determinado antes da cirurgia e durante sete dias de pós-operatório. A EVPH variou de 30 a 60 minutos. Dados foram analisados estatisticamente pelo teste T Student (nível de significância de 5%). RESULTADOS: Nas ressecções hepáticas maiores e menores, a função mitocondrial do fígado remanescente foi semelhante dos dois grupos. O pico máximo de aminotransferases ocorreu as 24 horas de pós-operatório e o perfil enzimático de ALT e AST foi semelhante nos grupos estudados ( minor vs major hepatectomy.) CONCLUSÃO: A EVPH não induziu alterações mitocondriais no tecido hepático em qualquer tipo de cirurgia, e os níveis de aminotransferases foram similares para pacientes hepatectomizados com e sem LPVE.Assim a LPVE foi um procedimento seguro que não induziu alterações significativas típicos de isquemia e reperfusão no fígado remanescente. Descritores: Hepatectomia. Mitocondria. Isquemia. Biochemical liver function after partial hepatic resection with or without partial hepatic vascular exclusion

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“…Todos os casos foram acompanhados em sua função hepatocitária através de exames laboratoriais durante a primeira semana de pós-operatório. 3,30 , the water jet scalpel 10,19,20 , the argon 17,26 cautery, vascular staplers 18,24,27 , and radiofrequency (RF).…”

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É possível diminuir o sangramento em hepatectomias sem a realização de exclusão vascular total ou parcial?: Resultados do uso de radiofrequência bipolar com agulhas resfriadas

Sampaio¹,

Waechter²,

Passarin³

et al. 2011

ABCD, arq. bras. cir. dig.

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RACIONAL: Embora a ressecção seja ainda o procedimento de escolha no tratamento curativo das lesões malignas do fígado, o sangramento permanece como fator de morbidade com grande impacto na cirurgia hepática. Com o intuito de minimizar esta complicação, diversas opções tecnológicas têm sido utilizadas, entre elas mais recentemente a radiofrequência, permitindo que o procedimento seja realizado com incisões menores, sem necessidade de clampeamento vascular, com mínima dissecção hepática, ou sangramento. OBJETIVO: Apresentar os resultados em uma série de pacientes utilizando nova técnica de ressecção do parênquima hepático através de agulhas paralelas de radiofrequência bipolar desenvolvidas pelos próprios autores, verificando o impacto no sangramento trans-operatório dos pacientes submetidos à hepatectomias. MÉTODOS: Sessenta pacientes foram submetidos à ressecção hepática através do uso da radiofrequência bipolar. O sangramento per-operatório foi avaliado através da medição do volume coletado em aspirador e pela diferença de peso nas compressas utilizadas durante o procedimento. Todos os casos foram acompanhados em sua função hepatocitária através de exames laboratoriais durante a primeira semana de pós-operatório. RESULTADOS: As ressecções hepáticas foram realizadas com média de 87 minutos, tamanho médio da incisão abdominal de 14 cm e sangramento médio de 58 mililitros. Nenhum paciente recebeu transfusão de sangue ou derivados. Não foram utilizados cateteres venosos centrais. Todos pacientes obtiveram rápida recuperação anestésica, obtendo alta da sala de recuperação para a enfermaria em menos de 12 horas. A drenagem pós-operatória foi anotada até a retirada do dreno abdominal em todos os pacientes. O tempo de internação hospitalar médio foi de 3,2 dias. Após um pico de elevação das provas de função hepática nos primeiros três dias, todos apresentaram retorno destes exames aos parâmetros pré-operatórios ao final do 1o mês. CONCLUSÃO: É possível, factível e válida a utilização de agulhas de radiofrequência para a realização de hepatectomias, mesmo maiores, reduzindo o sangramento.

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Argon ion beam hemostasis with albumin after liver resection

Cited by 17 publications

References 9 publications

Mechanical properties of coagulated albumin and failure mechanisms of liver repaired with the use of an argon‐beam coagulator with albumin

Mechanical properties of coagulated albumin and failure mechanisms of liver repaired with the use of an argon‐beam coagulator with albumin

Biochemical liver function after partial hepatic resection with or without partial hepatic vascular exclusion

É possível diminuir o sangramento em hepatectomias sem a realização de exclusão vascular total ou parcial?: Resultados do uso de radiofrequência bipolar com agulhas resfriadas

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