Bloodless hepatectomy technique

Abstract

Liver resection assisted by RF energy is feasible and safe. This technique could offer a new method for 'transfusion-free' resection without the need for sutures, ties, staples, tissue glue or admission to the intensive care unit.

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

“…This ensures occlusion of blood vessels and bile ducts of the line section, sealing also small lymphatic channels of the bloody face. The absence of biliary fistula associated with low levels of transoperative bleeding and postoperative drainage, seal the latter point of view, as well as the findings of other authors who use the RF for liver resections 13,14,22,25 . In the vast majority of hepatectomies aminotransferase elevations are described on a temporary basis, returning to normal levels by the end of a few days, a fact observed in these cases.…”

“…The temperature control of the needle prevents there early clotting cells around it, slowing the increase in tissue resistance, and allowing more uniform and extensive necrosis of the region. These authors 13,14,22,25 have shown that this distortion occurs in a cell radius of 0.5 cm around the needle, producing uniform and bloodless tissue mass. In the case of a monopolar system, the grounding plate is mandatory, and the risk of burns occur in front of the large discharge of energy, are not negligible.…”

“…In this series there was considerable decrease in surgical time with the use of two sets. This was particularly interesting, since with the technique of liver resection using monopolar RF no reference was done in the decrease of surgical time, with some authors referring increased operative time 13,14,22,25 . The low length of stay in hospital showed a favorable outcome, with less pain and faster return to daily activities.…”

“…Recent studies have shown 3,13,14,22,25 hepatectomies performed using the monopolar RF, where the blood loss and the occurrence of fistula bile was almost nil. In none of these series was demonstrated clinical or abnormal liver function that would represent failure.…”

“…In the technique applied in recent series 13,14,22,25 the theoretical basis of coagulation necrosis by the heat produced by RF, is based on tissue temperature elevation, which occurs at the expense of intermittent waves of energy through a conductor monopolar cooled continuously (Cool Tip Radionics, Burlington, MA). This energy is dissipated through a monopolar plate.…”