Current role of bloodless liver resection

Abstract

Liver resections are demanding operations which can have life threatening complications although they are performed by experienced liver surgeons. Recently new technologies are applied in the field of liver surgery, having one goal: safer and easier liver operations. The aim of this article is to address the issue of bloodless liver resection using radiofrequency energy. Radionics, Cool-tip TM System and Tissue Link are some of the devices which are using radiofrequency energy. All information included in this article, refers to these devices in which we have personal experience in our unit of liver surgery. These devices take advantage of its unique combination of radiofrequency current and internal electrode cooling to perform sealing of the small vessels and biliary radicals. Dissection is also feasible with the cool-tip probe. For the purposes of this study patient sex, age, type of disease and type of surgical procedure in association with the duration of parenchymal transection, blood loss, length of hospital stay, morbidity and mortality were analyzed. Cool-tip RF device may provide a unique, simple and rather safe method of bloodless liver resections if used properly. It is indicated mostly in cirrhotic patients with challenging hepatectomies (segment Ⅷ, central resections). The total operative time is eliminated and the average blood loss is significantly decreased. It is important to note that this technique should not be applied near the hilum or the vena cava to avoid damage of these structures.

Efficiency and safety of radiofrequency-assisted hepatectomy for hepatocellular carcinoma with cirrhosis: A single-center retrospective cohort study

“…Its efficacy in the treatment of small HCC is comparable to that of surgical resection [11] . Radiofrequency ablation can not only resect the tumor itself but is also effective in sealing vessels and bile ducts, which can facilitate nearly bloodless liver resection [23] . The use of RFA devices to perform liver resection was described in 2002 by Weber et al [12] .…”

Selection criteria for liver resection in patients with hepatocellular carcinoma and chronic liver disease

“…The evolution of transection devises and postoperative care had a major impact in both morbidity and mortality after LR. Most centers documented a less than 5% mortality rate recently [1,2,4,5] compared to a higher incidence reported 10 years ago. Blood transfusion requirements have also been restricted from 80% to 20% in major reference centres.…”

“…Over the past 10 years, there has been considerable progress in both diagnosis and surgical outcome of HCC patients [1,2] . Selective preoperative morphological assessment, preoperative use of portal vein embolization [3] and the improvement of surgical techniques [4,5] are factors that improve the safety of LR. In addition, better selection of the candidates for LR has been accomplished by both imaging advancements and preoperative accurate evaluation of liver functional reserve.…”

Saline conducted electric coagulation (SCEC): original experience in experimental hepatectomy

“…In conventional EC it is difficult to stop liver bleeding, because eschar is formed by electric spark and high temperature which block electric current and prevent heat conduction to inner tissue. In recent years, bloodless liver resection by radio frequency energy without hepatic inflow occlusion was being undertaken (Ayav et al, 2007;Delis et al, 2007). Salinelinked surface radiofrequency ablation (SLSRFA) was a well developed technique for bloodless liver resection, using saline, a good coolant and electric conductor, to maintain the surface temperature and avoid eschar formation (Gnerlich et al, 2009).…”