Significance of a soft-coagulation system with monopolar electrode for hepatectomy: A retrospective two-institution study by propensity analysis

Hamada, Takeomi; Nanashima, Atsushi; Yano, Koichi; Sumida, Yorihisa; Hiyoshi, Masahide; Imamura, Naoya; Tobinaga, Shuichi; Tsuchimochi, Yuki; Takeno, Shinsuke; Fujii, Yukihiko; Nagayasu, Takeshi

doi:10.1016/j.ijsu.2017.07.101

Cited by 8 publications

(10 citation statements)

References 32 publications

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“…To minimize bias, PSM was performed according to the background liver disease, preoperative liver functions, and type of surgical procedures. This statistical procedure has been widely applied to analyze groups with different backgrounds [3,29,30]. After matching, the monopolar group showed a reduction in blood loss, transfusion volume, and total operative time.…”

Section: Discussionmentioning

confidence: 99%

“…By contrast, when bleeding occurs from the cut surface of the liver, a hemostatic device is needed. Several hemostatic devices, such as ones providing soft coagulation with a monopolar electrode, a monopolar oating ball (TissueLink; Salient Surgical Technologies, Inc., Portsmouth, NH, USA), a Coolinside device (Apeiron Medical, Valencia, Spain), and the bipolar forceps coagulation, have been used clinically in recent years [3,15,18,27,28]. Each device has its own advantage; however, to date, there is no consensus on the ideal method for hepatectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Severe postoperative complications worsen long-term prognosis in patients with hepatic malignancy. Several surgical methods for hepatic transection and coagulation are currently available to minimize intraoperative blood loss [2,3]. Classical resection techniques include nger fracture, sharp dissection, and crush clamping [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Although some studies have investigated the role of hemostatic devices in hepatic transection, a comparison between monopolar and bipolar coagulation, particularly their usefulness or inferiority, has been poorly documented [3,15,18]. The purpose of this retrospective cohort study was to investigate whether the monopolar device has better hemostatic e ciency than the bipolar device and whether the monopolar device increases postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Operative Outcomes Between Monopolar and Bipolar Coagulation in Hepatectomy: A Propensity Score-Matched Analysis in a Single Center

Muraki

Morita

Ida

et al. 2022

Preprint

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Background: Various hemostatic devices have been utilized to reduce blood loss during hepatectomy. Nonetheless, a comparison between monopolar and bipolar coagulation, particularly their usefulness or inferiority, has been poorly documented. The aim of this study is to reveal the characteristics of these hemostatic devices.Methods: A total of 264 patients who underwent open hepatectomy at our institution from January 2009 to December 2018 were included. Monopolar and bipolar hemostatic devices were used in 160 (monopolar group) and 104 (bipolar group) cases, respectively. Operative outcomes and thermal damage to the resected specimens were compared between these groups using propensity score matching according to background factors. Multivariate logistic regression analysis was performed to identify predictive factors for postoperative complications.Results: After propensity score matching, 73 patients per group were enrolled. The monopolar group had significantly lower total operative time (239 vs. 275 min; P=0.013) and intraoperative blood loss (487 vs. 790 mL; P<0.001). However, the incidence rates of ascites (27.4% vs. 8.2%; P=0.002) and grade ≥3 intra-abdominal infection (12.3% vs. 2.7%; P=0.028) were significantly higher in the monopolar group. Thermal damage to the resected specimens was significantly longer in the monopolar group (4.6 vs. 1.2 mm; P<0.001). Use of monopolar hemostatic device was an independent risk factor for ascites (odds ratio, 5.626, 95% confidence interval 1.881–16.827; P=0.002) and severe intra-abdominal infection (odds ratio, 5.905, 95% confidence interval 1.096–31.825; P=0.039).Conclusions: Although monopolar devices have an excellent hemostatic ability, they might damage the remnant liver. The use of monopolar devices can be one of the factors that increase the frequency of complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of Operative Outcomes Between Monopolar and Bipolar Coagulation in Hepatectomy: A Propensity Score-Matched Analysis in a Single Center

Muraki

Morita

Ida

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Severe postoperative complications worsen long-term prognosis in patients with hepatic malignancy. Several surgical methods for hepatic transection and coagulation are currently available to minimize intraoperative blood loss [ 2 , 3 ]. Classical resection techniques include finger fracture, sharp dissection, and crush clamping [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of operative outcomes between monopolar and bipolar coagulation in hepatectomy: a propensity score-matched analysis in a single center

et al. 2022

View full text Add to dashboard Cite

Background Various hemostatic devices have been utilized to reduce blood loss during hepatectomy. Nonetheless, a comparison between monopolar and bipolar coagulation, particularly their usefulness or inferiority, has been poorly documented. The aim of this study is to reveal the characteristics of these hemostatic devices. Methods A total of 264 patients who underwent open hepatectomy at our institution from January 2009 to December 2018 were included. Monopolar and bipolar hemostatic devices were used in 160 (monopolar group) and 104 (bipolar group) cases, respectively. Operative outcomes and thermal damage to the resected specimens were compared between these groups using propensity score matching according to background factors. Multivariate logistic regression analysis was performed to identify predictive factors for postoperative complications. Results After propensity score matching, 73 patients per group were enrolled. The monopolar group had significantly lower total operative time (239 vs. 275 min; P = 0.013) and intraoperative blood loss (487 vs. 790 mL; P < 0.001). However, the incidence rates of ascites (27.4% vs. 8.2%; P = 0.002) and grade ≥ 3 intra-abdominal infection (12.3% vs. 2.7%; P = 0.028) were significantly higher in the monopolar group. Thermal damage to the resected specimens was significantly longer in the monopolar group (4.6 vs. 1.2 mm; P < 0.001). Use of monopolar hemostatic device was an independent risk factor for ascites (odds ratio, 5.626, 95% confidence interval 1.881–16.827; P = 0.002) and severe intra-abdominal infection (odds ratio, 5.905, 95% confidence interval 1.096–31.825; P = 0.039). Conclusions Although monopolar devices have an excellent hemostatic ability, they might damage the remnant liver. The use of monopolar devices can be one of the factors that increase the frequency of complications.

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Post‐operative Day 1 Serum Transaminase Levels in Relation to Morbidity After Liver Resection

et al. 2021

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Background Post-operative serum transaminases have been proposed as possible early predictors of morbidity after liver resection. This study aimed to verify the clinical value of post-operative serum transaminases. Methods Clinical data from 2001 to 2016 in a single non-academic referral HPB center were collected from a prospectively held database. Post-operative day 1 serum aspartate transaminase (AST) and alanine transaminase (ALT) were tested for their relationship with post-operative major morbidity, defined by a Clavien-Dindo score 3 or higher, and mortality. Results For this analysis, 371 patients were included, including 149 (40%) undergoing major liver resections. In total, 17% of the patients developed major morbidity. Stepwise logistic regression demonstrated that AST, and not ALT, is an independent predictor for major morbidity (p = 0.017). The probability of major morbidity significantly increased with increasing AST values. A threshold value of 242 U/L was found to be predictive for one or more major complications. Conclusions In this study, post-operative serum AST on day 1 was a predictive factor for major morbidity after liver resection. For patients with low AST value, early discharge could be considered. However, because of the substantial inter-individual variability of AST values, more studies are needed to translate these results into clinical practice.

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Significance of a soft-coagulation system with monopolar electrode for hepatectomy: A retrospective two-institution study by propensity analysis

Abstract: Mild postoperative hepatic thermal injury with VIO was confirmed, and therefore, surgeons should take care when using the VIO system to make frequent wide resected cuts on the surface of the liver.

Cited by 8 publications

References 32 publications

Comparison of Operative Outcomes Between Monopolar and Bipolar Coagulation in Hepatectomy: A Propensity Score-Matched Analysis in a Single Center

Comparison of Operative Outcomes Between Monopolar and Bipolar Coagulation in Hepatectomy: A Propensity Score-Matched Analysis in a Single Center

Comparison of operative outcomes between monopolar and bipolar coagulation in hepatectomy: a propensity score-matched analysis in a single center

Post‐operative Day 1 Serum Transaminase Levels in Relation to Morbidity After Liver Resection

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