Tissue preserving hepatectomy by a vessel sealing device

Abstract

This alternative technique of dividing the hepatic parenchyma seems to be simple and efficacious in preventing significant blood loss and bile leak in minor liver resections.

Impact of Neoadjuvant Chemotherapy on Hypertrophy of the Future Liver Remnant after Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy

“…Resection of hepatic primary and metastatic tumors remains the only curative treatment [1][2][3][4].…”

Rationale, bench testing and in vivo evaluation of a novel 5 mm laparoscopic vessel sealing device with homogeneous pressure distribution in long instrument jaws

“…Today, EBVS systems are offered by various manufacturers and widely used in several surgical specialties such as general and visceral surgery [1,3,4], gynecology [5,6], urology [2,7], cardio-thoracic [8], and pediatric surgery [7,9]. Recent systematic reviews and meta-analyses of randomized controlled clinical trials [10-12] revealed that EBVS systems are safe and at least equally effective concerning blood loss and operating time in comparison to ultrasonic energy devices for blood vessel transection in abdominal surgery.…”

The Aim of Technology During Liver Resection — A Strategy to Minimize Blood Loss During Liver Surgery

“…BVSD is capable to obliterate the lumen of veins and arteries up to 7 mm in diameter by the fusion of elastin and collagen proteins of the vessel walls; that makes BVSB the only safe and real alternative to sutures and clips for sealing vessel [68], [69], [70]. A: BVSD coagulates sealing vessels up to 7 mm in diameter with minimal charring, thermal spread or smoke, it's capable to reduce blood loss and the need for vessel occlusion techniques if compared to traditional techniques [8], [71], [72], A recently published randomized controlled trial demonstrated that the use of Ligasure in combination with a clamp crushing technique resulted in lower blood loss and faster transaction speed in minor liver resections compared with the conventional technique of electric cautery or ligature for controlling vessels in the transection plane [73].…”

“…D: after the application the coagulated tissue often sticks to the instrument's jaws causing new bleeding when the device is moved away; BVSD seems to be less effective in presence of cirrhosis for two reasons: first the portal hypertension correlated with cirrhosis causes thinning of the dilate portal vein's walls and makes their obliteration less effective; second cirrhosis makes crushing technique difficult and the hepatic tissue between the blades may disperse the power applied causing vessel to bleed [128]; moreover it seems to be ineffective in cystopericystectomy [77] (even if some surgeons sustain his effectiveness in this surgery [78]). Ligasure vessels sealing system has been widely use during liver transection in a "blind" way [70]- [71], achieving parenchymal fracture and vessel sealing in the same time without identìfication of tiny vasculatures and bile ducts. This could be considered a limits of this tools which do not allow the surgeon to clearly check the structures which are going to be sealed.…”