Randomized clinical trial of stapler hepatectomy <i>versus</i> LigaSure™ transection in elective hepatic resection

Fritzmann, Johannes; Kirchberg, Johanna; Sturm, Dorothée; Ulrich, Alexis; Knebel, Phillip; Mehrabi, Arianeb; Büchler, Markus W.; Weitz, Jürgen; Reißfelder, Christoph; Rahbari, Nuh N.

doi:10.1002/bjs.10902

Cited by 22 publications

(19 citation statements)

References 33 publications

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“…The hepatectomy was performed using staplers in about 70% of patients, and stapled hepatectomy was associated with a lower rate of excessive intraoperative bleeding. Similar to our findings, recent randomized-controlled trials have demonstrated that blood loss was lower during stapler hepatectomy compared with blood loss during other liver resection methods [26][27][28] . This indicates that the PM together with stapler hepatectomy may decrease intraoperative blood loss and prevent intraoperative blood transfusion.…”

Section: Discussionsupporting

confidence: 91%

“…Then, according to the location of the tumor, right or left EH was performed using a stapler (EndoGIA Universal; Covidien, Minneapolis, USA), LigaSure ™ vessel sealing system (Medtronic, Dublin, Ireland), clamp-crushing technique, or Cavitron ultrasonic surgical aspirator (CUSA, Söring GmbH; Quickborn, Germany). These transection methods are described elsewhere [26][27][28] . Central venous pressure was monitored and maintained between 0 and 5 mmHg to minimize blood loss during the operation.…”

Section: Operative Techniques Midline Incision With a Right Inferolamentioning

confidence: 99%

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Pringle Maneuver in Extended Liver Resection: A propensity score analysis

Al-Saeedi

Ghamarnejad

Khajeh

et al. 2020

Sci Rep

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Despite the ongoing decades-long controversy, pringle maneuver (pM) is still frequently used by hepatobiliary surgeons during hepatectomy. The aim of this study was to investigate the effect of PM on intraoperative blood loss, morbidity, and posthepatectomy hemorrhage (PHH). A series of 209 consecutive patients underwent extended hepatectomy (eH) (≥5 segment resection). The association of pM with perioperative outcomes was evaluated using multivariate analysis with a propensity score method to control for confounding. Fifty patients underwent PM with a median duration of 19 minutes. Multivariate analysis revealed that risk of excessive intraoperative bleeding (≥1500 ml; odds ratio [OR] 0.27, 95%-confidence interval [CI] 0.10-0.70, p = 0.007), major morbidity (OR 0.41, 95%-CI 0.18-0.97, p = 0.041), and PHH (OR 0.22, 95%-CI 0.06-0.79, p = 0.021) were significantly lower in PM group after EH. Furthermore, there was no significant difference in 3-year recurrence-free-survival between groups. pM is associated with lower intraoperative bleeding, pHH, and major morbidity risk after eH. Performing PM does not increase posthepatectomy liver failure and does not affect recurrence rate. Therefore, PM seems to be justified in EH. Extended hepatectomy (EH) is the only curative treatment option for patients with large primary or bilobar metastatic liver malignancies 1. Better patient selection and developments in surgical techniques and instruments have increased the number and safety of EH 2,3. However, the risk of complications such as intraoperative bleeding, especially in patients with large tumors or tumors near to major vessels, is still high. These factors are associated with poorer postoperative outcomes 4,5. Patients with massive intraoperative blood loss have a higher rate of posthepatectomy morbidity and mortality 2 and lower recurrence-free survival due to blood transfusion 6. Therefore, reducing intraoperative bleeding during EH and reducing the amount of blood products transfused are important points in liver surgery. Despite the ongoing controversy regarding the advantages and disadvantages of hepatic inflow control during hepatectomy, the Pringle maneuver (PM) remains the most commonly used and evidence-based method of hepatic inflow control 7. The PM significantly decreases intraoperative blood loss, the amount of blood products transfused, and operation time, especially when performed in combination with low central venous pressure 8-10. Nevertheless, there is no evidence that the PM can reduce posthepatectomy morbidity and mortality 11,12 ; in fact, the PM may result in ischemia-reperfusion injury of the liver, which negatively affects hepatocyte metabolism, thereby increasing the rate of posthepatectomy liver failure (PHLF) 13,14. Despite several studies investigating the role of the PM in liver resection, the effects of the PM on intra-and postoperative outcomes have not been investigated exclusively in EH, which has a higher risk of intraoperative bleeding than minor hepatectomies 15. In addition, applica...

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Section: Discussionsupporting

confidence: 91%

Section: Operative Techniques Midline Incision With a Right Inferolamentioning

confidence: 99%

Pringle Maneuver in Extended Liver Resection: A propensity score analysis

Al-Saeedi

Ghamarnejad

Khajeh

et al. 2020

Sci Rep

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“…The optical coherence tomography images showed that the microneedles pierced and spread the surrounding tissue. This effect may spread the tissue and compress the wound from all sides, working as a surgical stapler 13 that is superior to vascular sealing devices in reducing blood loss 14 . Furthermore, very small spaces were observed between the tissue surface and the microneedle sheet.…”

Section: Discussionmentioning

confidence: 99%

A biodegradable microneedle sheet for intracorporeal topical hemostasis

Yokoyama

Chihara

Tanaka

et al. 2020

Sci Rep

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Management of bleeding is critical for improving patient outcomes. While various hemostatic products are used in daily practice, technical improvement is still needed. To addresses this problem, we newly developed a microneedle hemostatic sheet based on microneedle technology. We demonstrated the unique features of this microneedle hemostatic sheet, including reduced hemostatic time, biodegradable polymer composition that allows intracorporeal use without increasing infectious risk incorporation of microneedles to fix the sheet to the wound even on the left ventricular wall of a swine while beating, and a mesh structure with flexibility comparable to that of bonding surgical tape and sufficient rigidity to penetrate human aorta tissue and swine left ventricular wall. One potential application of the microneedle hemostatic sheet is intracorporeal topical hemostasis for parenchymatous organs, large vessels, and heart wall during trauma or surgery, in addition to new, widespread applications.

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“…22,23 A number of randomized controlled trials (RCTs) have been reported on the methods of liver parenchymal transection using various devices. [1][2][3][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Although the results varied, none of the devices used for transection showed significant advantages over the classical crushing clamp method. Most papers concluded that the procedure should be performed with any method in which each institution is familiar.…”

Section: Discussionmentioning

confidence: 99%

Efficiency of a radiofrequency sealer (Aquamantys) for parenchymal transection during laparoscopic hepatectomy

Iida

Maehira

Mori

et al. 2020

Asian J Endoscop Surgery

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Introduction: The methods of liver parenchymal transection vary across institutions. In this study, we used a radiofrequency (RF) sealer (Aquamantys) as a hemostatic device during laparoscopic liver transection; we also evaluated the usefulness of RF sealers. Methods: From April 2016 to May 2019, 113 consecutive laparoscopic hepatectomy patients, excluding patients with combined resection of other organs, were examined. Patient characteristics, operative factors, and postoperative complications were compared between the Cavitron ultrasonic surgical aspirator (CUSA) + soft coagulation system (VIO) group; (n = 32) and the CUSA + Aquamantys group; (n = 81). The former underwent liver transection by CUSA and VIO from April 2016 to March 2017, while the latter underwent liver transection using CUSA and Aquamantys from April 2017 to May 2019. Results: The median difficulty score was significantly higher in the CUSA + VIO group (5.5 points vs 5.0 points; P = .04). Blood loss per unit area and the liver parenchymal transection speed were not significantly different between the groups. After propensity score matching, blood loss per unit area was similar between the groups, but the parenchymal transection speed of the CUSA + Aquamantys group was significantly higher (0.92 cm 2 /min vs 0.64 cm 2 /min; P = .017). Postoperative complications were similar between the groups. Conclusion: In laparoscopic hepatectomy, hemostasis of the transection plane with an RF sealer did not reduce blood loss during parenchymal transection. However, the liver parenchymal transection speed was increased.

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Randomized clinical trial of stapler hepatectomy versus LigaSure™ transection in elective hepatic resection

Abstract: Stapler hepatectomy was associated with reduced blood loss and a shorter duration of operation than the LigaSure™ device for parenchymal transection in elective partial hepatectomy. Registration number: NCT01858987 (http://www.clinicaltrials.gov).

Cited by 22 publications

References 33 publications

Pringle Maneuver in Extended Liver Resection: A propensity score analysis

Pringle Maneuver in Extended Liver Resection: A propensity score analysis

A biodegradable microneedle sheet for intracorporeal topical hemostasis

Efficiency of a radiofrequency sealer (Aquamantys) for parenchymal transection during laparoscopic hepatectomy

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