Application of stapling devices in liver surgery: Current status and future prospects

Abstract

The liver is a vascular-rich solid organ. Safe and effective dissection of the vessels and liver parenchyma, and control of intraoperative bleeding are the main concerns when performing liver resection. Several studies have confirmed that intraoperative blood loss and postoperative transfusion are predictors of postoperative morbidity and mortality in liver surgery. Various methods and instruments have been developed during hepatectomy. Stapling devices are crucial for safe and rapid anastomosis. They are used to divide hepatic veins and portal branches, and to transect liver parenchyma in open liver resection. In recent years, laparoscopic liver surgery has developed rapidly, and is now preferred by many surgeons. Stapling devices have also been gradually introduced in laparoscopic liver surgery, from dividing vascular and biliary structures to parenchymal transection. This may be because staplers make manipulation more simple, rapid and safe. Even in single incision laparoscopic surgery, which is recognized as a new minimally invasive technique, staplers are also utilized, especially in left lateral hepatectomy. For safe application of stapling devices in liver surgery, more related designs and modifications, such as application of a suitable laparoscopic articulating liver tissue crushing device, a staple line reinforcement technique with the absorbable polymer membrane or radiofrequency ablation assistance, are still needed. More randomized studies are needed to demonstrate the benefits and find broader indications for the use of stapling devices, to help expand their application in liver surgery.

Laparoscopic left hemihepatectomy in small dogs: an easy and effective new technique

“…Currently, laparoscopic hepatectomy often requires both an experienced surgeon and expensive equipment, such as the Endo-GIA stapling system (Consten et al 2008;Scuderi and Troisi 2014;Yao and Wu 2016), a saline-coupled bipolar sealer (Sastry et al 2019), an ultrasonic scalpel (Chai et al 2018;Kim et al 2017), a laparoscopic laser (Ellebrecht et al 2018) and a microwave applicator (Chong et al 2018;Dimitri et al 2019;Shen et al 2018). These factors restrict the widespread use of hepatic lobectomy in veterinary clinics.…”

Rationality and necessity of vascular stapler application during liver resection (Review)

“…This is a relatively low-cost procedure. However, liver surgeons are prone to using vascular staplers to limit transection durations and shorten the portal pedicle closure time, or they may even perform no occlusion ( 7 , 16 ). Transection of the hepatic veins or Glisson's pedicles using vascular staplers has been widely used in multiple surgical liver centers ( 2 , 9 , 10 , 17 ).…”

“…In addition, this decreases the need for portal triad clamping during liver ischemic reperfusion injury ( 2 , 10 ). Previous systemic reviews proposed that stapler devices should be used in open or laparoscopic LR and reported that up to nine vascular staplers are used for parenchymal transection in laparoscopic liver surgery ( 7 , 11 ). Using vascular staplers may improve the speed and safety of ligation in both inflow and outflow vessels, thereby facilitating LR ( 12 , 13 ).…”

Operative and Nonoperative Management of Blunt Liver Injuries

“…The vessels are ligated with absorbable suture and hemostasis of larger lacerations can be obtained with sutures and patches of omentum [20]. Liver stapling allows for transection and ligation of liver panenchyma, arteries, veins, and ducts in a quick, safe, and efficient manner and is useful in larger sections that require surgical excision [16]. The Pringle maneuver, which clamps the hepatoduodenal ligament and therefore the hepatic artery, portal vein, and common bile duct, can be performed for up to 1 h to limit blood flow through the liver and therefore more easily identify injuries [14].…”