Expert opinion on advanced techniques for hemostasis in liver surgery

A new technique for hepatic parenchymal transection using an articulating bipolar 5 cm radiofrequency device: results from the first 100 procedures

“…For open hepatectomy, in addition to the clamp and crush technique, various different techniques for PT have been described relying on a combination of vessel sealers, ultrasonic aspirators, advanced tissue coagulators, ablative technologies, staplers, and tissue sealants. [5][6][7][8][9][10][11][12][13][14][15][16][17] Due to the limitations of exposure, the number of different techniques used in laparoscopic liver resection is even more diverse, leading to the lack of standardization, inefficiency and increased costs. Acknowledging these challenges, we have been assessing a new articulating radiofrequency device for liver resection with the aim to simplify and facilitate parenchymal transection over the past 5 years.…”

Improving the adhesion, flexibility, and hemostatic efficacy of a sprayable polymer blend surgical sealant by incorporating silica particles

“…To simulate the use of PLGA/PEG and P-620 as hemostats in vivo, we sprayed the sealants directly onto a bleeding porcine liver immediately after resection (Video S1 and Video S2). This approach models a procedure such as liver resection, which has increased morbidity due to the risk of significant blood loss [35]. Immediately after deposition, PLGA/PEG showed blood permeating the sealant (Fig.…”

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“…One randomized study showed that use of ultrasonic dissector (UD) combined with TissueLink is superior to UD combined with bipolar cautery in terms of reduced blood loss and faster transection speed with no increase in morbidity [50].…”