Laparoscopic liver surgery: parenchymal transection using saline-enhanced electrosurgery

Abstract

Minimally invasive liver resection (MILR) has evolved considerably in the past decade. Safe hepatic parenchymal transection, has been one of the technical hurdles that has become evident during the growth of MILR. Advances in technology have now made safe liver transection a reality allowing resections of greater magnitude. In this review, the precoagulation approach is described in both methodology and technique. Using this method of liver transection, we have been able to perform MILR of all varieties and magnitudes, with favorable patient outcomes. A detailed description of one particular device will be highlighted to disseminate our experience and thus broaden the technical options for hepatobiliary surgeons wishing to offer their patients a minimally invasive therapy.

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.…”

Common uses and cited complications of energy in surgery

“…The advantages of RF energy and the necessity to reduce complications have resulted in the introduction of several new commercial devices [120, 121]. In [122], the Gyrus Plasma Trissector (GPT), a novel bipolar RF system in laparoscopic radical prostatectomies was shown to improve coagulation, reduce or eliminate sticking, seal large vessels and allow secure grasping and dissecting of tissue.…”

The Superficial Precoagulation, Sealing, and Transection Method

“…The other benefit of SPST method is the ecofriendly aspect: CUSA, VIO Soft-Coagulation, VIO BiClamp, and SonoSurg are all reusable by autoclave sterilization. Similar devices can be used in a modified SPST method, for example, TissueLink 15 instead of Soft-Coagulation, Ligasure 14 instead of BiClamp, and Harmonic scalpel 16 instead of SonoSurg. However, these devices are disposable and expensive.…”