Perioperative outcome of laparoscopic left lateral liver resection is improved by using a bioabsorbable staple line reinforcement material in a porcine model

Abstract

HypothesisLaparoscopic liver surgery is significantly limited by the technical difficulty encountered during transection of substantial liver parenchyma, with intraoperative bleeding and bile leaks. This study tested whether the use of a bioabsorble staple line reinforcement material would improve outcome during stapled laparoscopic left lateral liver resection in a porcine model.Study designA total of 20 female pigs underwent stapled laparoscopic left lateral liver resection. In group A (n = 10), the stapling devices were buttressed with a bioabsorbable staple line reinforcement material. In group B (n = 10), standard laparoscopic staplers were used. Operative data and perioperative complications were recorded. Necropsy studies and histopathological analysis were performed at 6 weeks. Data were compared between groups with the Student’s t-test or the chi-square test.ResultsOperating time was similar in the two groups (64 ± 11 min in group A versus 68 ± 9 min in group B, p = ns). Intraoperative blood loss was significantly higher in group B (185 ± 9 mL versus 25 ± 5 mL, p < 0.05). There was no mortality. There was no morbidity in the 6-week follow-up period; however, two animals in group B had subphrenic bilomas (20%) at necropsy. At necropsy, methylene blue injection via the main bile duct revealed leakage from the biliary tree in four animals in group B and none in group A (p < 0.05). Histopathological examination of the resection site revealed minor abnormalities in group A while animals in group B demonstrated marked fibrotic changes and damaged vascular and biliary endothelium.ConclusionUse of a bioabsorbable staple line reinforcement material reduces intraoperative bleeding and perioperative bile leaks during stapled laparoscopic left lateral liver resection in a porcine model.

Laparoscopic left hepatectomy in swine: a safe and feasible technique

“…Intraoperative blood loss was nearly the same as that reported when using standard laparoscopic staplers (174 ± 96 mL vs. 185 ± 9 mL) for laparoscopic left lateral liver resection [7]. With experience, our operative time decreased by 27 min (from 192 to 165 min) and could improve further with additional practice.…”

“…We controlled bleeding with partial clamping of the hepatic hilum, monopolar electrocoagulation, use of titanium clips, and penetrating ligation of the liver parenchyma. Intraoperative blood loss was nearly the same as that reported when using standard laparoscopic staplers (174 ± 96 mL vs. 185 ± 9 mL) for laparoscopic left lateral liver resection [ 7 ]. With experience, our operative time decreased by 27 min (from 192 to 165 min) and could improve further with additional practice.…”

Porcine Model In The Laparoscopic Liver Surgery Training

“…This is probably the reason why the time the trainees needed to perform simple tasks like Pringle manoeuver or liver ligaments division was quite long compared with total time of left lateral sectionectomy in porcine model in experienced hands. In the study by Consten et al the mean time of left lateral sectionectomy was 64±11 min (15). This has been completed in 2 hours in our case.…”

A Comparison of a Single Center’s Experience with Three Staple Line Reinforcement Techniques in 1,502 Laparoscopic Sleeve Gastrectomy Patients

“…APM has been associated with decreased leak and intraoperative bleeding rates when compared to non-buttressed staple lines in various intra-abdominal surgeries [9][10][11][12][13][14][15]. BPS has additionally been associated not only with decreased leak and bleeding rates but also with increased complications such as gastric fistula and infection [16][17][18].…”