A prospective randomized controlled trial of hemostasis with a bipolar sealer during hepatic transection for liver resection

• Published in: Surgery 2013-11, Vol.154 (5), p.1046-1052
• Main Authors: Kaibori, Masaki, MD, Matsui, Kosuke, MD, Ishizaki, Morihiko, MD, Sakaguchi, Tatsuma, MD, Matsushima, Hideyuki, MD, Matsui, Yoichi, MD, Kwon, A-Hon, MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cautery - instrumentation; Female; Hemostasis, Surgical - instrumentation; Hemostasis, Surgical - mortality; Hepatectomy - instrumentation; Hepatectomy - mortality; Hepatectomy - statistics & numerical data; Humans; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Male; Middle Aged; Prospective Studies; Suction - instrumentation; Surgery
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2013.04.053

Background Excessive intraoperative blood loss and the possible requirement for blood transfusion are major problems in hepatic resection for liver tumors. The decrease of blood loss is a goal in liver surgery, and several technical developments have been introduced for this purpose. The aim of this prospective randomized study was to compare the use of the Cavitron Ultrasonic Surgical Aspirator (CUSA) with a radiofrequency-based bipolar hemostatic sealer versus CUSA with standard bipolar cautery (BC) in patients undergoing hepatic resection. Methods One hundred nine patients with liver tumors were randomized to undergo hepatic transection via CUSA with a bipolar sealer (Aquamantys 2.3 Bipolar Sealer; n = 55) or BC ( n = 54). Blood loss during parenchymal transection and speed of transection were the primary end points, whereas the degree of postoperative liver injury and morbidity were secondary end points. Results Compared with the BC group, the bipolar sealer showed lesser blood loss during transection and blood loss divided by resection area ( P = .0079 and .0008, respectively), shorter transection time ( P  = .0025), faster speed of transection ( P < .0001), and fewer ties and ties divided by resection area required during transection ( P < .0001). Conclusion CUSA with a bipolar sealer is superior to CUSA with standard BC for various hepatectomy in terms of less blood loss and faster speed of transection, with no increase in morbidity.