The ligasure vessel sealer in liver resection

A pilot study

Antonio Chiappa, Andrew P. Zbar, Emilio Bertani, Ugo Pace, Giuseppe Viale, Giancarlo Pruneri, Marco Venturino, MariaGiulia Zampino, Nicola Fazio, Guido Bonomo, Pasquale Misitano, Bruno Andreoni

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background/Aims: The major complication for liver resection is hemorrhage. Energy sources other than electrosurgery have become popular with the promise of quick and effective vascular control. This study evaluates alternative energy sources in sealing ductal structures for use in liver resection with minimal blood loss. Methodology: Between June 1994 and December 2003, a consecutive 116 patients (59 male; 57 female; mean age: 60±11 years; range: 27-79 years) underwent surgery for primary (n=30), metastatic liver cancer (n=79), or benign lesions (n=7). The extent of hepatic parenchymal division is marked on the surface with a diathermy-scored line. The arteries, veins, and bile ducts crossing the line of division are grasped, singly or in groups, by the Ligasure (Autosuture, United States Surgical Corp., Norwalk, CT) electrocautery device. Results: Fifty-eight formal hepatic resections, and 58 non-anatomical wedge resection were performed. The blood loss ranged from 100mL to 3000mL (median: 430mL). Only 32 patients received preoperative blood transfusions. Perioperative mortality was nil (within 30 days following surgery), and postoperative major complications were seen in 14 patients (12%). Conclusions: The Ligasure device uses bipolar electrothermal energy to coagulate the opposing walls of the target vessels. A feedback-control mechanism ensures that tissues are not charred by overcoagulation. This results in a high-burst strength vessel seal. Sealing is effective in vessels up to 7mm in diameter. Larger vessels require formal suture or stapling. This described technique is simple, rapid, safe for parenchymal division during hepatectomy, resulting in minimal blood loss.

Original languageEnglish
Pages (from-to)2353-2357
Number of pages5
JournalHepato-Gastroenterology
Volume54
Issue number80
Publication statusPublished - Dec 2007

Fingerprint

Liver
Electrosurgery
Diathermy
Equipment and Supplies
Electrocoagulation
Hepatectomy
Liver Neoplasms
Bile Ducts
Ambulatory Surgical Procedures
Blood Transfusion
Sutures
Blood Vessels
Veins
Arteries
Hemorrhage
Mortality

Keywords

  • Complications
  • Hepatic resections
  • Metastatic liver tumors
  • Primary liver tumors

ASJC Scopus subject areas

  • Gastroenterology

Cite this

The ligasure vessel sealer in liver resection : A pilot study. / Chiappa, Antonio; Zbar, Andrew P.; Bertani, Emilio; Pace, Ugo; Viale, Giuseppe; Pruneri, Giancarlo; Venturino, Marco; Zampino, MariaGiulia; Fazio, Nicola; Bonomo, Guido; Misitano, Pasquale; Andreoni, Bruno.

In: Hepato-Gastroenterology, Vol. 54, No. 80, 12.2007, p. 2353-2357.

Research output: Contribution to journalArticle

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abstract = "Background/Aims: The major complication for liver resection is hemorrhage. Energy sources other than electrosurgery have become popular with the promise of quick and effective vascular control. This study evaluates alternative energy sources in sealing ductal structures for use in liver resection with minimal blood loss. Methodology: Between June 1994 and December 2003, a consecutive 116 patients (59 male; 57 female; mean age: 60±11 years; range: 27-79 years) underwent surgery for primary (n=30), metastatic liver cancer (n=79), or benign lesions (n=7). The extent of hepatic parenchymal division is marked on the surface with a diathermy-scored line. The arteries, veins, and bile ducts crossing the line of division are grasped, singly or in groups, by the Ligasure (Autosuture, United States Surgical Corp., Norwalk, CT) electrocautery device. Results: Fifty-eight formal hepatic resections, and 58 non-anatomical wedge resection were performed. The blood loss ranged from 100mL to 3000mL (median: 430mL). Only 32 patients received preoperative blood transfusions. Perioperative mortality was nil (within 30 days following surgery), and postoperative major complications were seen in 14 patients (12{\%}). Conclusions: The Ligasure device uses bipolar electrothermal energy to coagulate the opposing walls of the target vessels. A feedback-control mechanism ensures that tissues are not charred by overcoagulation. This results in a high-burst strength vessel seal. Sealing is effective in vessels up to 7mm in diameter. Larger vessels require formal suture or stapling. This described technique is simple, rapid, safe for parenchymal division during hepatectomy, resulting in minimal blood loss.",
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T2 - A pilot study

AU - Chiappa, Antonio

AU - Zbar, Andrew P.

AU - Bertani, Emilio

AU - Pace, Ugo

AU - Viale, Giuseppe

AU - Pruneri, Giancarlo

AU - Venturino, Marco

AU - Zampino, MariaGiulia

AU - Fazio, Nicola

AU - Bonomo, Guido

AU - Misitano, Pasquale

AU - Andreoni, Bruno

PY - 2007/12

Y1 - 2007/12

N2 - Background/Aims: The major complication for liver resection is hemorrhage. Energy sources other than electrosurgery have become popular with the promise of quick and effective vascular control. This study evaluates alternative energy sources in sealing ductal structures for use in liver resection with minimal blood loss. Methodology: Between June 1994 and December 2003, a consecutive 116 patients (59 male; 57 female; mean age: 60±11 years; range: 27-79 years) underwent surgery for primary (n=30), metastatic liver cancer (n=79), or benign lesions (n=7). The extent of hepatic parenchymal division is marked on the surface with a diathermy-scored line. The arteries, veins, and bile ducts crossing the line of division are grasped, singly or in groups, by the Ligasure (Autosuture, United States Surgical Corp., Norwalk, CT) electrocautery device. Results: Fifty-eight formal hepatic resections, and 58 non-anatomical wedge resection were performed. The blood loss ranged from 100mL to 3000mL (median: 430mL). Only 32 patients received preoperative blood transfusions. Perioperative mortality was nil (within 30 days following surgery), and postoperative major complications were seen in 14 patients (12%). Conclusions: The Ligasure device uses bipolar electrothermal energy to coagulate the opposing walls of the target vessels. A feedback-control mechanism ensures that tissues are not charred by overcoagulation. This results in a high-burst strength vessel seal. Sealing is effective in vessels up to 7mm in diameter. Larger vessels require formal suture or stapling. This described technique is simple, rapid, safe for parenchymal division during hepatectomy, resulting in minimal blood loss.

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