Abstract:

The principal cause of perioperative morbidity and mortality following hepatic resection is excessive intraoperative hemorrhage. This study evaluates the operative use of the LigaSure™ device in sealing ductal structures during major and minor hepatic resections. Patients were analyzed between June 1994 and December 2005, comparing 89 randomly selected cases undergoing hepatic resections using the clamp-crushing technique with LigaSure™ electrocautery and hepatic inflow occlusion where appropriate with 70 patients undergoing various hepatic resections using the clamp-crushing technique alone with hepatic inflow occlusion where appropriate. Intraoperative blood loss and perioperative blood transfusion requirements were significantly less for patients in the LigaSure™ group. LigaSure™-assisted hepatic resection was generally performed more quickly than the conventional clamp-crushing technique. The overall maximum postoperative AST, ALT, and bilirubin serum levels were similar in the two groups, as was the incidence of major postoperative complications. The LigaSure™ device in this randomized study is safe and simple to use, resulting in less perioperative blood loss and transfusion requirement during hepatic parenchymal transection.

Authors:

Antonio Chiappa, M.D., F.A.C.S., Professor of Surgery, Vice Director, Department of General Surgery, European Institute of Oncology, University of Milan, Milan, Italy, Emilio Bertani, M.D., Senior Assistant, Department of General Surgery, European Institute of Oncology, University of Milan, Milan, Italy, Roberto Biffi, M.D., Co-Director, Department of General Surgery, European Institute of Oncology University of Milan, Milan, Italy, Andrew P Zbar, M.D., F.R.C.S., F.R.A.C.S., Professor of Surgery, Director, Professorial Department of General Surgery, University of the West Indies, School of Clinical Medicine and Research, Cave Hill Campus, Barbados, Giuseppe Viale, M.D., F.R.C.P. (Path), Professor of Pathology, Director, Division of Pathology, European Institute of Oncology, University of Milan, Milan, Italy, Giancarlo Pruneri, M.D., Assistant Professor, Division of Pathology, European Institute of Oncology, University of Milan, Milan, Italy, Massimo Bellomi, M.D., Professor of Radiology, Director, Division of Radiology, European Institute of Oncology, University of Milan, Milan, Italy, Marco Venturino, M.D., Director, Division of Anesthesiology, European Institute of Oncology, University of Milan, Milan, Italy, Bruno Andreoni, M.D., Professor of Surgery, Director, Department of General Surgery, European Institute of Oncology, University of Milan, Milan, Italy

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