Bloodless Liver Resection Using the Monopolar Floating Ball plus Ligasure Diathermy: Preliminary Results of 16 Liver Resections

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• 作者：Yoshihiro Sakamoto ; Junji Yamamoto ; Norihiro Kokudo ; Makoto Seki ; Tomoo Kosuge ; Toshiharu Yamaguchi ; Tetsuichiro Muto and Masatoshi Makuuchi
• 刊名：World Journal of Surgery
• 出版年：2004
• 出版时间：February 2004
• 年：2004
• 卷：28
• 期：2
• 页码：166-172
• 全文大小：135 KB
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgery
  Abdominal Surgery
  Cardiac Surgery
  General Surgery
  Thoracic Surgery
  Vascular Surgery
  
• 出版者：Springer New York
• ISSN：1432-2323

文摘

Blood loss during liver transection and ischemia-reperfusion injury associated with hepatic inflow occlusion are significant drawbacks during liver surgery. Sixteen patients underwent liver resection using the Monopolar Floating Ball (FB) plus LigaSure (LS) diathermy without occlusion of the hepatoduodenal ligament (group FB-LS). The liver parenchyma was precoagulated using the FB, and the uncovered tiny vessels were sealed using LS. Surgical outcomes were retrospectively compared with 16 well matched patients who underwent liver resection using the conventional clamp crushing method with Pringle’s maneuver (group CC). The amount of blood loss during liver transection was significantly less in group FB-LS than in group CC [200 ml (0–990 ml) vs. 480 ml (120–1800 ml);p = 0.006]. The median time it took to complete the liver transection was significantly longer in group FB-LS than in group CC [144 minutes (43–335 minutes) vs. 58 minutes (18–94 minutes); p < 0.0001]. Hepatic inflow occlusion was temporally used in five patients in group FB-LS to achieve hemostasis in hepatic venous tributaries for 6,10, 19, 26, and 61 minutes, respectively. Using these two electronic devices allows liver resection to be safely performed, with the advantage of minimal blood loss and a reduced inflow occlusion period compared to the conventional method. The major disadvantage may be a slower transection speed. A prospective randomized trial is needed to clarify the clinical benefits of liver resections performed using this novel technique.