Two different methods for donor hepatic transection: Cavitron ultrasonic surgical aspirator with bipolar cautery versus cavitron ultrasonic surgical aspirator with radiofrequency coagulator-A randomized controlled trial
ABSTRACT The aim of this study was to compare the Cavitron ultrasonic surgical aspirator (CUSA) with bipolar cautery (BP) to CUSA with a radiofrequency coagulator [TissueLink (TL)] in terms of efficacy and safety for hepatic transection in living donor liver transplantation. Twenty-four living liver donors (n = 12 for each group) were randomized to undergo hepatic transection using CUSA with BP or CUSA with TL. Blood loss during parenchymal transection and speed of transection were the primary endpoints, whereas the degree of postoperative liver injury and morbidity were secondary endpoints. Median blood loss during liver transection was significantly lower in the TL group than in the BP group (195.2 +/- 84.5 versus 343.3 +/- 198.4 mL; P = 0.023), and liver transection was significantly faster in the TL group than in the BP group (0.7 +/- 0.2 versus 0.5 +/- 0.2 cm(2)/minute; P = 0.048). Significantly fewer ties were required during liver transection in the TL group than in the BP group (15.8 +/- 4.8 versus 22.8 +/- 7.9 ties; P = 0.023). The morbidity rates were similar for the 2 groups. In conclusion, CUSA with TL is superior to CUSA with BP for donor hepatectomy in terms of blood loss and speed of transection with no increase in morbidity.
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Article: Two different methods for donor hepatic transection: Cavitron ultrasonic surgical aspirator with bipolar cautery versus cavitron ultrasonic surgical aspirator with radiofrequency coagulator-A randomized controlled trial
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ABSTRACT: BACKGROUND: Living donor liver transplantation (LDLT) has been widely accepted over the past decade, and hepatic dysfunction often occurs in the donor in the early stage after liver donation. The present study aimed to evaluate the effect of intra-operative cholangiography (IOC) and parenchymal resection on liver function of donors in LDLT, and to assess the role of IOC in influencing the biliary complications and improving the overall outcome. METHODS: Data from 40 patients who had donated their right lobes for LDLT were analyzed. Total bilirubin (TB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT) at different time points were compared, and the follow-up data and the biliary complications were also analyzed. RESULTS: The ALT and AST values were significantly increased after IOC (P<0.001) and parenchymal resection (P<0.001). However, the median values of TB, ALP and GGT were not significantly influenced by IOC (P>0.05) or parenchymal resection (P>0.05). The biochemical changes caused by IOC or parenchymal resection were not correlated with the degree of post-operative liver injury or the recovery of liver function. The liver functions of the donors after operation were stable, and none of the donors suffered from biliary stenosis or leakage during the follow-up. CONCLUSIONS: IOC and parenchymal resection may induce a transient increase in liver enzymes of donors in LDLT, but do not affect the recovery of liver function after operation. Moreover, the routine IOC is helpful to clarify the division line of the hepatic duct, thus reducing the biliary complication rate.Hepatobiliary & pancreatic diseases international: HBPD INT 06/2014; 13(3):259-63. DOI:10.1016/S1499-3872(14)60252-6 · 1.17 Impact Factor