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

Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Kyoto University, Kyoto, Japan.
Liver Transplantation (Impact Factor: 4.24). 01/2009; 15(1):102-5. DOI: 10.1002/lt.21658
Source: PubMed


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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Available from: Toshimi Kaido, Sep 09, 2014
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    • "Many devices have been successfully employed in liver surgery, each of them with advantages and disadvantages but with little evidence about the superiority of any of them [4] [5]. In recent years, the saline-cooled radiofrequency probe has gained favor among surgeons performing hepatic resections [6] [7] [8] [9] [10]. The device coagulates liver parenchyma allowing for near bloodless liver Received 4 April 2013; accepted 15 July 2013. "
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    ABSTRACT: Background/aims: The aim of our study was to determine whether post-radiofrequency syndrome may also develop following hepatectomy using saline-cooled radiofrequency coagulation. Methods: We retrospectively reviewed 95 consecutive patients who underwent 110 liver resections between May 2000 and September 2012. We stated that 80.9% of the resections were carried out employing the saline-cooled radiofrequency device. All medical records were searched for the occurrence of flu-like symptoms, without evidence of sepsis or infection, in the first two postoperative weeks. Results: Eleven patients (11.5%) developed flu-like symptoms after hepatectomy without evidence of sepsis or infection. All their hepatectomies were performed employing the saline-cooled radiofrequency probe (p = .089), and all cases but one appeared following colorectal liver metastases surgery (p = .042). Eight of them were readmitted to the hospital because of their symptoms. In all 11 cases, a fluid collection was present, 8 of them with gas presence. Nine patients underwent a percutaneous drainage whose cultures were negative. Ten patients recovered without treatment or with the intake of nonsteroidal anti-inflammatory drugs within 1 week, but one patient developed a secondary infection with gram-positive bacteria after percutaneous drainages that prolonged his hospital stay. Conclusion: Liver splitting using saline-cooled radiofrequency coagulation may cause postoperative symptoms that may mimic surgical site infection. Surgeons employing this device should keep this in mind to avoid potentially unwarranted treatments that may be unnecessary, expensive, and even harmful.
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