Use of a collagen-sealing device in hepatic resection: A comparative analysis to standard resection technique

Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario and University of Toronto, Toronto, Ontario, Canada.
HPB (Impact Factor: 2.68). 02/2006; 8(3):194-9. DOI: 10.1080/13651820600593087
Source: PubMed


Blood transfusion has been reported as an independent risk factor for poor outcome after liver resection in spite of its well known benefits. Refinements in parenchymal dissection have been pursued to reduce blood loss and transfusion. A collagen-sealing device (CSD) has recently been touted as an alternative technique that aids in blood conservation. We report the results of our initial series of patients undergoing a CSD-assisted resection and present a historical comparison.
Consecutive patients who were undergoing liver resection at a single tertiary cancer centre were enrolled in this study. The Ligasure Atlas device (Valleylab Inc., Division of Tyco Healthcare) was used for parenchymal division in the CSD group. Known blood conservation techniques (i.e. low central venous pressure, ultrasonic dissection, Pringle clamp) were standardized in both groups. Clinical and outcome variables including operative time, estimated blood loss and transfusion requirements were collected. All statistical analyses were performed with SAS version 8.2e.
In all, 28 consecutive patients underwent CSD-assisted hepatic resection between October 2003 and September 2004. The control group included 188 patients treated between January 1991 and September 2003. In the CSD group, we observed a reduction in mean estimated blood loss (930 vs 1450 ml, p=0.002) and mean transfusion requirements (0.46 vs 1.19 units, p=0.002). There was no increase in operative time with the new instrument (326 vs 363 min, p=0.167).
Use of a CSD has the potential to further reduce blood loss and transfusion requirements without increasing operative time.

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    • "It has been available since October 2007 and is designed for open procedures. It has been used for dissection in surgery of the liver, gallbladder, thyroid and breast [13-18]. It has been used in other lymphatic dissections in an attempt to reduce lymphatically related complications and has been shown to reduce operative times and reduce lymphatic spillage with similar rates of lymph node harvest for both modified lateral neck dissections and central neck dissections in thyroid cancer[16,17]. "
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