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: Nomenclature describing liver anatomy and liver resection has been standardized with the Brisbane 2000 terminology. When performing liver resection, blood loss should be minimized by using low central venous pressure (CVP) anesthesia and vascular occlusion as appropriate. There are many options for transection of the liver parenchyma, and although no technique has been shown to be superior to clamp-crushing, hepatic surgeons should be familiar with the techniques available.
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