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Chedid MF, Brum PW, Grezzana-Filho TDJM, Silva RKD, Pereira PF, Chedid AD, Kruel CRP. PARTIAL HEPATECTOMY USING LINEAR CUTTER STAPLER: ARE THERE ADVANTAGES? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1775. [PMID: 38088722 PMCID: PMC10712918 DOI: 10.1590/0102-672020230057e1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/18/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Morbidity of liver resections is related to intraoperative bleeding and postoperative biliary fistulas. The Endo-GIA stapler (EG) in liver resections is well established, but its cost is high, limiting its use. The linear cutting stapler (LCS) is a lower cost device. AIMS To report open liver resections, using LCS for transection of the liver parenchyma and en bloc stapling of vessels and bile ducts. METHODS Ten patients were included in the study. Four patients with severe abdominal pain had benign liver tumors (three adenomas and one focal nodular hyperplasia). Among the remaining six patients, four underwent liver resection for the treatment of colorectal liver metastases, three of which had undergone preoperative chemotherapy. The other two cases were one patient with metastasis from a testicular teratoma and the other with metastasis from a gastrointestinal neuroectodermal tumor. RESULTS The average length of stay was five days (range 4-7 days). Of the seven patients who underwent resections of segments II/III, two presented postoperative complications: one developed a seroma and the other a collection of abdominal fluid who underwent percutaneous drainage, antibiotic therapy, and blood transfusion. Furthermore, the three patients who underwent major resections had postoperative complications: two developed anemia and received blood transfusions and one had biloma and underwent percutaneous drainage and antibiotic therapy. CONCLUSIONS The use of the linear stapler in hepatectomies was efficient and at lower costs, making it suitable for use whenever EG is not available. The size of the LCS stapler shaft is more suitable for en bloc transection of the left lateral segment of the liver, which is thinner than the right one. Further studies are needed to evaluate the safety of LCS for large liver resections and resections of tumors located in the right hepatic lobe.
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Affiliation(s)
- Marcio Fernandes Chedid
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
| | - Pietro Waltrick Brum
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
| | - Tomaz de Jesus Maria Grezzana-Filho
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
| | - Rafaela Kathrine da Silva
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
| | - Pedro Funari Pereira
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
| | - Aljamir Duarte Chedid
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
| | - Cleber Rosito Pinto Kruel
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
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Raoof M, Aloia TA, Vauthey JN, Curley SA. Morbidity and mortality in 1,174 patients undergoing hepatic parenchymal transection using a stapler device. Ann Surg Oncol 2014; 21:995-1001. [PMID: 24248530 DOI: 10.1245/s10434-013-3331-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Transection of liver parenchyma using staplers is now commonly performed. Large studies are needed to assess the usefulness of the technique as well as perioperative outcomes. METHODS This is a retrospective study of a prospectively maintained database. A total of 1,174 patients undergoing liver resections in routine surgical practice, using a stapler device at MD Anderson Cancer Center between January 1, 1994 and November 10, 2011 were evaluated. RESULTS There were 900 major resections (3 segments or more) (77 %) and 274 minor resections (<3 segments or wedge resections) (23 %). A vast majority, 1,133 (96.5 %), were indicated for an underlying malignancy (24 % primary liver or gall bladder and 72.5 % metastatic) compared with benign disease, 41 (3.5 %), with the most common indication being metastatic colorectal cancer 584 (49.7 %). Of the total 1,174 patients 128 (10.9 %) had a prior liver resection. Median OR time and blood loss was 206 min and 300 mL, respectively, with 11 % of patients requiring transfusion in the perioperative or postoperative period. Overall morbidity and mortality rate was 14 and 3.2 %, respectively, with a median hospital stay of 7 days (interquartile range [IQR], 4 days). Multivariate logistic regression demonstrated blood loss and extent of liver resection to be independent predictors of adverse outcome. A total of 13 instances (1.1 %) of misfired staplers were noted and were associated with higher blood loss (p < 0.001) and mortality (15 vs. 3.1 %, p = 0.013). CONCLUSIONS Use of stapler device for hepatic resection is safe and effective, but rare instances of a misfired stapler device are associated with an adverse outcome.
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Affiliation(s)
- Mustafa Raoof
- Department of Surgery, University of Arizona Health Science Center, Tucson, AZ, USA
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Buell JF, Gayet B, Han HS, Wakabayashi G, Kim KH, Belli G, Cannon R, Saggi B, Keneko H, Koffron A, Brock G, Dagher I. Evaluation of stapler hepatectomy during a laparoscopic liver resection. HPB (Oxford) 2013; 15:845-50. [PMID: 23458439 PMCID: PMC4503281 DOI: 10.1111/hpb.12043] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 11/28/2012] [Indexed: 12/12/2022]
Abstract
METHODS An international database of 1499 laparoscopic liver resections was analysed using multivariate and Kaplan-Meier analysis. RESULTS In total, 764 stapler hepatectomies (SH) were compared with 735 electrosurgical resections (ER). SH was employed in larger tumours (4.5 versus 3.8 cm; P < 0.003) with decreased operative times (2.6 versus 3.1 h; P < 0.001), blood loss (100 versus 200 cc; P < 0.001) and length of stay (3.0 versus 7.0 days; P < 0.001). SH incurred a trend towards higher complications (16% versus 13%; P = 0.057) including bile leaks (26/764, 3.4% versus 16/735, 2.2%: P = 0.091). To address group homogeneity, a subset analysis of lobar resections confirmed the benefits of SH. Kaplan-Meier analysis in non-cirrhotic and cirrhotic patients confirmed equivalent patient (P = 0.290 and 0.118) and disease-free survival (P = 0.120 and 0.268). Multivariate analysis confirmed the parenchymal transection technique did not increase the risk of cancer recurrence, whereas tumour size, the presence of cirrhosis and concomitant operations did. CONCLUSIONS A SH provides several advantages including: diminished blood loss, transfusion requirements and shorter operative times. In spite of the smaller surgical margins in the SH group, equivalent recurrence and survival rates were observed when matched for parenchyma and extent of resection.
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Affiliation(s)
- Joseph F Buell
- Tulane Transplant Institute, Tulane UniversityNew Orleans, LA, USA
| | - Brice Gayet
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris DescartesParis, France
| | - Ho-Seong Han
- Department of Surgery, Seoul National University, Bundang HospitalSeoul, South Korea
| | - Go Wakabayashi
- Department of Surgery, Iwate Medical UniversityMorioka City, Japan
| | - Ki-Hun Kim
- Department of Surgery, Ulsan University and Asan Medical CenterSeoul, South Korea
| | - Giulio Belli
- Department of Surgery, Loreto Nuovo HospitalNaples, Italy
| | - Robert Cannon
- Department of Surgery, School of Public Health and Information Sciences, University of LouisvilleLouisville, KY, USA
| | - Bob Saggi
- Tulane Transplant Institute, Tulane UniversityNew Orleans, LA, USA
| | - Hiro Keneko
- Department of Surgery, Toho University School of MedicineTokyo, Japan
| | - Alan Koffron
- Division of Transplantation, William Beaumont HospitalDetroit, MI, USA
| | - Guy Brock
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of LouisvilleLouisville, KY, USA
| | - Ibrahim Dagher
- Department of General Surgery, Antoine Beclere Hospital, Paris-Sud School of MedicineClamart, France
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D'Amico FE, Allen PJ, Eaton AA, DeMatteo RP, Fong Y, Kingham TP, Blumgart LH, Jarnagin WR, D'Angelica MI. Vascular inflow control during hemi-hepatectomy: a comparison between intrahepatic pedicle ligation and extrahepatic vascular ligation. HPB (Oxford) 2013; 15:449-56. [PMID: 23659568 PMCID: PMC3664049 DOI: 10.1111/j.1477-2574.2012.00618.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 10/05/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intrahepatic pedicle ligation (IPL) is an alternative to extrahepatic portal dissection (EPD). Although IPL has been well described, concern has arisen over a possible association with increased complication rates. METHODS Patients who underwent hemi-hepatectomy during January 1995 to December 2010 were reviewed and the inflow control technique (IPL versus EPD) documented. Patient, tumour, treatment and outcome variables were compared. RESULTS A total of 798 patients underwent hemi-hepatectomy, 568 (71.2%) of the right and 230 (28.8%) of the left liver. In univariate analysis, factors associated with the choice of IPL included surgeon, right hepatectomy, preoperative portal vein embolization, diagnosis of colorectal cancer liver metastasis, and smaller tumour size (P < 0.011). In multivariate analysis, right hepatectomy [versus left: hazard ratio (HR) 3.878, 95% confidence interval (CI) 1.15-13.14; P = 0.029] and smaller tumour size (median of 4.5 cm versus 5.5 cm: HR 0.72, 95% CI 0.59-0.88; P = 0.002) were associated with IPL. Pringle manoeuvre time was longer in IPL procedures (40 min versus 29 min; P < 0.001). Complication rates (49.8% in IPL versus 48.4% in EPD; P = 0.706) were similar in both groups, as was the severity of complications; 17.6% of EPD and 22.3% of IPL patients experienced complications of grade ≥3 (P = 0.225). CONCLUSIONS Patients with small tumours undergoing right hepatectomy were more likely to undergo IPL. In selected patients, IPL was not associated with an increased complication rate and thus it should be considered a safe approach.
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Affiliation(s)
| | - Peter J Allen
- Department of Surgery, Hepatopancreatobiliary DivisionNew York, NY, USA
| | - Anne A Eaton
- Department of Epidemiology and Biostatistics, Memorial Sloan–Kettering Cancer CenterNew York, NY, USA
| | - Ronald P DeMatteo
- Department of Surgery, Hepatopancreatobiliary DivisionNew York, NY, USA
| | - Yuman Fong
- Department of Surgery, Hepatopancreatobiliary DivisionNew York, NY, USA
| | - T Peter Kingham
- Department of Surgery, Hepatopancreatobiliary DivisionNew York, NY, USA
| | - Leslie H Blumgart
- Department of Surgery, Hepatopancreatobiliary DivisionNew York, NY, USA
| | | | - Michael I D'Angelica
- Department of Surgery, Hepatopancreatobiliary DivisionNew York, NY, USA,Correspondence Michael I. D'Angelica, Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan–Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. Tel: + 1 212 639 3226. Fax: + 1 212 717 3218. E-mail:
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Wang X, Li J, Wang H, Luo Y, Ji W, Duan W, Zhang X, Guo S, Xu K, Dong J, Zheng S. Validation of the Laparoscopically Stapled Approach as a Standard Technique for Left Lateral Segment Liver Resection. World J Surg 2013; 37:806-11. [DOI: 10.1007/s00268-013-1912-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Savlid M, Strand AH, Jansson A, Agustsson T, Söderdahl G, Lundell L, Isaksson B. Transection of the Liver Parenchyma With an Ultrasound Dissector or a Stapler Device: Results of a Randomized Clinical Study. World J Surg 2012; 37:799-805. [DOI: 10.1007/s00268-012-1884-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rahbari NN, Elbers H, Koch M, Bruckner T, Vogler P, Striebel F, Schemmer P, Mehrabi A, Büchler MW, Weitz J. Clamp-crushing versus stapler hepatectomy for transection of the parenchyma in elective hepatic resection (CRUNSH)--a randomized controlled trial (NCT01049607). BMC Surg 2011; 11:22. [PMID: 21888669 PMCID: PMC3177759 DOI: 10.1186/1471-2482-11-22] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 09/04/2011] [Indexed: 01/05/2023] Open
Abstract
Background Hepatic resection is still associated with significant morbidity. Although the period of parenchymal transection presents a crucial step during the operation, uncertainty persists regarding the optimal technique of transection. It was the aim of the present randomized controlled trial to evaluate the efficacy and safety of hepatic resection using the technique of stapler hepatectomy compared to the simple clamp-crushing technique. Methods/Design The CRUNSH Trial is a prospective randomized controlled single-center trial with a two-group parallel design. Patients scheduled for elective hepatic resection without extrahepatic resection at the Department of General-, Visceral- and Transplantation Surgery, University of Heidelberg are enrolled into the trial and randomized intraoperatively to hepatic resection by the clamp-crushing technique and stapler hepatectomy, respectively. The primary endpoint is total intraoperative blood loss. A set of general and surgical variables are documented as secondary endpoints. Patients and outcome-assessors are blinded for the treatment intervention. Discussion The CRUNSH Trial is the first randomized controlled trial to evaluate efficacy and safety of stapler hepatectomy compared to the clamp-crushing technique for parenchymal transection during elective hepatic resection. Trial Registration ClinicalTrials.gov: NCT01049607
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Affiliation(s)
- Nuh N Rahbari
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Germany
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Santo MA, Takeda FR, Sallum RAA. Staplers in digestive surgery: technological advancement in surgeons' own hands. ARQUIVOS DE GASTROENTEROLOGIA 2011; 48:1-2. [PMID: 21537533 DOI: 10.1590/s0004-28032011000100001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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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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Affiliation(s)
- Scott A Celinski
- Division of Surgical Oncology, Baylor University Hospital, Dallas, TX, USA
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Delis SG, Bakoyiannis A, Karakaxas D, Athanassiou K, Tassopoulos N, Manesis E, ketikoglou I, Papakostas P, Dervenis C. Hepatic parenchyma resection using stapling devices: peri-operative and long-term outcome. HPB (Oxford) 2009; 11:38-44. [PMID: 19590622 PMCID: PMC2697859 DOI: 10.1111/j.1477-2574.2008.00003.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 08/30/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND Stapler-assisted hepatectomy has not been well established, as a routine procedure, although few reports exist in the literature. This analysis assesses the safety and outcome of the method based on peri-operative data. MATERIALS AND METHODS From February 2005 to December 2006, endo GIA vascular staplers were used for parenchymal liver transection in 62 consecutive cases in our department. There were 18 (29%) patients with hepatocellular carcinoma (HCC), 31 (50%) with metastatic lesions and 13 (21%) with benign lesions [adenoma, focal nodular hyperplasia (FNH), simple cysts]. Twenty-one patients underwent major resections (33.9%) (i.e. removal of three segments or more) and 41 (66.1%) minor hepatic resections. RESULTS Median blood loss was 260 ml. The median total operative time was 150 min and median transection time was 35 min. No patient required more than 2 days of intensive care unit (ICU) treatment. The median hospital stay was 8 days. Surgical complications included two (3%) cases of bile leak, two (3%) cases of pneumonia, two (3%) cases with wound infection and two (3%) cases with pleural effusion. The peri-operative mortality was zero. In a 30-month median follow-up, all patients with benign lesions were alive and free of disease. The 3-year disease-free survival for patients with HCC was 61% (57% for patients with colorectal metastases) and the 3-year survival 72% (68% for patients with colorectal metastases). CONCLUSION Stapler-assisted liver resection is feasible with a low incidence of surgical complications. It can be used as an alternative for parenchyma transection especially in demanding hepatectomies for elimination of the operating time and control of bleeding.
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Affiliation(s)
- Spiros G Delis
- Liver Surgical Unit, 1st Department of Surgery, Kostantopouleio-‘Agia Olga’ HospitalAthens, Greece
| | - Andreas Bakoyiannis
- Liver Surgical Unit, 1st Department of Surgery, Kostantopouleio-‘Agia Olga’ HospitalAthens, Greece
| | - Dimitrios Karakaxas
- Liver Surgical Unit, 1st Department of Surgery, Kostantopouleio-‘Agia Olga’ HospitalAthens, Greece
| | - Kostantinos Athanassiou
- Liver Surgical Unit, 1st Department of Surgery, Kostantopouleio-‘Agia Olga’ HospitalAthens, Greece
| | | | | | | | | | - Christos Dervenis
- Liver Surgical Unit, 1st Department of Surgery, Kostantopouleio-‘Agia Olga’ HospitalAthens, Greece
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Balaa FK, Gamblin TC, Tsung A, Marsh JW, Geller DA. Right hepatic lobectomy using the staple technique in 101 patients. J Gastrointest Surg 2008; 12:338-43. [PMID: 17701266 DOI: 10.1007/s11605-007-0236-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Accepted: 06/30/2007] [Indexed: 01/31/2023]
Abstract
BACKGROUND Application of linear stapling devices for extrahepatic vascular control in liver surgery has been well-established. However, the technique for use of stapling devices in hepatic parenchymal transection is not well defined. PURPOSE To describe the safety and efficacy of our technique for use of vascular stapling devices in hepatic parenchymal transection during open right hepatic lobectomy is the purpose of this study. METHODOLOGY We reviewed our experience with 101 consecutive open right hepatic lobectomies performed by a single surgeon between January 2003 and July 2006, in which vascular staplers were utilized for the parenchymal transection phase. RESULTS Of the 101 patients who underwent resection, 53 (52%) were female. The mean age was 58 years. Malignant disease was the indication for resection in the majority of patients (88%). Of those with cancer, 78% (69 of 89) had metastatic colorectal cancer, 6% (5 of 89) had metastatic neuroendocrine tumor, 4% (4 of 89) had hepatocellular carcinoma, 4% (4 of 89) had cholangiocarcinoma, and the remaining 8% were other metastatic cancers. Twelve patients (12%) underwent resection for hepatic adenoma or symptomatic benign disease (FNH or hemangioma). Forty-eight patients (48%) underwent a major ancillary procedure at the time of hepatic resection. Thirty-nine patients (39%) had a nonanatomic wedge resection of a left lobe lesion, 27 patients (27%) had one or more lesions treated with radiofrequency ablation (RFA), and 6 patients (6%) were treated with a synchronous bowel resection. The median total operative time was 336 min (range 155-620 min). A Pringle maneuver for temporary vascular inflow occlusion was utilized in all cases, with a median time of 9 min (range 4-17 min). Ten patients (10%) required blood transfusion during surgery or in the postoperative period. The maximum transfusion was 2 U of packed red blood cells (PRBC) in seven patients and 1 U of PRBC in three patients. The mean nadir postoperative hematocrit was 28.2. All patients with malignant disease had tumor-free margins at the completion of the procedure. The average hospital length of stay was 6.0 days. One patient (1%) developed a clinically significant bile leak requiring a postoperative endoscopic retrograde cholangiography (ERCP). No patient required reoperation. The 30 and 60-day postoperative survival was 100%. CONCLUSION These findings indicate that application of vascular stapling devices for parenchymal transection in major hepatic resection is a safe technique, with low transfusion requirements and minimal postoperative bile leak. The technique allows for rapid transection of the entire right hepatic lobe in under 10 min. Short video clips of the technique will be demonstrated.
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Affiliation(s)
- Fady K Balaa
- UPMC Liver Cancer Center, Thomas E Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA
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13
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Balaa FK, Gamblin TC, Heckman JT, Geller DA. Right Hemihepatectomy for Metastatic Cloacogenic Carcinoma using the Staple Technique. Ann Surg Oncol 2008. [DOI: 10.1245/s10434-007-9642-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Eguchi S, Kawashita Y, Takatsuki M, Kanematsu T. Application of endovascular stapler in living-donor liver transplantation. Am J Surg 2007; 193:258-9. [PMID: 17236858 DOI: 10.1016/j.amjsurg.2006.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2006] [Revised: 04/21/2006] [Accepted: 04/21/2006] [Indexed: 11/24/2022]
Abstract
We used an endovascular stapler in recipients of living-donor liver transplantation (LDLT). Hepatic veins were transected in 10 recent LDLTs (6 right-lobe and 4 left-lobe grafts), and the portocaval shunt was transected in 5 of these 10 LDLTs. Median operative time with the vascular stapler was 861 minutes (range 675 to 932), whereas the median time to liver explantation was 292 minutes (range 200 to 461) (both with P < or = .05 vs vascular stapler use). To our knowledge, this is the first report on the use of an endovascular stapler device in LDLT.
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Affiliation(s)
- Susumu Eguchi
- Department of Transplantation and Digestive Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, 852-8501, Japan.
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Schemmer P, Friess H, Hinz U, Mehrabi A, Kraus TW, Z'graggen K, Schmidt J, Uhl W, Büchler MW. Stapler Hepatectomy is a Safe Dissection Technique: Analysis of 300 Patients. World J Surg 2006; 30:419-30. [PMID: 16467982 DOI: 10.1007/s00268-005-0192-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In many surgical procedures, stapling devices have been introduced for safety and to reduce the overall operative time. Their use for transection of hepatic parenchyma is not well established. Thus, the feasibility of stapler hepatectomy and a risk analysis of surgical morbidity based on intraoperative data have been prospectively assessed on a routine clinical basis. MATERIALS AND METHODS From October 1, 2001, to January 31, 2005, a total of 416 patients underwent liver resection in our department. During this period endo GIA vascular staplers were used for parenchymal transection in 300 cases of primary (22%) and metastatic (57%) liver cancer, benign diseases (adenoma, focal nodular hyperplasia [FNH], cysts) (14%), gallbladder carcinoma (2%), and other tumors (5%). There were 193 (64%) major resections (i.e., removal of three segments or more) and 107 minor hepatic resections. Additional extrahepatic resections were performed in 44 (15%) patients. RESULTS Median values for operative time and intraoperative hemorrhage were 210 minutes and 700 ml, respectively. Further, transfusion of RBC and FFP was needed in 17% and 11% of patients, respectively. A postoperative ICU stay for >2 days was required in 18% of patients. The median postoperative hospital stay was 10 days (IQR 8-14 days). The most frequent surgical complications were bile leak (8%), wound infection (3%), and pneumothorax (2%). In 7% of cases after stapler hepatectomy a relaparotomy was necessary. Treated medical complications were pleural effusion (7%), renal insufficiency (5%), and cardiac insufficiency (3%). Risk assessment revealed that both operative time and indication for resection had significant impact on surgical morbidity. Mortality (4%) and morbidity (33%) were comparable to other high-volume centers performing conventional liver resection techniques. CONCLUSION In conclusion, stapler hepatectomy can be used in a routine clinical setting with a low incidence of surgical complications.
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Affiliation(s)
- Peter Schemmer
- Department of General Surgery, Ruprecht-Karls-University, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany
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Machado MAC, Herman P, Amico EC, Makdissi FF, Bacchella T, Machado MCC. [Use of vascular stapling device in liver resections]. ARQUIVOS DE GASTROENTEROLOGIA 2005; 42:107-10. [PMID: 16127566 DOI: 10.1590/s0004-28032005000200008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Among several liver resection techniques, the use of stapler in the portal pedicles is an interesting option. AIM To describe the technique of liver resection using a vascular stapling device. PATIENTS AND METHODS A total of eight patients underwent hepatic resections with stapling techniques. The authors have used intrahepatic approach glissonian pedicles with the application of a vascular stapler device in all cases. Liver parenchyma and hepatic veins were transected as usual. RESULTS There were no deaths. No complications directly attributable to stapler ligations of portal pedicles were observed. CONCLUSION Stapling techniques can be helpful in hepatic resection procedures. The vascular stapler may significantly reduce glissonian pedicle section time.
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Dixon E, Vollmer CM, Bathe OF, Sutherland F. Vascular occlusion to decrease blood loss during hepatic resection. Am J Surg 2005; 190:75-86. [PMID: 15972177 DOI: 10.1016/j.amjsurg.2004.10.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2004] [Revised: 10/05/2004] [Accepted: 10/05/2004] [Indexed: 02/06/2023]
Abstract
BACKGROUND Historically, the primary hazard with liver surgery has been intraoperative blood loss. This led to the refinement of inflow and outflow occlusive techniques. The utility of the different methods of inflow and outflow techniques for hepatic surgery were reviewed. METHODS A search of the English literature (Medline, Embase, Cochrane library, Cochrane clinical trials registry, hand searches, and bibliographic reviews) using the terms "liver," "hepatic," "Pringle," "total vascular exclusion," "ischemia," "reperfusion," "inflow," and "outflow occlusion" was performed. RESULTS A multitude of techniques to minimize blood loss during hepatic resection have been studied. The evidence suggests that inflow occlusion techniques are generally well tolerated. These should be used with caution in patients with cirrhosis, fibrosis, steatosis, cholestasis, and recent chemotherapy, and for prolonged time intervals. CONCLUSIONS Harmful effects of intraoperative blood loss and transfusion occur during hepatic resection. Portal triad clamping (PTC) is associated with less blood loss compared with no clamping. In procedures with ischemic times <1 hour in length, PTC-C (continuous) is likely equal to PTC-I (intermittent). In patients with chronic liver disease or undergoing lengthy operations, PTC-I is likely superior to PTC-C. PTC is superior to total vascular exclusion except in patients with tumors that are large and deep seated, hypervascular, and/or abutting the hepatic veins or vena cava and in patients with increased right-sided heart pressures.
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Affiliation(s)
- Elijah Dixon
- Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Kaneko H, Otsuka Y, Takagi S, Tsuchiya M, Tamura A, Shiba T. Hepatic resection using stapling devices. Am J Surg 2004; 187:280-4. [PMID: 14769320 DOI: 10.1016/j.amjsurg.2003.11.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2002] [Revised: 04/09/2003] [Indexed: 11/26/2022]
Abstract
BACKGROUND The progress and development of stapling devices has been remarkable. They have become indispensable for gastrointestinal diseases and are increasingly utilized in laparoscopic operations. Liver surgery applications for this technique are continuing to emerge, and in this study, we introduced the use of stapling devices to hepatic surgery. METHODS We examined the operative procedure and efficacy of hepatic resections using stapling devices as follows: transection of Glisson's pedicle and the hepatic vein using endolineal stapling devices in right and left lobectomies; bisegmentectomy II and III en masse using a stapling device; and application of endolineal stapling devices to vessel transections and dissections of the hepatic parenchyma in laparoscopic hepatectomies. RESULTS It was considered useful to tactfully apply stapling devices to vessel transections and dissections of the hepatic parenchyma in order to simplify the operative procedures of right or left lobectomies and lateral segmentectomies. Furthermore, the use of endoscopic stapling devices was an acceptable alternative to vessel transactions and dissections of the hepatic parenchyma in laparoscopic hepatectomies. CONCLUSIONS We believe that stapling devices will become utilized in liver surgery hereafter.
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Affiliation(s)
- Hironori Kaneko
- Second Department of Surgery, Toho University School of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo 143-0015, Japan.
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Abstract
Hepatic surgery has emerged over the last three decades and has proven to be a safe and effective treatment for primary and secondary malignancies, as well as for benign diseases of the liver. During the past 10 years, several major advances have been made in 1) surgical technique with the advent of portal pedicle ligation maneuvers and the implementation of mechanical staplers, 2) intraoperative management with the development of low central venous pressure anesthesia, and 3) surgical technology with the innovation of laparoscopy for staging of patients with cancer and performing minimally invasive liver resection. We present a summary of our experience with these advances.
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Affiliation(s)
- R P DeMatteo
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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20
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Affiliation(s)
- Y Fong
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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21
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Bellah JR. Surgical stapling of the spleen, pancreas, liver, and urogenital tract. Vet Clin North Am Small Anim Pract 1994; 24:375-94. [PMID: 8197676 DOI: 10.1016/s0195-5616(94)50158-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Stapling instrumentation designed primarily for specific gastrointestinal procedures and transection of vascular pedicles have been adapted for use in parenchymal organs of the abdomen and urogenital tract. This article reviews current veterinary clinical and experimental use of stapling instrumentation for splenic, pancreatic, hepatic, and urogenital surgery.
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Affiliation(s)
- J R Bellah
- Department of Small Animal Clinical Sciences, University of Florida, College of Veterinary Medicine, Gainesville
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Affiliation(s)
- A M Cohen
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
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