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Hamada T, Nanashima A, Yano K, Sumida Y, Hiyoshi M, Imamura N, Tobinaga S, Tsuchimochi Y, Takeno S, Fujii Y, Nagayasu T. Significance of a soft-coagulation system with monopolar electrode for hepatectomy: A retrospective two-institution study by propensity analysis. Int J Surg 2017; 45:149-155. [PMID: 28774659 DOI: 10.1016/j.ijsu.2017.07.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The VIO soft-coagulation system (VIO) with a monopolar electrode is a novel hemostatic device that provides hemostasis by superficial contact at the bleeding site without carbonization. Because heat injury remains a concern, surgical records and postoperative liver dysfunction were retrospectively evaluated in a cohort study. METHODS Between September 2010 and March 2016, 322 patients underwent hepatectomy in which hemostatic devices were used at two institutions. Surgical results with use of VIO at one institute (VIO group) were compared with those without use of VIO at a second institute (control group), and propensity analysis was performed. RESULTS In limited resection and segmentectomy or sectionectomy performed in the VIO group, the prevalence of liver cirrhosis was significantly higher and the operation time was significantly longer in comparison with the control group (p < 0.05). In all hepatectomies, postoperative levels of total bilirubin and aspartate or alanine transaminase tended to be increased and prothrombin activity tended to be lower in the VIO group in comparison with the control group (p < 0.05). The prevalence of hepatic failure in the VIO group was significantly higher in comparison with that in the control group (p < 0.05). In cases of segmentectomy or sectionectomy, blood loss was significantly increased in the VIO group in comparison with that in the control group (p < 0.05) Propensity score matching showed that although the surgical records and outcomes were not significantly different between the groups, postoperative liver dysfunction was significant in the VIO group in comparison with the control group (p < 0.05). CONCLUSIONS Mild postoperative hepatic thermal injury with VIO was confirmed, and therefore, surgeons should take care when using the VIO system to make frequent wide resected cuts on the surface of the liver.
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Affiliation(s)
- Takeomi Hamada
- Division of Hepato-biliary-pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Atsushi Nanashima
- Division of Hepato-biliary-pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan; Division of Gastrointestinal, Endocrine and Pediatric Surgery, Department of Surgery, University of Miyazaki, Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan; Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Koichi Yano
- Division of Hepato-biliary-pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Yorihisa Sumida
- Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Masahide Hiyoshi
- Division of Hepato-biliary-pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Naoya Imamura
- Division of Hepato-biliary-pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Shuichi Tobinaga
- Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Yuki Tsuchimochi
- Division of Hepato-biliary-pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Shinsuke Takeno
- Division of Gastrointestinal, Endocrine and Pediatric Surgery, Department of Surgery, University of Miyazaki, Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Yoshiro Fujii
- Division of Hepato-biliary-pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
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Nanashima A, Abo T, Arai J, Takagi K, Matsumoto H, Takeshita H, Tsuchiya T, Nagayasu T. Usefulness of vessel-sealing devices combined with crush clamping method for hepatectomy: a retrospective cohort study. Int J Surg 2013; 11:891-7. [PMID: 23954369 DOI: 10.1016/j.ijsu.2013.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 07/10/2013] [Accepted: 07/26/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Blood loss during resection of the hepatic parenchyma in hepatectomy can be minimized using vessel-sealing (VS) devices. Some sealing devices were retrospectively compared to evaluate the efficacy of each device for controlling blood loss, transection time and postoperative complications in hepatectomy as a cohort study. METHODS Between 2005 and September 2012, hepatectomy was underwent in 150 patients using one of three types of LigaSure™ (Dolphin Tip Laparoscopic Instrument, Precise or Small Jaw) or the Harmonic Focus or Ace ultrasonic dissecting sealer. Results were compared to crush-clamping alone as the control method by the historical study (n = 81). RESULTS Irrespective of the vessel-sealing device used for underlying chronic hepatitis, blood loss, blood transfusion rate, operating time and transection time were significantly reduced in the VS group compared with controls (p < 0.05). Rates of postoperative bile leakage and intra-abdominal abscess formation were significantly lower in the VS group than in controls (p < 0.05). Comparing devices, LigaSure Small Jaw and Harmonic Focus showed lower blood loss, shorter transection time and reduced rates of post-hepatectomy complications, in turn resulting in shorter hospital stays (p < 0.05). Tendencies toward uncontrolled ascites and bile leakage were only concern with the use of Harmonic Focus. Satisfactory surgical results were achieved using the sealing device for laparoscopic hepatectomy. CONCLUSIONS The use of energy sealing devices improves surgical results and avoids hepatectomy-related complications. Adequate use of vessel sealers is necessary for safe and rapid completion of hepatic resection.
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Affiliation(s)
- Atsushi Nanashima
- Division of Surgical Oncology and Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan.
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