Feasibility of Microwave-Based Scissors and Tweezers in Partial Hepatectomy: An Initial Assessment on Canine Model

Purpose: This study aimed to assess the feasibility of partial hepatectomy (PH) simplified by using microwave-based devices in animal experiments.

Methods: PH was performed on 16 beagles using either Acrosurg Scissors (AS) or Acrosurg Tweezers (AT) without hepatic pedicle (HP) control. Parenchymal transection time, Glissonean pedicle (GP) seal time, bleeding volume, bile leak, and burst pressure were recorded. Probable complications were investigated after 4 weeks.

Results: Transection time (6.5 [6.0–7.6] vs. 11.8 [10.5–20.2] min, p < 0.001) with AT were significantly shorter than with AS. GP sealing times (60 [55–60] vs. 57 [46–91] s, p = 0.859) by both devices were nearly similar. Bleeding volume in the AT group was approximately one-fourth of that in the AS group (6.7 [1.4–22] vs. 28.8 [5.8–48] mL, p = 0.247). AT created higher burst pressure on the bile duct stumps (p = 0.0161). The two devices did not differ significantly in morbidity and mortality after four-week follow-up.

Conclusion: Acrosurg devices achieved a safe PH without HP control owing to microwave-based sealing. AS could be used alone in PH, whereas the clamp-crushing function of AT seemed more advantageous in reducing the transection time and blood loss.

Gas jet transection of liver parenchima: experimental research

BACKGROUND

There exists a great variety of liver parenchyma transection techniques. The objective of this research is to develop a new method of liver transection, and to compare it with the traditional ones.

METHODS

An original gas jet transection method of biological tissues and the apparatus "Pneumojet" to make the method practicable were developed in our institute. Comparison between the efficiency of gas jet, water jet, ultrasonic methods of liver transection and clamp crushing technique were carried out on 24 mini-pigs. Pringle maneuver was not included.

RESULTS

The mean blood loss was the smallest in the group of animals that had a gas jet transection (3.5±0.15 mL/cm(2)) but the highest in the clamp crushing technique group (5.5±0.46 mL/cm(2)). Indicators significantly showed the statistical difference (P<0.001). The transection speed was the highest in the Clamp crushing technique group (2.9±0.25 cm(2)/min) and was credibly higher than in the gas jet (2.4±0.16 cm(2)/min), ultrasonic (2.4±0.13 cm(2)/min) and water jet (2.5±0.14 cm(2)/min) transection groups. Compared with the water jet and ultrasonic methods of liver transection, the original method does not have statistically significant distinctions on the basic indexes of work.

CONCLUSIONS

The research conducted proves high efficiency and safety of the gas jet transection method. The gas jet transection, therefore, could be recommended for further improvement and clinical application.

Open hepatic parenchymal transection using ultrasonic dissection and bipolar coagulation

Liver transection is the most challenging part of liver resection due to the risk of massive blood loss which is associated with increased postoperative morbidity and mortality, as well as reduced long-term survival after resection of malignancies. Among the devices used for open parenchyma transection, ultrasonic dissection with bipolar cautery forceps is one of the most widely used technique worldwide. We identified four retrospective comparative studies and three randomized controlled trials dealing with the efficacy of ultrasonic dissector (UD) compared with other techniques including the historical clamp crushing technique. UD is associated with similar blood loss and slower resection time compared with water-jet or clamp crushing technique. However, it seems to be more precise in dissecting vessels. Its use does not impact on morbidity and hospital stay compared with other techniques. From an economic point of view, UD is the most expensive technique and may be a disadvantage for low centre volume. UD with bipolar cautery is one of the safest and the most efficient device for liver transection, even if its superiority over the clamp crushing technique has not been well established. It is considered as a standard technique for liver transection.