Abstract |
Hepatic resection presents unique surgical challenges to reduce blood loss during parenchymal division. The development of saline-coupled bipolar devices, in which hemostasis is achieved at lower temperatures than electrocautery or other bipolar sealing devices, have been employed for open hepatic resection. Saline-coupled bipolar devices have now become available for minimally invasive use. The goals of this study were to evaluate the feasibility and safety of a laparoscopic saline-coupled bipolar device for minimally invasive hepatectomy. Seventeen patients (median age 66 years, range 36-81) were consented for inclusion and enrolled. Patient demographics, intraoperative data, and surgeon feedback were collected. Seven robot-assisted partial hepatectomies, 9 laparoscopic partial hepatectomies, and 1 laparoscopic cholecystectomy with liver abscess resection were performed. Average operating time was 222 ± 33 minutes (median 188 minutes; range 61-564 minutes) with no difference between robotic versus laparoscopic time. Successful seals were achieved in all cases following application of 150 to 200 J energy (average 179 ± 3 J, average time to achieve a successful seal 9.3 ± 2.7 minutes). Estimated blood loss was 362 ± 74 mL (median 300 mL, range 5-1200 mL) and 3/17 patients received intraoperative blood transfusion. No bile leaks were detected in any of the patients. Median length of stay was 5 days (range 1-20 days), and there were no readmissions within 30 days. Postoperative morbidity occurred in 5/17 patients, all of which were Clavien Grade 1. There was no mortality within 90 days or complications requiring a return to the operating room, and there were no liver-specific morbidities. These data suggest the laparoscopic Aquamantys device represents a useful device for use in minimally invasive liver resection.
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Authors | Amit Sastry, Jesse K Sulzer, Michael Passeri, Erin H Baker, Dionisios Vrochides, Iain H McKillop, David A Iannitti, John B Martinie |
Journal | Surgical innovation
(Surg Innov)
Vol. 26
Issue 6
Pg. 668-674
(Dec 2019)
ISSN: 1553-3514 [Electronic] United States |
PMID | 31215345
(Publication Type: Journal Article)
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Equipment Design
- Female
- Hepatectomy
(adverse effects, instrumentation, methods)
- Humans
- Laparoscopy
(adverse effects, methods)
- Liver Diseases
(surgery)
- Male
- Middle Aged
- Operative Time
- Postoperative Complications
- Robotic Surgical Procedures
(adverse effects, methods)
- Treatment Outcome
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