scholarly journals Use of linear radiofrequency device in liver resection

2010 ◽  
Vol 67 (11) ◽  
pp. 910-915 ◽  
Author(s):  
Miroslav Stojanovic ◽  
Milan Radojkovic ◽  
Goran Stanojevic
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Liver Parenchyma ◽  
High Price ◽  
Control Group ◽  
Liver Ischemia ◽  
Intraoperative Blood Loss ◽  
Liver Transection ◽  
Disposable Device ◽  
Parenchyma Transection

Background/Aim. Linear radiofrequency device (LRFD) is disposable tool designed for liver parenchyma transection using controlled radiofrequency to 'seal' blood vessels and bile ducts, making liver resection easier and safer compared to classical resectional techniques. The aim of this study was to determine real value of the LRFD compared to the standard 'keliclasia' technique. Methods. This prospective study analyzed the significant intraoperative parameters and postoperative results of the 200 patients who underwent surgery at the Surgery Clinic of Clinical Centre in Nis, between January 1, 2001, and January 1, 2009. The patients were divided into two groups: the control Keli group (144 patients) with the 'keliclasia' resection technique and the control RF group (with resection performed using LRFD - Tissue Link / Dissection Sealer (DS - 3.0) (56 patients). The following parameters were analyzed: duration of liver ischemia, liver parenchyma transection time, intraoperative blood loss, significant intraoperative and postoperative complication rate, duration of hospitalization and mortality. Results. LRFD was used in 56 liver resections. The average duration of liver ischemia in the RF group was shorter than in the Keli group (7 versus 22 minutes). Parenchymal liver transection was significantly slower in the RF group than in the Keli group (2.05 versus 4.34 cm2/minutes, respectively). There was less intraoperative bleeding using LRFD 'Keliclasia' tehniquethan in the control group (390 mL compared to 420 mL, respectively). After the use of LRFD two cases of biliary leak and 4 pleural effusions were registered. Conclusion. LRFD is simple device for safe liver transection with decreased need for liver ischemia and singificant reducing of the intraoperative blood loss. High price for disposable device and slow parenchyma transection are disadvantages of this device.

scholarly journals A Comparative Study of Intraoperative Fluid Management Using Stroke Volume Variation in Liver Resection

2018 ◽  
Vol 103 (3-4) ◽  
pp. 199-206
Author(s):  
K. Kitaguchi ◽  
N. Gotohda ◽  
H. Yamamoto ◽  
S. Takahashi ◽  
M. Konishi ◽  
...  
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Stroke Volume ◽  
Liver Surgery ◽  
Stroke Volume Variation ◽  
Fluid Management ◽  
Control Group ◽  
Fluid Restriction ◽  
Intraoperative Blood Loss ◽  
Liver Transection

Objective: The aim of this study is to examine whether intraoperative fluid management with stroke volume variation (SVV) can achieve safe intravenous fluid restriction and contribute to decreasing intraoperative blood loss in liver surgery. Background: In liver surgery, maintaining the central venous pressure (CVP) at a low level is effective in decreasing intraoperative blood loss. Recently, several studies have suggested that SVV obtained using the FloTrac system demonstrated a better fluid responsiveness than CVP. Methods: We enrolled 30 patients undergoing liver resection since May 2015 in this prospective observational study, and we set the SVV target during liver transection at 13%–20% (SVV group). Forty-three cases of liver resection that we performed between January 2014 and March 2015 without using CVP or SVV were used as the Control group. We compared the 2 groups by using intraoperative blood loss as the primary endpoint. Results: There was no significant difference in patient characteristics between the 2 groups. The mean SVV during liver transection in the SVV group was 15.6 ± 4.4%. The infusion volume until completion of liver transection in the Control group was 9.4 mL/kg/h, whereas that of the SVV group was 3.3 mL/kg/h, a significantly lower volume (P < 0.001). The median intraoperative blood loss was significantly decreased in the SVV group compared with the Control group (391 versus 1068 mL; P < 0.001). The intraoperative transfusion rate was also significantly decreased in the SVV group. Conclusion: We demonstrated that intraoperative management with SVV can achieve safe intravenous fluid restriction and is useful for decrease intraoperative blood loss in liver surgery.

scholarly journals Safety and effectiveness evaluation of a two-handed technique combining harmonic scalpel and laparoscopic Peng’s multifunction operative dissector in laparoscopic hemihepatectomy

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jingwei Cai ◽  
Guixing Jiang ◽  
Yuelong Liang ◽  
Yangyang Xie ◽  
Junhao Zheng ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Harmonic Scalpel ◽  
Peak Level ◽  
Bile Leakage ◽  
Liver Parenchyma ◽  
Control Group ◽  
Case Group ◽  
Intraoperative Blood Loss ◽  
And Control

Abstract Objectives This study was designed to evaluate the safety and effectiveness of a two-hand technique combining harmonic scalpel (HS) and laparoscopic Peng’s multifunction operative dissector (LPMOD) in patients who underwent laparoscopic hemihepatectomy (LHH). Methods We designed and conducted a case-control study nested in a prospectively collected laparoscopic liver surgery database. Patients who underwent LHH for liver parenchyma transection using HS + LPMOD were defined as cases (n = 98) and LPMOD only as controls (n = 47) from January 2016 to May 2018. Propensity score matching (1:1) between the case and control groups was used in the analyses. Results The case group had significantly less intraoperative blood loss in milliliters (169.4 ± 133.5 vs. 221.5 ± 176.3, P = 0.03) and shorter operative time in minutes (210.5 ± 56.1 vs. 265.7 ± 67.1, P = 0.02) comparing to the control group. The conversion to laparotomy, postoperative hospital stay, resection margin, the mean peak level of postoperative liver function parameters, bile leakage rate, and others were comparable between the two groups. There was no perioperative mortality. Conclusions We demonstrated that the two-handed technique combing HS and LPMOD in LHH is safe and effective which is associated with shorter operative time and less intraoperative blood loss compared with LPMOD alone. The technique facilitates laparoscopic liver resection and is recommended for use.

scholarly journals A new Simplified Method of Selective Exposure of Hepatic Pedicles for Controlled Hepatectomies

HPB Surgery ◽  
1989 ◽  
Vol 1 (2) ◽  
pp. 119-130 ◽  
Author(s):  
E. I. Galperin ◽  
S. R. Karagiulian
Keyword(s):  
Blood Loss ◽  
Liver Parenchyma ◽  
Selective Exposure ◽  
Liver Ischemia ◽  
Hepatoduodenal Ligament ◽  
Intraoperative Blood Loss ◽  
Elastic Surface ◽  
Inferior Surface ◽  
Simplified Method ◽  
Lateral Branches

Our experience of 90 hepatectomies (HE) and examinations of 64 cadaver livers resulted in the elaboration of a simplified technique for the exposure of hepatic pedicles (HP) and the rapid selective ligation without significant normothermal ischemia of the retained parts of the liver. The method comprises 4 consecutive steps: 1) a superficial T-shaped incision of Glisson's capsule at the site of HP projection on the liver's inferior surface, 2) introduction of the surgeon's forefinger into the liver parenchyma, controlled by clamping the hepatoduodenal ligament, the fingertip finding a tubular structure well distinguished by its smooth elastic surface from the friable parenchyma and bending the finger to hook the pedicle, 3) drawing the hooked pedicle downwards through the slit in the capsule and temporarily clamping it, while releasing the hepatoduodenal ligament so as to restore blood supply to the retained parts of the liver, 4) checking for correct ligature position on the HP before its final ligation by matching the actual ischemic area with the intended line of resection and moving the clamp proximally or distally along the exposed pedicle for the release or clamping of lateral branches as necessary. Whereupon resection can be performed by any of the known methods.This method has been used in 8 major HE, allowing to reduce intraoperative blood loss from 2200±247 ml to 1000±225 ml and reducing general liver ischemia from 10 minutes and more to 2–3 minutes.

scholarly journals Safety and Effectiveness Evaluation of A Two-Handed Technique Combining Harmonic Scalpel and Laparoscopic Peng’s Multifunction Operative Dissector in Laparoscopic Hemihepatectomy

2021 ◽  
Author(s):  
Jingwei Cai ◽  
Guixing Jiang ◽  
Yuelong Liang ◽  
Yangyang Xie ◽  
Junhao Zheng ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Harmonic Scalpel ◽  
Peak Level ◽  
Bile Leakage ◽  
Liver Parenchyma ◽  
Control Group ◽  
Case Group ◽  
Intraoperative Blood Loss ◽  
And Control

Abstract ObjectivesThis study was designed to evaluate the safety and effectiveness of a two-hand technique combining harmonic scalpel (HS) and laparoscopic Peng’s multifunction operative dissector (LPMOD) in patients who underwent laparoscopic hemihepatectomy (LHH).MethodsWe designed and conducted a case-control study nested in a prospectively collected laparoscopic liver surgery database. Patients who underwent LHH for liver parenchyma transection using HS + LPMOD were defined as cases (n = 98) and LPMOD only as controls (n = 47) from January, 2016 to May, 2018. Propensity score matching (1:1) between the case and control groups was used in the analyses. ResultsThe case group had significantly less intraoperative blood loss in mL (169.4 ± 133.5 vs. 221.5 ± 176.3, P = 0.03) and shorter operative time in minutes (210.5 ± 56.1 vs. 265.7 ± 67.1, P = 0.02) comparing to the control group. The conversion to laparotomy, postoperative hospital stay, resection margin, the mean peak level of postoperative liver function parameters, bile leakage rate and others were comparable between the two groups. There was no perioperative mortality. ConclusionsWe demonstrated that the two-handed technique combing HS and LPMOD in LHH is safe and effective which is associated with shorter operative time and less intraoperative blood loss compared with LPMOD alone. The technique facilitates laparoscopic liver resection and is recommended for use.

scholarly journals A non-bioartificial liver support system combined with transplantation in HBV-related acute-on-chronic liver failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Peng Li ◽  
Xi Liang ◽  
Shan Xu ◽  
Ye Xiong ◽  
Jianrong Huang
Keyword(s):  
Survival Rate ◽  
Blood Loss ◽  
Liver Failure ◽  
Control Group ◽  
Observation Group ◽  
Intraoperative Blood Loss ◽  
Chronic Liver Failure ◽  
Short Term ◽  
Liver Support ◽  
Liver Support System

AbstractWe aim to determine the impact of an artificial liver support system (ALSS) treatment before liver transplantation (LT), and identify the prognostic factors and evaluate the predictive values of the current commonly used ACLF prognostic models for short-term prognosis after LT. Data from 166 patients who underwent LT with acute-on-chronic liver failure (ACLF) were retrospectively collected from January 2011 to December 2018 from the First Affiliated Hospital of Zhejiang University School of Medicine. Patients were divided into two groups depending on whether they received ALSS treatment pre-LT. In the observation group, liver function tests and prognostic scores were significantly lower after ALSS treatment, and the waiting time for a donor liver was significantly longer than that of the control group. Both intraoperative blood loss and period of postoperative ICU care were significantly lower; however, there were no significant differences between groups in terms of total postoperative hospital stays. Postoperative 4-week and 12-week survival rates in the observation group were significantly higher than those of the control group. Similar trends were also observed at 48 and 96 weeks, however, without significant difference. Multivariate Cox regression analysis of the risk factors related to prognosis showed that preoperative ALSS treatment, neutrophil–lymphocyte ratio, and intraoperative blood loss were independent predicting factors for 4-week survival rate after transplantation. ALSS treatment combined with LT in patients with HBV-related ACLF improved short-term survival. ALSS treatment pre-LT is an independent protective factor affecting the 4-week survival rate after LT.

scholarly journals Placenta previa with posterior extrauterine adhesion: clinical features and management practice

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yoshikazu Nagase ◽  
Shinya Matsuzaki ◽  
Masayuki Endo ◽  
Takeya Hara ◽  
Aiko Okada ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Cesarean Delivery ◽  
Clinical Features ◽  
Surgical Outcomes ◽  
Multivariate Regression ◽  
Placenta Previa ◽  
Control Group ◽  
Intraoperative Blood Loss ◽  
Intraoperative Bleeding

Abstract Background A diagnostic sign on magnetic resonance imaging, suggestive of posterior extrauterine adhesion (PEUA), was identified in patients with placenta previa. However, the clinical features or surgical outcomes of patients with placenta previa and PEUA are unclear. Our study aimed to investigate the clinical characteristics of placenta previa with PEUA and determine whether an altered management strategy improved surgical outcomes. Methods This single institution retrospective study examined patients with placenta previa who underwent cesarean delivery between 2014 and 2019. In June 2017, we recognized that PEUA was associated with increased intraoperative bleeding; thus, we altered the management of patients with placenta previa and PEUA. To assess the relationship between changes in practice and surgical outcomes, a quasi-experimental method was used to examine the difference-in-difference before (pre group) and after (post group) the changes. Surgical management was modified as follows: (i) minimization of uterine exteriorization and adhesion detachment during cesarean delivery and (ii) use of Nelaton catheters for guiding cervical passage during Bakri balloon insertion. To account for patient characteristics, propensity score matching and multivariate regression analyses were performed. Results The study cohort (n = 141) comprised of 24 patients with placenta previa and PEUA (PEUA group) and 117 non-PEUA patients (control group). The PEUA patients were further categorized into the pre (n = 12) and post groups (n = 12) based on the changes in surgical management. Total placenta previa and posterior placentas were more likely in the PEUA group than in the control group (66.7% versus 42.7% [P = 0.04] and 95.8% versus 63.2% [P < 0.01], respectively). After propensity score matching (n = 72), intraoperative blood loss was significantly higher in the PEUA group (n = 24) than in the control group (n = 48) (1515 mL versus 870 mL, P < 0.01). Multivariate regression analysis revealed that PEUA was a significant risk factor for intraoperative bleeding before changes were implemented in practice (t = 2.46, P = 0.02). Intraoperative blood loss in the post group was successfully reduced, as opposed to in the pre group (1180 mL versus 1827 mL, P = 0.04). Conclusions PEUA was associated with total placenta previa, posterior placenta, and increased intraoperative bleeding in patients with placenta previa. Our altered management could reduce the intraoperative blood loss.

Restrictive Pulmonary Dysfunction May Increase Blood Loss During Liver Resection

2021 ◽  
pp. 000313482110604
Author(s):  
Takahiro Yoshikawa ◽  
Daisuke Hokuto ◽  
Satoshi Yasuda ◽  
Naoki Kamitani ◽  
Yasuko Matsuo ◽  
...  
Keyword(s):  
Risk Factor ◽  
Liver Resection ◽  
Blood Loss ◽  
Perioperative Outcomes ◽  
Complication Rates ◽  
Pulmonary Dysfunction ◽  
Intraoperative Blood Loss ◽  
Control Groups ◽  
Anatomical Liver Resection ◽  
And Control

Background Restrictive pulmonary dysfunction (RPD) is a risk factor for perioperative complications during gastrointestinal surgery. We hypothesized that high airway pressure due to RPD results in increased intraoperative blood loss during liver surgery. Thus, we investigated the effects of RPD on perioperative outcomes for liver resection. Methods This study included 496 patients who underwent curative liver resection at our hospital between April 2009 and April 2020. Perioperative outcomes for the RPD and control groups were compared. Restrictive pulmonary dysfunction was defined as % vital capacity <80%. Results Forty-one patients (8.3%) had RPD. No significant differences were observed in intraoperative blood losses (440 mL vs 320 mL, P = .340), overall complication rates (29.3% vs 31.2%, P = .797), or pulmonary complication rates (4.9% vs 9.0%, P = .286) between the RPD and control groups. In the 256 patients who underwent anatomical liver resection, 18 patients (7.0%) had RPD. The intraoperative blood loss was significantly higher in the RPD group (925 mL vs 456 mL, P = .013), but no differences in the overall complication rates (44.4% vs 37.3%, P = .528) or pulmonary complication rates (11.1% vs 10.5%, P = .589) between the two groups were detected. A multivariate analysis showed that RPD was an independent risk factor for intraoperative blood loss ≥500 mL during anatomical liver resection (odds ratio 4.132; 95% confidence interval 1.135-15.045; P = .031). Discussion Restrictive pulmonary dysfunction may be a risk factor for intraoperative blood loss during anatomical liver resection, which requires exposure of the main hepatic vein.

scholarly journals Safety of laparoscopic pancreaticoduodenectomy in patients with liver cirrhosis using propensity score matching

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0246364
Author(s):  
Ke Cheng ◽  
Wei Liu ◽  
Jiaying You ◽  
Shashi Shah ◽  
Yunqiang Cai ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Cirrhosis ◽  
Blood Loss ◽  
Postoperative Morbidity ◽  
Control Group ◽  
Complication Rates ◽  
Laparoscopic Pancreaticoduodenectomy ◽  
Intraoperative Blood Loss ◽  
Cirrhotic Patients

Currently, safety of laparoscopic pancreaticoduodenectomy (LPD) in patients with liver cirrhosis is unknown. The aim of this study was to explore postoperative morbidity and mortality and long-term outcomes of cirrhotic patients after LPD. The study was a one-center retrospective study comprising 353 patients who underwent LPD between October 2010 and December 2019. A total of 28 patients had liver cirrhosis and were paired with 56 non-cirrhotic counterparts through propensity score matching (PSM). Baseline data, intra-operative data, postoperative data, and survival data were collected. Postoperative morbidity was considered as primary outcome whereas postoperative mortality, surgical parameters (operative durations, intraoperative blood loss), and long-term overall survival were secondary outcomes. Cirrhotic patients showed postoperative complication rates of 82% compared with rates of patients in the control group (48%) (P = 0.003). Further, Clavien-Dindo ≥III complication rates of 14% and 11% (P = 0.634), Clavien-Dindo I-II complication rates of 68% and 38% (P = 0.009), hospital mortality of 4% and 2% (P = 0.613) were observed for cirrhotic patients and non-cirrhotic patients, respectively. In addition, an overall survival rate of 32 months and 34.5 months (P = 0.991), intraoperative blood loss of 300 (200–400) ml and 150 (100–250) ml (P<0.0001), drain amount of 2572.5 (1023.8–5275) ml and 1617.5 (907.5–2700) ml (P = 0.048) were observed in the cirrhotic group and control group, respectively. In conclusion, LPD is associated with increased risk of postoperative morbidity in patients with liver cirrhosis. However, the incidence of Clavien-Dindo ≥III complications and post-operative mortality showed no significant increase. In addition, liver cirrhosis showed no correlation with poor overall survival in patients who underwent LPD. These findings imply that liver cirrhosis patients can routinely be considered for LPD at high volume centers with rigorous selection and management.

scholarly journals Immediate results of spleen-preserving distal subtotal pancreatic resection

2021 ◽  
Vol 26 (1) ◽  
pp. 100-106
Author(s):  
T. S. Mirzaev ◽  
D. V. Podluzhny ◽  
R. E. Izrailov ◽  
Yu. I. Patyutko ◽  
E. V. Glukhov ◽  
...  
Keyword(s):  
Blood Loss ◽  
Pancreatic Resection ◽  
The Body ◽  
Pancreatic Tumors ◽  
Benign Tumors ◽  
Control Group ◽  
Intraoperative Blood Loss ◽  
Spleen Preserving ◽  
Subtotal Pancreatectomy ◽  
Malignancy Potential

Aim. To assess the possibility of open spleen-preserving distal subtotal pancreatic resection for tumors of the body and tail of the pancreas.Material and methods. A retrospective comparative analysis of the immediate results of the spleen-preserving interventions in 41 patients was carried out. Mainly benign tumors or tumors with a low malignancy potential of the corpus and (or) the tail of the pancreas were detected. Distal subtotal pancreatectomy with splenectomy was performed in 53 patients with pancreatic tumors of different histogenesis with low malignancy potential (control group).Results. The duration of spleen-preserving distal subtotal pancreatectomy was 12 minutes shorter, compared with the distal subtotal pancreatectomy with splenectomy group (p = 0.180). Significantly lower volume of intraoperative blood loss during spleen-preserving procedure was noted – by 460 ml (p = 0.0001). The level of postoperative complications in the spleen-preserving pancreatectomy group was 15 (37%), while in the group of distal subtotal pancreatectomy with splenectomy was 26 (49%) (p = 0.227), respectively. External pancreatic fistula after spleenpreserving pancreatectomy was noted in 13 (32%) patients, in the other group in 21 (40%; p = 0.429). The duration of hospital stay did not statistically significantly differ in the compared groups and amounted to: 18.6 ± 6.9 and 20.3 ± 5.4 days (p = 0.123), respectively.Conclusion. Open spleen-preserving pancreatectomy is a relatively safe type of surgical treatment for patients with benign tumors and tumors with a low potential for malignancy of the body and/or tail of the pancreas. The surgery is shorter in time, accompanied by a lower level of complications, significantly less intraoperative blood loss, compared with a similar procedure involving splenectomy.

Risk Factors for and Outcomes of Intraoperative Blood Loss in Liver Resection for Hepatocellular Tumors

2020 ◽  
pp. 000313482094999
Author(s):  
Daisuke Imai ◽  
Takashi Maeda ◽  
Huanlin Wang ◽  
Tomonari Shimagaki ◽  
Kensaku Sanefuji ◽  
...  
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Serum Creatinine ◽  
Tumor Size ◽  
Major Hepatectomy ◽  
Anesthetic Technique ◽  
Intraoperative Blood Loss ◽  
Liver Malignancies ◽  
Data Set ◽  
Surgical Devices

Intraoperative blood loss (IBL) during liver resection is a predictor of morbidity, mortality, and tumor recurrence after hepatectomy; however, there have been few reports on patient factors associated with increased IBL. We enrolled consecutive patients who underwent liver resection for primary liver malignancies, and evaluated the predictors of IBL using a data set in which factors that might influence IBL, such as surgical devices, methods and anesthetic technique, were all standardized. We studied 244 patients. A multivariate analysis revealed that higher IBL was an independent risk factor for post-hepatectomy liver failure grade ≥B and overall survival. Multiple linear regression analyses showed serum creatinine, clinically significant portal hypertension (CSPH), tumor size, and major hepatectomy were all significant predictors of IBL. In conclusion, higher IBL was significantly associated with increased morbidity and mortality in patients with primary HCC who underwent liver resection. The risk of IBL was related to several factors including tumor size, serum creatinine, CSPH, and major hepatectomy.

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