Abstract
Background
The use of radiofrequency (RF) energy has been described to perform open liver resection safely and with minimal blood loss. Yet no data are available on the potential contribution of RF energy to the limitation of intraoperative blood loss during laparoscopic liver resection (LLR). The aim of this prospective, nonrandomized study was to investigate the potential contribution of RF energy to the limitation of intraoperative blood loss in patients undergoing LLR.
Methods
Forty-five patients [male/female ratio 22/23, age 57 years (26–80)] underwent LLR. Eleven benign and 47 malignant lesions (mostly colorectal metastases) were resected. Median number [1 (1–3)] and maximum diameter [40 mm (8–170)] of tumors as well as median tumor free margins [10mm (1–30)] were comparable in patients undergoing LLR with (20 patients) or without (25 patients) RF-assistance. Thirty-eight minor (≤2 segments) and 9 major (>3 segments) resections were performed. Eighteen patients simultaneously underwent additional surgery.
Results
No mortality occurred. Median intraoperative blood loss was 200 (5–4000) ml and was similar in patients undergoing LLR with or without RF-assistance. The type of surgical procedure was a determinant for the amount of intraoperative blood loss (p = 0.0002). Significant bleeding occurred from large hepatic vessels at major resections. Median operation time was 115 (45–360) minutes. RF-assistance didn’t seem to reduce perioperative morbidity.
Conclusions
LLR can be performed with minimal intraoperative blood loss, which is determined by the type of hepatectomy. Significant intraoperative bleeding occurs from large hepatic vessels during major resections. RF-assisted parenchymal transection in LLR doesn’t seem to reduce blood loss, operation time, or perioperative morbidity.
Similar content being viewed by others
References
Belli G, Fantini C, D’Agostino A, Belli A, Russolillo N (2004) Laparoscopic liver resections for hepatocellular carcinoma (HCC) in cirrhotic patients. HPB 6: 236–246
Biertho L, Waage A, Gagner M (2002) Hépatectomies sous laparopscopie. Ann Surg 127: 164–170
Buell JF, Koffron AJ, Thomas MJ, Rudich S, Abecassis M, Woodle ES (2005) Laparoscopic liver resection. J Am Col Surg 200: 472–480
Cherqui D, Husson E, Hammoud R, Malassagne B, Stéphan F, Bensiad S, Rotman N, Fagniez PL (2000) Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg 232: 753–762
Cherqui D (2002) Résections hépatiques par voie coelioscopic: utiles ou futiles? Ann Chir 127: 171–174
Cherqui D, Yachouchi-Chouillard E (2002) Lobectomy gauche par abord coelioscopic. J Chir (Paris) 139: 25–28
Cherqui D (2003) Laparoscopic liver resection. Br J Surg 90: 644–646
Consten ECJ, Gagner M (2005) Perioperative outcome of laparoscopic left lateral liver resection is improved by using staple line reinforcement technique: a case report. J Gastrointest Surg 9: 360–364
Croce E, Olmi S, Bertolini A, Erba L, Magogne S (2003) Laparoscopic liver resection with radiofrequency. Hepatogastroenterology 50: 2088–2092
Descottes B, Glineur D, Lachachi F, Valleix D, Paineau J, Hamy A, Morino M, Bismuth H, Castaing D, Savier E, Honore P, Detry O, Legrand M, Azagra JS, Goergen M, Ceuterick M, Marescaux J, Mutter D, de Hemptinne B, Troisi R, Weerts J, Dallemagne B, Jehaes C, Gelin M, Donckier V, Aerts R, Topal B, Bertrand C, Mansvelt B, Van Krunckelsven L, Herman D, Kint M, Totte E, Schockmel R, Gigot JF (2003) Laparoscopic liver resection of benign liver tumors. Surg Endosc 17: 23–30
Dulucq JL, Wintringer P, Stabilini C, Mahajna A (2005) Laparoscopic liver resections: a single center experience. Surg Endosc 19: 886–891
Elias D, Cavalcanti A, Sabourin JC, Pignon, Ducreux M, Lasser P (1998) Results of 136 curative hepatectomies with a safety margin of less than 10mm for colorectal liver metastases. J Surg Oncol 69: 88–93
Fujita F, Fujita R, Kanematsu T (2005) New approaches to the minimally invasive treatment of liver cancer. Cancer J 11: 52–56
Gagner M (2003) Pioneers in laparoscopic solid organ surgery. Surg Endosc 17: 1853–1854
Gagner M, Rogula T, Selzer D (2004) Laparoscopic liver resection: benefits and controversies. Surg Clin North Am 84: 451–462
Gigot JF, Glineur D, Azagra JS, Goergen M, Ceuterick M, Morino M, Etienne J, Marescaux J, Mutter D, van Krunckelsven L, Descottes B, Valleix D, Lachachi F, Bertrand C, Mansvelt B, Hubens G, Saey JP, Schockmel R (2002) Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study. Ann Surg 236: 90–97
Haghighi KS, Wang F, King J, Daniel S, Morris DL (2005) In-line radiofrequency ablation to minimize blood loss in hepatic parenchymal transection. Am J Surg 190: 43–47
Hansen P (2004) Laparoscopic resections of liver and pancreas. J Gastrointest Surg 8: 925–926
Kalil AN, Mastalir ET (2002) Laparoscopic hepatectomy for benign liver tumors. Hepatogastroenterology 49: 803–805
Kaneko H, Takagi S, Otsuka Y, Tsuchiya M, Tamura A, Katagiri T, Maeda T, Shiba T (2005) Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg 189: 190–194
Laurent A, Cherqui D, Lesurtel M, Brunetti F, Tayar C, Fagniez PL (2003) Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg 138: 763–769
Lesurtel M, Cherqui D, Laurent A, Tayar C, Fagniez PL (2003) Laparoscopic versus open left lateral lobectomy: a case-control study. J Am Coll Surg 196: 236–242
Linden BC, Humar A, Sielaff TD (2003) Laparoscopic stapled left lateral segment liver resection – technique and results. J Gastrointest Surg 7: 777–782
Machi J (2004) New technique for liver resection using heat coagulative necrosis – letter to the editor. Ann Surg 241: 194–196
Mala T, Edwin B, Gladhaug I, Fosse E, Søreide O, Bergan A, Mathisen O (2002) A comparative study of the short-term outcome following open and laparoscopic liver resection of colorectal metastases. Surg Endosc 16: 1059–1063
Morino M, Morra I, Rosso E, Miglietta C, Garrone C (2003) Laparoscopic vs open hepatic resection: a comparative study. Surg Endosc 17: 1914–1918
Navarra G, Spalding D, Zacharoulis D, Nicholls JP, Kirby S, Costa I, Habib NA (2002) Bloodless hepatectomy technique. HPB Surg 4: 95–97
Navarra G, Lorenzini C, Currò G, Basaglia E, Habib N (2004) Early results after radiofrequency-assisted liver resection. Tumori 90: 32–35
O’Rourke N, Fielding G (2004) Laparoscopic right hepatectomy: surgical technique. J Gastrointest Surg 8: 213–216
O’Rourke N, Shaw I, Nathanson L, Martin I, Fielding G (2004) Laparoscopic resection of hepatic colorectal metastases. HPB 6: 230–235
Shimada M, Harimoto N, Maehara S, Tsujita E, Rikimaru T, Yamashita Y, Tanaka S, Shirabe K (2002) Minimally invasive hepatectomy: modulation of systemic reactions to operation or laparoscopic approach? Surgery 131(Suppl 1): S312–S317
Stella M, Percivale A, Pasqualini M, Profeti A, Gandolfo N, Serafini G, Pellici R (2003) Radiofrequency-assisted liver resection. J Gastrointest Surg 7: 797–801
Tepel J, Klomp HJ, Habib N, Fändrich F, Kremer B (2004) Modification of the liver resection technique with radiofrequency coagulation. Chirurg 75: 53–55
Topal B, Kaufman L, Aerts R, Penninckx F (2003) Patterns of failure following curative resection of colorectal liver metastases. Eur J Surg Oncol 29: 248–253
Vibert E, Kouider A, Gayet B (2004) Laparoscopic anatomic liver resection. HPB 6: 222–229
Vittimberga FJ, Foley DP, Meyers WC, Callery MP (1998) Laparoscopic surgery and the systemic immune response. Ann Surg 227: 326–334
Weber JC, Navarra G, Jiao LR, Nicholls JP, Lindkar Jensen S, Habib NA (2002) New technique for liver resection using heat coagulative necrosis. Ann Surg 236: 560–563
Weber JC, Navarra G, Habib NA, Bachelier P, Jaeck D (2003) Laparoscopic radiofrequency-assisted liver resection. Surg Endosc 17: 834
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hompes, D., Aerts, R., Penninckx, F. et al. Laparoscopic liver resection using radiofrequency coagulation. Surg Endosc 21, 175–180 (2007). https://doi.org/10.1007/s00464-005-0846-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-005-0846-6