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Analysis of laparoscopic laser liver resection in standardized porcine model

Surgical Endoscopy volume 32, pages 4966–4972 (2018)Cite this article

Abstract

Background

Hepatocellular carcinoma is a highly prevalent and lethal primary neoplasia of the liver and metastases of other malignancies affect most frequently the liver. Minimally invasive surgical approach for liver resections is advancing. Dissection of liver parenchyma by laparoscopic technique remains challenging and new technologies are in need. Therefore, we asked whether it is feasible to dissect liver tissue comparably in terms of speed and hemostasis with a non-contact 1.9-µm cw-laser device and whether there are differences in the postoperative healing process compared to a gold standard device (ultrasound aspirator) in an experimental model.

Methods

Laparoscopic laser and ultrasound aspirator standardized partial liver resections were performed in seven pigs. Resection time, hemostasis time, and blood loss were evaluated. After at least 10 days, representative specimen of the resection areas was collected via re-laparoscopy and biopsy and side effects like hematoma, abscess, or bilioma were noted. Histologically, coagulation necrosis margin, granulation tissue zone, tissue fibrosis, and giant cell count were analyzed.

Results

Laparoscopic laser liver resection was three times faster compared to the laparoscopic ultrasound aspirator. Blood loss was equal in both groups. No side effects like hematoma or bilioma occurred. Histologically, specimen showed the same expansion of coagulation necrosis zone and granulation tissue. Fibrotic scar could be determined in three cases in both groups, respectively. However, giant cell count was significant higher in the laser resection group.

Conclusions

The 1.9-µm cw-laser device enables a safe and fast liver resection in an experimental pig model compared to a gold standard (ultrasound aspirator) laparoscopic liver resection method. Wound healing is not interfered by laser liver resection.

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Acknowledgements

This study was supported by the German Government/BMBF (16SV2024) and BMWI (KF2341202AK0).

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Authors and Affiliations

  1. Department of Surgery, University Medical Centre Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    David Benjamin Ellebrecht, Tobias Keck & Markus Kleemann

  2. Medical Laser Center Lübeck, Peter Monnik Weg 4, 23562, Lübeck, Germany

    Dirk Theisen-Kunde

  3. Pathology of the University Hospital Schleswig-Holstein, Campus Lübeck and the Research Center Borstel, Leibniz Lung Center, Site Luebeck, Department of Pathology, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Christiane Kuempers

  4. Department of Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Heike Wolken

Authors
  1. David Benjamin Ellebrecht
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  2. Dirk Theisen-Kunde
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  4. Tobias Keck
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  6. Heike Wolken
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Corresponding author

Correspondence to David Benjamin Ellebrecht.

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Disclosures

Dr. David Benjamin Ellebrecht, Mr. Dirk Theisen-Kunde, Dr. Christiane Kuempers, Prof. Dr. Tobias Keck, Prof. Dr. Markus Kleemann, and Dr. Heike Wolken have no conflicts of interest or financial ties to disclose.

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Ellebrecht, D.B., Theisen-Kunde, D., Kuempers, C. et al. Analysis of laparoscopic laser liver resection in standardized porcine model. Surg Endosc 32, 4966–4972 (2018). https://doi.org/10.1007/s00464-018-6258-1

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  • DOI: https://doi.org/10.1007/s00464-018-6258-1

Keywords

  • Hepatocellular carcinoma
  • Liver metastasis
  • Liver resection
  • Laser
  • Laparoscopy