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Laparoscopic Hepatic Transection Using Bipolar Radiofrequency Ablation (EnSeal)

  • Keith M. Baldwin
  • Ponnandai Somasundar
  • Steven C. Katz
  • N. Joseph EspatEmail author
Chapter

Abstract

Hepatic parenchymal transection under laparoscopic conditions remains a formidable challenge without a defined optimal technique. Because of the unique technical challenges of laparoscopic liver resection, devices that can both coagulate and safely transect small vessels and bile ducts are an important adjunct to the use of endomechanical stapling devices. At present, the authors’ preferred energy device for laparoscopic hepatic parenchymal precoagulation transection (PCT) is the bipolar radiofrequency device (BRF, EnSeal; Ethicon Endo-Surgery, Cincinnati, OH). The device allows the surgeon to seal and transect small to large vessels and tissue bundles, and is approved for transection of blood vessels up to 7 mm in size. Bipolar radiofrequency energy uses a unique “line-of-sight” form of energy delivery which is described in detail herein. It is ideally suited for laparoscopic use, and has been tested and used in vivo in colorectal surgery, where it has been used to safely transect the inferior mesenteric artery and vein without incident. As with most energy devices, there is a short learning curve and a few caveats that should be considered when using the device, such as the avoidance of staples between the jaws. Overall, the bipolar radiofrequency device offers very secure vessel sealing and excellent ergonomics that provide both tissue sealing and cutting in one surgeon-controlled movement.

Supplementary material

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References

  1. 1.
    Lupo L, Gallerani A, Panzera P et al. (2007) Randomized clinical trial of radiofrequency-assisted versus clamp-crushing liver resection. Br J Surg 94:278–291CrossRefGoogle Scholar
  2. 2.
    Sahin DA, Kusaslan R, Sahin O et al. (2007) Histopathological effects of bipolar vessel sealing devices on liver parenchyma and comparison with suture method: an experimental study. Eur Surg Res 39:111–117PubMedCrossRefGoogle Scholar
  3. 3.
    EnSeal product information, Ethicon Endo-Surgery, Cincinnati, OHGoogle Scholar
  4. 4.
    Person B, Vivas DA, Ruiz D et al. (2008) Comparison of four energy-based vascular sealing and cutting instruments: a porcine model. Surg Endosc 22:534–538PubMedCrossRefGoogle Scholar
  5. 5.
    Golstein SL, Harold KL, Lentzner A et al. (2002) Comparison of thermal spread after ureteral ligation with the laparo-sonic ultrasonic shears and the Ligasure system. J Laparoendosc Adv Surg Tech 12:61–63CrossRefGoogle Scholar
  6. 6.
    Helton S, Van Cott C, Zuckerman R (2009). Enseal bipolar cutting device enables safe and bloodless hepatic subsegmentectomy. Presented at the IHPBA 8th European Congress, June 2009Google Scholar
  7. 7.
    Smaldone MC, Gibbons EP, Jackman SV (2008) Laparoscopic nephrectomy using the Enseal tissue sealing and haemostasis system; successful therapeutic application of nanotechnology. JSLS 12:213–216Google Scholar
  8. 8.
    Albert M, Atallah S, Larach S, Parra-Davila E (2009) Vessel sealing in laparoscopic colonic surgery. Presented at: 2009 scientific session of the society of American gastrointestinal and endoscopic surgeons (SAGES), Phoenix, AZ, 22–25 April 2009Google Scholar
  9. 9.
    Quinteros F, Maricek S, Clinton J, et al. (2009) Experience with EnSeal vessel-sealing device in colectomy. Presented at the 2009 scientific session of the society of American gastrointestinal and endoscopic surgeons (SAGES), Phoenix, AZ, 22–25 April 2009Google Scholar
  10. 10.
    Somasundar P, Boutros C, Helton WS, Espat NJ (2009) Evaluation of a bipolar radiofrequency device for laparoscopic hepatic transaction: technique and clinical experience in 18 patients. HPB 11:145–149PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Alemi F, Kwon E, Chiu J, Aoki H, Stewart L, Corvera CU (2011) Laparoscopic treatment of liver tumors using a two-needle probe bipolar radiofrequency ablation device. HPB (Oxford) 13(9):656–64Google Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • Keith M. Baldwin
    • 1
  • Ponnandai Somasundar
    • 1
  • Steven C. Katz
    • 1
  • N. Joseph Espat
    • 1
    Email author
  1. 1.Department of SurgeryRoger Williams Medical CenterProvidenceUSA

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