Skip to main content
SpringerLink
Log in

Laparoscopic blood-saving liver resection using a new radiofrequency-assisted device: preliminary report of an in vivo study with pig liver

  • New Technology
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The aim of any device designed for liver resection is to allow blood saving and quick resections. This may be optimized using a minimally invasive approach. A radiofrequency-assisted device is described that combines a cooled blunt-tip electrode with a sharp blade on one side in an in vivo preliminary study using hand-assisted laparoscopy to perform partial hepatectomies.

Methods

Eight partial hepatectomies were performed on pigs with hand-assisted laparoscopy using the radiofrequency-assisted device as the only method for transection and hemostasis. The main outcome measures were transection time, blood loss, transection area, transection speed, blood loss per transection area, and tissue coagulation depth. The risk for biliary leak also was assessed using the methylene blue test.

Results

The transection time was 13 ± 7 min for a mean transected area of 34 ± 11 cm2. The mean total blood loss was 26 ± 34 ml. The mean transection speed was 3 ± 1 cm2/min, and the blood loss per transection area was 1 ± 1 ml/cm2. Abdominal examination showed no complications in nearby organs. One biliary leak was identified in one case using the methylene blue test. The transection surface was 34 ± 11 cm2, and the mean tissue coagulation depth was 9 ± 2 mm. The inviability of the coagulated surface was assessed by adenine dinucleotide (NADH) staining.

Conclusions

The radiofrequency-assisted device has shown with a laparoscopic approach that it can perform liver resections faster and with less blood loss using a single device in a minimally invasive manner without vascular control than other commercial devices. The results show no significant differences with the same device used in an open procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Belghiti J, Hiramatsu K, Benoist S, Massault PP, Sauvanet A (2000) Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 191:38–46

    Article  PubMed  CAS  Google Scholar 

  2. Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, Carlos Corvera C, Weber S, Blumgart LH (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 236(4):397–406

    Article  PubMed  Google Scholar 

  3. Poon RT, Lo CM, Fan ST, Liu CL, Lam CM, Yuen WK, Yeung C, Wong J (2004) Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1,222 consecutive patients from a prospective database. Ann Surg 240:698–710

    PubMed  Google Scholar 

  4. Postema RR, Plaisier PW, Ten Kate FJ, Terpstra OT (1993) Haemostasis after partial hepatectomy using argon beam coagulation. Br J Surg 80:1563–1565

    Article  PubMed  CAS  Google Scholar 

  5. Takayama T, Makuuchi M, Kubota K, Harihara Y, Hui A, Sano K, Ijichi M, Hasegawa K (2001) Randomized comparison of ultrasonic vs clamp transection of the liver. Arch Surg 136:922–928

    Article  PubMed  CAS  Google Scholar 

  6. Baer HU, Stain SC, Guastella T, Maddern GJ, Blumgart LH (1993) Hepatic resection using water jet dissector. HBP Surg 6:189–196

    CAS  Google Scholar 

  7. Stephenson K, Steinberg S, Hughes KS, Vetto JT, Sugarbaker PH, Chang AE (1998) Perioperative blood transfusions are associated with decreased time to recurrence and decreased survival after resection of colorectal liver metastases. Ann Surg 208:679–687

    Article  Google Scholar 

  8. Kooby DA, Stockman J, Ben-Porat L, Gonen M, Jarnagin WR, Dematteo RP, Tuorto S, Wuest D, Blumgart LH, Fong Y (2003) Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg 237:860–870

    PubMed  Google Scholar 

  9. Yamamoto J, Kosuge T, Takayama T, Shimada K, Yamasaki S, Ozaki H, Yamaguchi N, Mizuno S, Makuuchi M (1994) Perioperative blood transfusion promotes recurrence of hepatocellular carcinoma after hepatectomy. Surgery 115:303–309

    PubMed  CAS  Google Scholar 

  10. Tsao JI, Loftus JP, Nagorney DM, Adson MA, Ilstrup DM (1994) Trends in morbidity and mortality of hepatic resection for malignancy: a matched comparative analysis. Ann Surg 220:199–205

    Article  PubMed  CAS  Google Scholar 

  11. Pringle J (1908) Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg 48(4):541–549

    Article  PubMed  CAS  Google Scholar 

  12. Huguet C, Gavelli A, Chieco PA, Bona S, Harb J, Joseph JM, Jobard J, Gramaglia M, Lasserre M (1992) Liver ischemia for hepatic resection: where is the limit? Surgery 111:251–259

    PubMed  CAS  Google Scholar 

  13. Abdalla EK, Noun R, Belghiti J (2004) Hepatic vascular occlusion: which technique? Surg Clin North Am 84:563–585

    Article  PubMed  Google Scholar 

  14. Arita J, Hasegawa K, Kokudo N, Sano K, Sugawara Y, Makuuchi M (2005) Randomized clinical trial of the effect of a saline-linked radiofrequency coagulator on blood loss during hepatic resection. Br J Surg 92:954–959

    Article  PubMed  CAS  Google Scholar 

  15. Aloia TA, Zorzi D, Abdalla EK, Vauthey JN (2005) Two-surgeon technique for hepatic parenchymal transection of the noncirrhotic liver using saline-linked cautery and ultrasonic dissection. Ann Surg 242(2):172–177

    Article  PubMed  Google Scholar 

  16. Lesurtel, M, Selzner M, Petrowsky H, McCormack L, Clavien PA (2005) How should transection of the liver be performed? A prospective randomized study in 100 consecutive patients: comparing four different transection strategies. Ann Surg 242:814–823

    Article  PubMed  Google Scholar 

  17. Nakayama H, Masuda H, Shibata M, Amano S, Fukuzawa M (2003) Incidence of bile leakage after three types of hepatic parenchymal transection. Hepatogastroenterology 50(53):1517–1520

    PubMed  Google Scholar 

  18. Aldrighetti L, Pulitanò C, Arru M, Catena M, Finazzi R, Ferla G (2006) “Technological” approach versus clamp-crushing technique for hepatic parenchymal transection: a comparative study. Gastrointest Surg 10:974–979

    Article  Google Scholar 

  19. Ferko A, Lesko M, Subrt Z, Melichar B, Hoffman P, Dvorak P, Vacek Z, Liao LR, Habib NA, Koci J, Motycka P (2006) A modified radiofrequency-assisted approach to right hemihepatectomy. Eur J Surg Oncol 32(10):1209–1211

    Article  PubMed  CAS  Google Scholar 

  20. Bachellier P, Ayav A, Pai M, Weber JC, Rosso E, Jaeck D, Habib NA, Jiao LR (2007) Laparoscopic liver resection assisted with radiofrequency. Am J Surg 193:427–430

    Article  PubMed  Google Scholar 

  21. Simillis C, Constantinides VA, Tekkis PP, Darzi A, Lovegrove R, Jiao L, Antoniou A (2007) Laparoscopic versus open hepatic resections for benign and malignant neoplasms: a meta-analysis. Surgery 141(2):203–211

    Article  PubMed  Google Scholar 

  22. Burdío F, Navarro A, Berjano EJ, Sousa R, Burdío JM, Güemes A, Subiró J, Gonzalez A, Cruz I, Castiella T, Tejero E, Lozano R, Grande L, de Gregorio MA (2007) A radiofrequency-assisted device for bloodless rapid transection of the liver: a comparative study in a pig liver model. Eur J Surg Oncol doi:10.1016/j.ejso.2007.05.008

  23. Court FG, Wemyss-Holden SA, Morrison CP, Teague BD, Laws PE, Kew J, Dennison AR, Maddern GJ (2003) Segmental nature of the porcine liver and its potential as a model for experimental partial hepatectomy. Br J Surg 90:440–444

    Article  PubMed  CAS  Google Scholar 

  24. Lam CM, Lo CM, Liu CL, Fan ST (2001) Biliary complications during liver resection. World J Surg 25:1273–1276

    Article  PubMed  CAS  Google Scholar 

  25. Topp SA, McClurken M, Lipson D, Upadhya GA, Ritter JH, Linehan D, Strasberg SM (2004) Saline-linked surface radiofrequency ablation: factors affecting steam popping and depth of injury in the pig liver. Ann Surg 239:518–527

    Article  PubMed  Google Scholar 

  26. Yamamoto Y, Ikai I, Kume M, Sakai Y, Yamauchi A, Shino-hara H, Morimoto T, Shimahara Y, Yamamoto M, Yamaoka Y (1999) New technique for hepatic parenchymal resection using a cavitron ultrasonic aspirator and bipolar cautery equipped with a channel for water dripping. World J Surg 23:1032–1037

    Article  PubMed  CAS  Google Scholar 

  27. Weber JC, Navarra G, Jiao LR, Nicholls JP, Jensen SL, Habib NA (2002) New technique for liver resection using heat coagulative necrosis. Ann Surg 236:560–563

    Article  PubMed  Google Scholar 

  28. Stella MS, Percivale A, Pasqualini A, Profeti A, Gandolfo N, Serafini G, Pellicci R (2003) Radiofrequency-assisted liver resection. J Gastrointest Surg 7:797–801

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the R+D+i Linguistic Assistance Office at the Polytechnic University of Valencia for itsr help in revising this article. This study was supported by a grant for medical research from the Spanish government (PETRI 2005/0353). The authors did not receive any funding from any company. The tested device reported in this article is currently under protection by a patent application held by the University of Barcelona (AVCRI). F. B. and A.G. are listed as inventors of this patent application, but neither individual holds a patent for this device. None of the other authors declare any conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Hospital Clínico Universitario Lozano Blesa, San Blas 104 3°C, 50003, Zaragoza, Spain

    Ana Navarro, Antonio Güemes, Ramón Sousa, Maria Rufas, Eloy Tejero & Ricardo Lozano

  2. Department of Surgery, Hospital del Mar, Barcelona, Spain

    Fernando Burdio & Luis Grande

  3. Department of Electronic Engineering, Polytechnic University of Valencia, Valencia, Spain

    Enrique J. Berjano

  4. Department of Urology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain

    Jorge Subirá

  5. Department of Animal Pathology and Surgery, Veterinary Faculty, University of Zaragoza, Zaragoza, Spain

    Ana Gonzalez

  6. Department of Electric Engineering and Communications, University of Zaragoza, Zaragoza, Spain

    Jose M. Burdío

  7. Department of Pathology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain

    Tomás Castiella

  8. Department of Interventional Radiology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain

    Miguel A. De Gregorio

Authors
  1. Ana Navarro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fernando Burdio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Enrique J. Berjano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonio Güemes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ramón Sousa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria Rufas
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jorge Subirá
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ana Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jose M. Burdío
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tomás Castiella
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Eloy Tejero
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Miguel A. De Gregorio
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Luis Grande
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Ricardo Lozano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ana Navarro.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Navarro, A., Burdio, F., Berjano, E.J. et al. Laparoscopic blood-saving liver resection using a new radiofrequency-assisted device: preliminary report of an in vivo study with pig liver. Surg Endosc 22, 1384–1391 (2008). https://doi.org/10.1007/s00464-008-9793-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-008-9793-3

Keywords

Search

Navigation