Optimum Hepatic Parenchymal Dissection to Prevent Bile Leak : A Comparative Study Using Electrosurgical and Stapling Devices in Swine

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  • Ikeda Tetsuo
    Center for Integration of Advanced Medicine, Graduate School of Medical Sciences, Kyushu University
  • Akahoshi Tomohiko
    Center for Integration of Advanced Medicine, Graduate School of Medical Sciences, Kyushu University
  • Kawanaka Hirofumi
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Uchiyama Hideaki
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Yamashita Yo-ichi
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Morita Masaru
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Oki Eiji
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Saeki Hiroshi
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Sugimachi Keishi
    Department of Surgery, Kyushu University Beppu Hospital
  • Ikegami Toru
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Yoshizumi Tomoharu
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Soejima Yuji
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Shirabe Ken
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Mimori Koshi
    Department of Surgery, Kyushu University Beppu Hospital
  • Watanabe Masayuki
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • Hashizume Makoto
    Center for Integration of Advanced Medicine, Graduate School of Medical Sciences, Kyushu University
  • Maehara Yoshihiko
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University

Bibliographic Information

Other Title
  • 腹腔鏡下肝切除における適切な肝実質切離方法の検討 : 電気手術器具と吻合器の比較検討

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Abstract

Background : Bile leakage is a serious complication of liver resection, and its treatment is very time-consuming. In open liver resection, Glisson's sheaths are usually disconnected by ligation to the extent possible during the parenchyma dissection. However, in laparoscopic surgery, the ligation, suture, and hemostasis are more difficult than in open surgery. For this reason, in laparoscopic liver resection, liver parenchyma dissection is generally accomplished using electrosurgical or stapling devices. Purpose : The purpose of this study was to verify the authenticity of electrosurgical devices attached an automatic irrigation function (AI) and stapling devices for laparoscopic liver parenchymal dissection. Methods : Four devices were used for liver parenchymal dissection in laparoscopic hepatic wedge resection, in pigs : monopolar high-frequency electric cautery attached AI (MCI) (n = 6), bipolar high-frequency electric cautery attached AI (BCI) (n = 6), bipolar tissue sealing system (LigaSure™) attached AI (BSI) and an endoscopic stapling device (ECHELON FLEX™ ENDOPATH®) (ES). In each group, burst pressures were tested using an electronic manometer, paying special attention to the location (s) of the first disruption (s). The dissected tissues were examined histologically. Results : Pressures used in electrosurgical devices attach AI were significantly higher compared to pressures used in a ES (P < 0.001). While thermal denaturation of the liver parenchyma occurred at approximately 2-3 mm of depth when bipolar high-frequency electric cautery was used for dissection, it reached up to more than 10 mm with monopolar high-frequency electric cautery. All of the first disruption points of stapling were at stapling line. Conclusions : Electrosurgical devices with an automatic irrigation function are useful devices to dissect the liver parenchyma.

Journal

  • 福岡醫學雜誌

    福岡醫學雜誌 104 (12), 507-514, 2013-12-25

    Fukuoka Medical Association

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