A novel method of hemostasis for laparoscopic hepatectomy: saline-linked electrocautery combined with wet oxidized cellulose (SLiC-WOC) method

Abstract

Introduction: In Laparoscopic hepatectomy, once bleeding starts, it is difficult to control. We introduced the new technique of hemostasis during laparoscopic hepatic transection using saline-linked cautery with wet oxidized cellulose (SLiC-WOC method) and describe its efficacy and safety. Methods: From February 2017 to May 2018, 24 patients underwent pure laparoscopic hepatectomy at our institution. SLiC-WOC method was applied for 13 patients. We counted the number of bleeding in which SLiC-WOC method was applied and also measured time for achieving complete hemostasis. Surgical procedures: When bleeding occurs from the dissected parenchyma, hemostasis using saline-linked electrocautery is first tried. However, bleeding from the bottom of the cut surface or the small cavity on the dissected parenchyma is hard to control. In Case that hemostasis is expected to be hard to achieve by using saline-linked electrocautery alone, SLiC-WOC method is applied. First, one or two layers of fibrillar type cellulose oxidase is inserted to the bleeding point and compressed. Next, the inserted cellulose oxidase is saturated with saline dripped from the saline-linked electrocautery. Surplus saline and blood was continuously suctioned away from the bleeding point to prevent pooling too much. Subsequently, ball-tip electrocautery is activated toward the bleeding point through the saline soaked cellulose oxidase. Results: SLiC-WOC method was applied 32 times and achieved hemostasis in 30 times (94%). Median time for hemostasis in 30 cases was 33 second (range 18-150 second),In 25 cases, SLiC-WOC method was applied after incomplete hemostasis by using saline-linked electrocautery alone. Among them, median time of hemostatic maneuver using saline-linked electocautery alone was 27 second (range 10-95 second). There were two bleeding which was unable to control by SLiC-WOC method. Conclusion: For the bleeding which is difficult to control by electrocautery alone, saline-linked electrocautery combined with wet oxidized cellulose method is effective and time-efficient.