An improved technique for liver transection using a new device for soft coagulation in living donor hepatectomy.

Abstract

In LDLT, parechymal resection is the most invasive process in the donor procedure. The control of bleeding is crucial for donor safety without the occlusion of hepatic inflow. Therefore, a reliable coagulation device is necessary for the transection of the hepatic parenchyma. This study evaluated a newly developed monopolar applicator, SOFT COAG (ERBE Elektromedizin, Tübingen) for rapid soft coagulation with regulated power output. Our objective was to assess an improved hepatic resection technique using a the SOFT COAG device for LDLT. Between July 1999 and May 2008, 195 consecutive donors underwent a hepatic resection for LDLT. For graft extraction, 50 patients had a left lateral sectionectomy (LLS), 65 had a left hemihepatectomy (LHH), and 80 had a right hemihepatectomy (RHH). In 125 donors, the control of parenchymal bleeding was performed by coagulation with bipolar forceps and in 70 donors it was controlled by soft coagulation with a monopolar electrode. The intraoperative blood loss was 763.9±494.4 mL and 435.2±424.7mL in RHH with bipolar and soft coagulation, respectively, with a statistically significant difference. Regarding postoperative liver function, most of the laboratory data showed no significant difference according to coagulation device. There was no significant difference in the incidence of postoperative complications. It is evident that the new soft coagulation device represents a safe and feasible technique for donor hepatic parenchymal transection without inflow occlusion.