Bipolar pulse coagulation for resection of the cirrhotic liver

Abstract

Background: The major technical challenge of liver surgery is controlling bleeding during transection of the parenchyma. The aim of this study was to compare the effectiveness of the traditional “clamp crush” technique (CCT) with that of a vessel sealing system that uses the Gyrus hand piece (GHP) in controlling bleeding during liver resection. The GHP is a bipolar cautery pulsation instrument that is similar in design to a large hemostat clamp that divides tissue while the clamp remains closed. The advantage of the GHP is that it can be used in the traditional “clamp crush” manner, but, unlike traditional CCT, does not require metal clips or ties. Methods: We retrospectively analyzed the peri-operative data from 10 patients with early cirrhosis (grade 1-2 fibrosis) who underwent liver resection for hepatocellular cancer between February 2004 and July 2005. Five resections were performed using CCT and five were performed using the GHP. Data are presented as means ± standard error (SE). This was a retrospective study of a nonrandom sample of patients, thus we present the descriptive data. Results: Eight patients underwent minor hepatectomy (< 3 segments) and two underwent major hepatectomy (> 3 segments). When the CCT was used, the average Pringle time was 13 ± 3 min, mean blood loss was 630 ± 67 ml, and mean operative time was 312 ± 29 min. When the GHP was used, the mean Pringle time was 13 ± 5 min, mean blood loss was 520 ml ± 118, and mean operative time was 252 ± 15 min. There were 3 major complications in the CCT group and 2 in the GHP group. Major complications included transient hepatic failure (i.e.ascites / encephalopathy) and biloma. One patient from each group suffered a minor wound complication. The average hospital stay was 8 days (range 7-10) for the CCT group, and 8 days (range 6-9) for GHP group. The operative mortality was 0%. Conclusion: The GHP appears to provide an excellent and safe alternative to CCT for dividing the liver parenchyma in cirrhotic patients.