High Complexity Major Liver Resection by Thunderbeat as a Sole Device under the Pringle Maneuver and Infra-Hepatic Inferior Vena Cava Clamping (With Video)

Abstract

Introduction: In addition to conventional major or minor classification in liver resection (LR), recently, a complexity classification with 3 categories (low, medium, or high) according to its technical difficulty was proposed and validated. We describe the outcomes of high complexity major LR by Thunderbeat (TB) as a sole device under the Pringle maneuver and infra-hepatic inferior vena cava (IVC) clamping. Methods: Of 85 patients undergoing LR between July 2013 and November 2019, we reviewed seven patients who underwent this procedure. To evaluate the safety and rapidity, we compared the parenchymal transection time (PTT), estimated blood loss (EBL), and postoperative major complications (PMC) with nine patients who underwent medium or high complexity open major LR by the basic procedure, i.e. the clamp-crushing or the CUSA with supplemental use of energy devices. Results: Seven patients underwent extended right hepatectomy with hepaticojejunostomy (n=3), anatomical middle hepatectomy (n=2), and right trisectionectomy (n=1) or extended left hepatectomy (n=1) with IVC resection and reconstruction. Two patients experienced PMC (Clavien-Dindo classification IIIa: n=1, IIIb: n=1). There was no in-hospital mortality. Six patients are currently alive without recurrence with a median follow-up of 24 months. PTT [median (range)] in the TB group was significantly shorter: 19 (13-45) compared to 52 (18-174) min in the basic group (p=0.012). There was no significant difference in terms of EBL (p=0.918) and PMC (p=0.771). Conclusions: TB with the Pringle maneuver and infra-hepatic IVC clamping is feasible and may offer rapidity during high complexity major LR.