Liver Mobilisation during Recipient Hepatectomy Using Argon Plasma Coagulation - Tricks of Trade

Abstract

Introduction: Recipient hepatectomy is one of the difficult and challenging procedure during liver transplant. Blood loss during recipient hepatectomy is one of the main determinants of outcome during liver transplant. In a patient with recurrent spontaneous bacterial peritonitis there are dense adhesion between liver and peritoneum which are highly vascularized. It is difficult to find plains for blood less dissection. In order to over come this problem we have developed our own technique of mobilization of liver. Methods: There are many energy devices available for blood less dissection during mobilization of liver. Right from electrocautery, bipolar, harmonic scalpel, ligasure, argon plasma coagulation and many more. We have developed our own technique for mobilization of liver when dense adhesions are present between liver and peritoneal area. We use APC for releasing right and left triangular ligament. Using gentle traction on liver and spraying APC between liver and adherent area. Results: With use of APC a blood less dissection is feasible perticulary in the areas where there is no clear plain for dissection. Moreover, it helps in prevention of rents of diaphragm. If dissection is done either with other devices there is need to dissect plain which leads to bleeding from newly formed collaterals and if they are used without dissection can lead to rents in diaphragm. Conclusion: A blood less dissection is feasible in recurrent SBP patient using APC.