Stapler Hepatectomy is a Novel and Safe Dissection Technique: Analysis of 300 Patients

Abstract

In many surgical procedures, stapling devices have been introduced for safety and to reduce the overall operative time. Their use for transection of hepatic parenchyma is not well established. Thus, the feasibility of the novel technique of stapler hepatectomy and a risk analysis of surgical morbidity based on intraoperative data have been prospectively assessed on a routine clinical basis. From October 1st, 2001 to January 31st, 2005 a total of 416 patients underwent liver resection in our Department. During this period endo GIA vascular staplers were used for parenchymal transection in 300 cases of primary (22%) and metastatic (57%) liver cancer, benign diseases (adenoma, FNH, cysts) (14%), gall bladder carcinoma (2%) and other tumors (5%). There were 193 (64%) major resections (i.e., removal of 3 segments or more) and 107 minor hepatic resections. The median time for dissection of liver parenchyma was 7 minutes. Additional extrahepatic resections were performed in 44 (15%) patients. Median values for operative time and intraoperative hemorrhage was 210 minutes and 700 mL, respectively. Further, transfusion of RBC and FFP was needed in 17% and 11% of patients, respectively. A postoperative ICU stay for >2 days was required in 18% of patients. The median postoperative hospital stay was 10 days (IQR 8–14 days). The most frequent surgical complications were bile leak (8%), wound infection (3%) and pneumothorax (2%). In 7% of cases after stapler hepatectomy a relaparotomy was necessary. Medical complications were pleural effusion (7%), renal insufficiency (5%), and cardiac insufficiency (3%). Risk assessment revealed that both operative time and indication for resection had significant impact on surgical morbidity. Mortality (4%) and morbidity (33%) were comparable to other high-volume centers performing conventional liver resection techniques. In conclusion, stapler hepatectomy can be used in a routine clinical setting with a low incidence of surgical complications and shows great potential in reducing operative time for hepatic resection in the future.