An Improved Technique for Liver Transection Using a New Device for Soft Coagulation in Living Donor Hepatectomy
An Improved Technique for Liver Transection Using a New Device for Soft Coagulation in Living Donor Hepatectomy
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DOI：
10.5754/hge10088
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发表时间：
2012-09-01
影响因子：
--
通讯作者：
Baba, Hideo
中科院分区：
文献类型：
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作者：
Ishiko, Takatoshi;Inomata, Yukihiro;Baba, Hideo
背景/目的：在LDLT中，实质切除是供体手术中最具侵入性的过程。在不阻断肝脏流入的情况下，控制出血对供体安全至关重要。因此，一个可靠的凝固装置是必要的横断肝实质。本研究评价了一种新开发的单极施源器，SOFT COAG（埃尔贝Elektromedizin，Tubingen），用于快速软凝固，具有可调节的功率输出。我们的目的是评估使用SOFT COAG器械进行LDLT的改良肝切除技术。方法学：在1999年7月至2008年5月期间，195名连续供体接受了肝切除术用于LDLT。对于移植物取出，50名患者接受了左外侧部分切除术（LLS），65名患者接受了左半肝切除术（LHH），80名患者接受了右半肝切除术（RHH）。结果如下：在125名供体中，通过双极钳凝固来控制实质出血，在70名供体中通过单极电极软凝固来控制实质出血。双极和软凝RHH的术中失血量分别为763.9 +/-494.4 mL和435.2 +/-424.7 mL，差异具有统计学意义。关于术后肝功能，根据凝血装置，大多数实验室数据显示无显著差异。术后并发症发生率无显著差异。结论：很明显，新的软凝固装置代表了一种安全可行的技术，供肝实质横断没有流入阻塞。
Background/Aims: 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, Tubingen) 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. Methodology: 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). Results: 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 +/- 494.4mL 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. Conclusions: It is evident that the new soft coagulation device represents a safe and feasible technique for donor hepatic parenchymal transection without inflow occlusion.