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Faster and safer resection with a stapler device: randomised, controlled trial of laparoscopic liver resection in a porcine model
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
University of Oslo, Norway.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
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(English)Article in journal (Other academic) Submitted
Abstract [en]

Introduction. Many surgeons use stapling during liver resection. The stapler has the potential to close all luminal structures in the liver tissue and thus result in minimal bleeding, reduced danger of gas embolism, and a faster surgery.

Material. Sixteen piglets where randomised into two groups receiving either laparoscopic liver resection with a vessel sealing system and an ultrasonic dissector (group-L) or with stapling (group-S). Pneumoperitoneum at 16 mmHg pressure was used. Gas embolism was detected with transesophageal ultrasound and intra-operative bleeding estimated. Monitoring of gas exchange with continuous recording of PaCO2, PaO2, end-tidal CO2, and pH was used. Invasive monitoring of systemic and pulmonary circulation was performed.

Results. Stapling resulted in less bleeding (P = 0.026), less gas embolism (P = 0.001), and a shorter operating time (P = 0.004).

Conclusion. In this animal model, stapling of the liver parenchyma led to a faster and safer resection compared to the use of a vessel sealing system and an ultrasonic dissector.

Keyword [en]
Pneumoperitoneum, laparoscopy, liver surgery, stapling device, gas embolism, bleeding
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-171731OAI: oai:DiVA.org:uu-171731DiVA: diva2:512218
Available from: 2012-03-27 Created: 2012-03-26 Last updated: 2012-08-01Bibliographically approved
In thesis
1. Technical Aspects of Laparoscopic Liver Resection. An Experimental Study
Open this publication in new window or tab >>Technical Aspects of Laparoscopic Liver Resection. An Experimental Study
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Various techniques are used to transect the liver. With increase in laparoscopic liver resections (LLR), it is of even more interest to develop surgical techniques to minimize bleeding and the risk for gas embolism during transection. Instrument like argon enhanced coagulator provides good hemostasis but increases the danger of gas embolism. The CO2 pneumoperitoneum that is routinely used in most types of laparoscopic surgery can be modified by the use of different gas pressure. It can be assumed that different pressure influences bleeding but also the risk for gas embolism.

In presented porcine studies, three instrumental combinations have been studied. In study I sixteen piglets were randomized to LLR with either the cavitron ultrasonic aspirator (CUSA™) in combination with vessels sealing system (Ligasure™) or with CUSA™ and ultrascision scissors (Autosonix™), with the endpoints of intra-operative bleeding and gas embolism.  In study IV sixteen piglets were randomized to LLR either with staple device (Endo-GIA™) or the Ligasure™ - CUSA™ combination with same primary endpoints and additionally secondary endpoints of effect on gas-exchange, systemic- and pulmonary hemodynamic.

Focusing on intra-abdominal pressure (IAP) in study II, sixteen piglets were randomized to LLR with an IAP of either 8 or 16 mmHg.  Primary endpoints were bleeding and gas embolism and secondary endpoints, effect on gas-exchange, systemic- and pulmonary hemodynamic.

In study III effect of argon gas was tested during LLR. Sixteen piglets were randomized to either argon pneumoperitoneum or CO2 pneumoperitoneum. Primary endpoints were effect on gas-exchange, systemic- and pulmonary hemodynamic.

In presented studies, we tested efficacy and safety of different techniques for LLR. CUSA™ can be used in combination with either Ligasure™ or Autosonix™. However, Ligasure™ reduces the amount of bleeding. The recent introduction of staplers seems promising with a further reduction in bleeding, gas embolism, and operating time. The IAP influences both the amount of bleeding as well as gas embolism. It seems reasonable to use a higher IAP to decrease bleeding with caution and with close monitoring for gas embolism. Argon gas embolism gives more extensive effect on gas-exchange and hemodynamic and should probably be avoided in this type of surgery.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 104 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 756
Keyword
Gas embolism, laparoscopy, liver resection, pneumoperitoneum, carbon dioxide, argon, bleeding, stapling device
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-171735 (URN)978-91-554-8321-0 (ISBN)
Public defence
2012-05-11, Enghoffsalen, Akademiska Sjukhuset, entrance 50, ground floor, Uppsala, 13:00 (Norwegian)
Opponent
Supervisors
Available from: 2012-04-20 Created: 2012-03-26 Last updated: 2012-08-01Bibliographically approved

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Eiriksson, KristinnFors, DiddiRubertsson, StenArvidsson, Dag

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