The Ligasure vessel sealer in liver resection : a pilot study

Background/Aims: The major complication for liver resection is hemorrhage. Energy sources other than electrosurgery have become popular with the promise of quick and effective vascular control. This study evaluates alternative energy sources in sealing ductal structures for use in liver resection with minimal blood loss. Methodology: Between June 1994 and December 2003, a consecutive 116 patients (59 male; 57 female; mean age: 60 +/- 11 years; range: 27-79 years) underwent surgery for primary (n=30), metastatic liver cancer (n=79), or benign lesions (n=7). The extent of hepatic parenchymal division is marked on the surface with a diathermy-scored line. The arteries, veins, and bile ducts crossing the line of division are grasped, singly or in groups, by the Ligasure (Auto-suture, United States Surgical Corp., Norwalk, CT) electrocautery device. Results: Fifty-eight formal hepatic resections,and 58 non-anatomical wedge resection were performed. The blood loss ranged from 100mL to 3000mL,(median: 430mL). Only 32 patients received preoperative blood transfusions. Perioperative mortality was nil (within 30 days following surgery), and postoperative major complications were seen in 14 patients (12%). Conclusions: The Ligasure device uses bipolar electrothermal energy to coagulate the opposing walls of the target vessels. A feedback-control mechanism ensures that tissues are not charred by overcoagulation. This results in a high-burst strength vessel seal. Sealing is effective in vessels up to 7mm in diameter. Larger vessels require formal suture or stapling. This described technique is simple, rapid, safe for parenchymal division during hepatectomy, resulting in minimal blood loss.