[Colorectal liver metastases resected with safe margin achieved by tissuelink monopolar floating ball]

Nowadays many technological devices are present in hepatic surgery to permit safer liver resections. Main purpose is decrease the intraoperative blood loss. The aim of this study is to analyze our initial experience in hepatic resections for liver metastasis using the new water-cooled, high-density, monopolar device, the Tissuelink Monopolar Floating Ball and Dissecting Sealer (Tissuelink Medical, Inc., Dover, NH).

We analyzed patients who underwent hepatic surgery for metastases from colorectal cancer between January 2003 and December 2004. Sex, age, type of surgical procedure, duration of the surgical procedure, blood loss, use of vascular clamping of the liver, length of hospital stay, morbidity, and mortality were analyzed.

Three liver resection, one segmentectomy and two limited resections were performed with the use of these new devices. In one case the devices was used to increase safe free margin of hepatic resection. Average blood loss was 150 ml (range, 50 to 300 ml). No mortality or morbidity were recorder.

In conclusion, this new device permits a bloodless liver resection avoiding vascular clamping. In plus the effect of radiofrequency waves can be useful to enlarge free resection border in patients submitted to hepatic resection without macroscopically safe margins. Prospective randomized studies are needed in order to establish the effective usefulness.