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Right Hemihepatectomy by Suprahilar Intrahepatic Transection of the Right Hemipedicle using a Vascular Stapler
Published on: January 25, 2010
Stapler hepatectomy is a safe dissection technique: analysis of 300 patients
Peter Schemmer1, Helmut Friess, Ulf Hinz
1Department of General Surgery, Ruprecht-Karls-University, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.
Background:
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 stapler hepatectomy and a risk analysis of surgical morbidity based on intraoperative data have been prospectively assessed on a routine clinical basis.
Materials And Methods:
From October 1, 2001, to January 31, 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, focal nodular hyperplasia [FNH], cysts) (14%), gallbladder carcinoma (2%), and other tumors (5%). There were 193 (64%) major resections (i.e., removal of three segments or more) and 107 minor hepatic resections. Additional extrahepatic resections were performed in 44 (15%) patients.
Results:
Median values for operative time and intraoperative hemorrhage were 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. Treated 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.
Conclusion:
In conclusion, stapler hepatectomy can be used in a routine clinical setting with a low incidence of surgical complications.
Insights
Stapler hepatectomy is a feasible liver resection technique in routine clinical practice, demonstrating a low incidence of surgical complications. This method offers a safe alternative for liver surgery, comparable to conventional approaches.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Surgical Technology
Background:
- Surgical staplers are increasingly used to enhance safety and reduce operative time in various procedures.
- The application of staplers for hepatic parenchyma transection remains less established.
- This study prospectively evaluates the feasibility and risk of stapler hepatectomy.
Purpose of the Study:
- To assess the feasibility of using staplers for liver resection (hepatectomy).
- To analyze surgical morbidity associated with stapler hepatectomy using intraoperative data.
- To compare outcomes with conventional liver resection techniques.
Main Methods:
- A prospective study of 416 liver resections from October 2001 to January 2005.
- Endo GIA vascular staplers were utilized for parenchymal transection in 300 cases.
- Included were resections for primary/metastatic liver cancer, benign diseases, gallbladder carcinoma, and other tumors, encompassing major and minor resections.
Main Results:
- Median operative time was 210 minutes with 700 ml median blood loss.
- Postoperative complications included bile leak (8%), wound infection (3%), and pneumothorax (2%).
- Mortality was 4% and morbidity 33%, comparable to conventional methods; relaparotomy was needed in 7%.
Conclusions:
- Stapler hepatectomy is a viable option for routine clinical use.
- The technique is associated with a low incidence of surgical complications.
- Outcomes are comparable to established liver resection methods.
