Bipolar pulse coagulation for resection of the cirrhotic liver

The major technical challenge of liver surgery is controlling bleeding during transection of the parenchyma. The Gyrus hand piece (GHP) is a bipolar diathermy pulsation instrument that is similar in design to a large hemostat (Péan) clamp that divides tissue while the clamp remains closed.

We retrospectively analyzed the peri-operative data from 10 patients with early cirrhosis (stage 1-4) who underwent liver resection for hepatocellular cancer between February 2004 and July 2005. Five consecutive patients who underwent resection using the GHP were compared to five other patients who underwent resection using the traditional "crush clamp technique" (CCT). Six patients underwent minor hepatectomy (<3 segments) and four underwent major hepatectomy (>3 segments).

When the GHP was used, the mean Pringle time was 13 +/- 5 min, mean blood loss was 520 mL +/- 118, and mean operative time was 252 +/- 15 min. When the CCT was used, the average Pringle time was 13 +/- 3 min, mean blood loss was 630 +/- 67 mL, and mean operative time was 312 +/- 29 min. There were 2 major complications in the GHP group and 3 in the CCT group. Major complications included transient hepatic failure (i.e., ascites/encephalopathy) and biloma formation.

One patient from each group suffered a minor wound complication. The average hospital stay was 8 days (range, 6-9) for the GHP group, and 8 days (range, 7-10) for CCT group. The operative mortality rate was 0%. Our preliminary results demonstrate that GHP provides an excellent and safe alternative to CCT for dividing the liver parenchyma in cirrhotic patients.