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Utility of the Gyrus open forceps in hepatic parenchymal transection
Matthew R Porembka1, M B Majella Doyle, Nicholas A Hamilton
1Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Washington University, Saint Louis, MO 63110, USA.
Objective:
This study aimed to evaluate if the Gyrus open forceps is a safe and efficient tool for hepatic parenchymal transection.
Background:
Blood loss during hepatic transection remains a significant risk factor for morbidity and mortality associated with liver surgery. Various electrosurgical devices have been engineered to reduce blood loss. The Gyrus open forceps is a bipolar cautery device which has recently been introduced into hepatic surgery.
Methods:
We conducted a single-institution, retrospective review of all liver resections performed from November 2005 through November 2007. Patients undergoing resection of at least two liver segments where the Gyrus was the primary method of transection were included. Patient charts were reviewed; clinicopathological data were collected.
Results:
Of the 215 open liver resections performed during the study period, 47 patients met the inclusion criteria. Mean patient age was 61 years; 34% were female. The majority required resection for malignant disease (94%); frequent indications included colorectal metastasis (66%), hepatocellular carcinoma (6%) and cholangiocarcinoma (4%). Right hemihepatectomy (49%), left hemihepatectomy (13%) and right trisectionectomy (13%) were the most frequently performed procedures. A total of 26 patients (55%) underwent a major ancillary procedure concurrently. There were no operative mortalities. Median operative time was 220 min (range 97-398 min). Inflow occlusion was required in nine patients (19%) for a median time of 12 min (range 3-30 min). Median total estimated blood loss was 400 ml (range 10-2000 ml) and 10 patients (21%) required perioperative transfusion. All patients had macroscopically negative margins. Median length of stay was 8 days. Two patients (4%) had clinically significant bile leak. The 30-day postoperative mortality was zero.
Conclusions:
Use of the Gyrus open forceps appears to be a safe and efficient manner of hepatic parenchymal transection which allows rapid transection with acceptable blood loss, a low rate of perioperative transfusion, and minimal postoperative bile leak.
