Technology-assisted versus clamp-crush liver resection: a systematic review and meta-analysis

Area of Science:

• Hepatobiliary Surgery
• Surgical Technology
• Minimally Invasive Procedures

Background:

• Liver resection is a complex procedure with potential complications.
• Technology-assisted surgical techniques aim to improve outcomes and reduce risks.
• Vessel sealing systems (VSS), Cavitron Ultrasonic Surgical Aspirator (CUSA), and radiofrequency dissecting sealer (RFDS) are among these technologies.

Purpose of the Study:

• To systematically review and meta-analyze evidence comparing technology-assisted liver resection with conventional clamp-crushing (CC) techniques.
• To evaluate the impact of VSS, CUSA, and RFDS on operative time, intraoperative bleeding, mortality, hospital stay, and postoperative bile leaks.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) and non-randomized studies.
• Comparison of VSS, CUSA, and RFDS against the conventional clamp-crushing (CC) technique.
• Data synthesis and statistical comparison of outcomes.

Main Results:

• Vessel sealing systems (VSS) were associated with significantly lower blood loss (109 mL), a 63% reduced risk of postoperative bile leak, and a 2-day shorter hospital stay compared to CC.
• No significant differences in liver parenchyma transection time or mortality were observed with VSS.
• Cavitron Ultrasonic Surgical Aspirator (CUSA) and radiofrequency dissecting sealer (RFDS) showed no significant benefits over the conventional clamp-crushing technique for any studied outcome.

Conclusions:

• Only vessel sealing systems (VSS) demonstrated significant advantages over the standard clamp-crushing (CC) technique in liver resection.
• The findings are limited by the scarcity and heterogeneity of existing studies.
• Further large, well-designed randomized controlled trials are necessary to validate the utility of novel modalities in liver resection.