Disposable bipolar irrigated sealer (Aquamantys(®)) for liver resection: use with caution

The disposable bipolar irrigated sealer has been demonstrated to reduce perioperative bleeding, but its role in preventing postoperative cut-surface complications has not been evaluated to date. A prospective observational study was performed between January and September 2013 to evaluate a disposable bipolar irrigated sealed (Aquamantys(®)) on a continuous series of 51 first liver resections without biliary reconstruction. Primary end-point was the occurrence of cut-surface complications during the postoperative period. Secondary endpoints were postoperative complications and the 1-year overall survival rate. The results were compared to a propensity score matched group of 153 liver resections performed with conventional monopolar cautery. A cut-surface complication occurred in 13/51 (25.5 %) resected patients. Bleeding, bile leakage and subphrenic abscess occurred in 7.8, 11.8 and 11.8 % patients, respectively. Compared to the matched group, the resected group had a higher rate of cut-surface complications (25.5 vs. 14.7 %, p < 0.01) and a higher rate of Clavien-Dindo type ≥3 postoperative complications (29.5 vs. 17.2 %, p < 0.01). In the multivariate analysis, preoperative chemotherapy (p = 0.03, 95 % CI 1.09-5.9, OR 2.53), blood transfusion (p = 0.02, 95 % CI 1.78-6.55, OR 2.78) and Aquamantys(®) use (p = 0.02, 95 % CI 1.21-6.7, OR 2.85) were independent of cut-surface complications within the first 90 postoperative days. The overall 1-year survival rates were not different between the two groups (p = 0.078). Aquamantys(®) use is associated with an increased rate of postoperative complications compared to classical monopolar cautery, and we recommend that it should be used with caution in this type of surgery.