Expert opinion on advanced techniques for hemostasis in liver surgery

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Perioperative blood loss and intraoperative transfusion significantly impact liver surgery outcomes.
• Current consensus on optimal techniques for blood loss reduction is lacking.

Purpose of the Study:

• To establish expert consensus on the best surgical techniques and equipment for minimizing blood loss during liver resection.
• To provide evidence-based recommendations for managing blood loss in both open and laparoscopic liver surgery.

Main Methods:

• Convened an international Panel of Experts (EP) comprising experienced hepatobiliary surgeons.
• Conducted a literature review, face-to-face meeting, and online surveys based on case scenarios.
• Appraised frequently researched surgical techniques for their efficacy in reducing intraoperative blood loss.

Main Results:

• Experts acknowledged a scarcity of high-quality research in this field.
• A risk stratification algorithm was agreed upon.
• A hemostatic device is recommended alongside preferred surgical instrumentation for all liver resections, irrespective of bleeding risk stratification.
• The combination of Ultrasonic Dissector (UD) and a saline-coupled bipolar sealing device (Aquamantys®) was identified as the preferred technique.

Conclusions:

• The EP recommends utilizing a bipolar sealer and UD as essential equipment for liver resection.
• This combined approach is proposed as the optimal technique to minimize blood loss in both open and laparoscopic liver surgery.
• Recommendations are stratified according to transfusion risk.