Use of linear radiofrequency device in liver resection

Abstract

Background/Aim. Linear radiofrequency device (LRFD) is disposable tool designed for liver parenchyma transection using controlled radiofrequency to 'seal' blood vessels and bile ducts, making liver resection easier and safer compared to classical resectional techniques. The aim of this study was to determine real value of the LRFD compared to the standard 'keliclasia' technique. Methods. This prospective study analyzed the significant intraoperative parameters and postoperative results of the 200 patients who underwent surgery at the Surgery Clinic of Clinical Centre in Nis, between January 1, 2001, and January 1, 2009. The patients were divided into two groups: the control Keli group (144 patients) with the 'keliclasia' resection technique and the control RF group (with resection performed using LRFD - Tissue Link / Dissection Sealer (DS - 3.0) (56 patients). The following parameters were analyzed: duration of liver ischemia, liver parenchyma transection time, intraoperative blood loss, significant intraoperative and postoperative complication rate, duration of hospitalization and mortality. Results. LRFD was used in 56 liver resections. The average duration of liver ischemia in the RF group was shorter than in the Keli group (7 versus 22 minutes). Parenchymal liver transection was significantly slower in the RF group than in the Keli group (2.05 versus 4.34 cm2/minutes, respectively). There was less intraoperative bleeding using LRFD 'Keliclasia' tehniquethan in the control group (390 mL compared to 420 mL, respectively). After the use of LRFD two cases of biliary leak and 4 pleural effusions were registered. Conclusion. LRFD is simple device for safe liver transection with decreased need for liver ischemia and singificant reducing of the intraoperative blood loss. High price for disposable device and slow parenchyma transection are disadvantages of this device.Uvod/Cilj. Linearni radiofrekventni noz (LRFN) je uredjaj za jednokratnu upotrebu koji sluzi za transekciju jetrinog parenhima primenom kontrolisane radiofrekventne struje, cime se postize zatvaranje, odnosno 'varenje' krvnih sudova i zucnih vodova sto resekciju jetre cini sigurnijom u odnosu na klasicne tehnike. Cilj rada bio je da se odredi realna vrednost LRFN u odnosu na standardnu tehniku keliklazije. Metode. Ispitivanje je sprovedeno kao prospektivna analiza perioperativnih parametara kod 200 bolesnika kojima je uradjena resekcija jetre u Klinici za opstu hirurgiju Klinickog centra u Nisu u periodu od 1. januara 2001. do 1. januara 2009. godine. Bolesnici su bili podeljeni u dve grupe: Keli grupa sa 144 bolesnika kojima je resekcija jetre uradjena tehnikom keliklazije i RF grupa sa 56 bolesnika kojima je je transekcija jetrinog parenhima uradjena pomocu LRFN - Tissue Link - Dissection Sealer (DS - 3,0). Analizirani su duzina trajanja ishemije jetre, brzina transekcije parenhima, intraoperativni gubitak krvi, procenat znacajnih intraoperativnih i postoperativnih komplikacija, duzina hospitalizacije i mortalitet. Rezultati. Kod 28% bolesnika sa resekcijom jetre, transekcija je uradjena pomocu LNRF. Prosecno vreme ishemije jetre u RF grupi iznosilo je 7 min, a u Keli grupi 22 min Brzina transekcije parenhima bila je dvostruko manja u RF grupi nego u Keli grupi (2,05 cm2/min prema 4,34 cm2/min). Ukupni gubitak krvi bio je znacajno manji u RF grupi, nego u Keli grupi (390 mL prema 420 mL). Nakon primene LRFN registrovane su dve bilijarne fistule i cetiri pleuralne efuzije. Zakljucak. Linearni radiofrekventni noz relativno je jednostavan uredjaj koji omogucava bezbednu transekciju parenhima uz smanjenu potrebu za ishemijom jetre i uz znacajno smanjenje gubitaka krvi. Negativne strane uredjaja su njegova visoka cena za jednokratnu upotrebu i sporija transekcija parenhima.