Randomized clinical trial of efficacy and costs of three dissection devices in liver resection

Abstract

Background: In recent decades a variety of instruments for liver dissection has become available. This randomized controlled trial analysed the efficacy and costs of three different liver dissection devices. Methods: Ninety-six patients without cirrhosis undergoing liver resection were randomized to either ultrasonic dissection, waterjet dissection or dissecting sealer (32 in each group). Patients were unaware of the device used. The primary endpoint was dissection speed. Secondary endpoints were intraoperative blood loss, morbidity and mortality, and costs of dissection devices, staplers and haemostatic agents. Results: Dissection was slower with the dissecting sealer (P = 0.004 versus waterjet dissector). The difference was more pronounced for extended resections (mean(s.e.m.) 1.62(0.36) cm2/min versus 3.42(0.53) and 3.63(0.51) cm2/min for ultrasonic and water dissectors respectively; P = 0.037). Costs were significantly higher for the dissecting sealer when atypical or segmental resections were performed. Four patients died after extended resections; postoperative complications did not differ between groups. Conclusion: The dissecting sealer is slower than the ultrasonic dissector or water dissector. The three devices are equally safe in terms of blood loss, transfusions and postoperative complications. Ultrasonic and water dissectors might be more favourable economically than the dissecting sealer. Registration number: ISRCTN52294555 (http://www.controlled-trials.com). Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.