肝実質切離における凝固機器のランダム化比較試験

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  • A prospective randomized controlled trial of hemostasis with a bipolar sealer during hepatic transection for liver tumors

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　 　Background: Excessive intraoperative blood loss and the possible requirement for blood transfusion are major problems in hepatic resection for liver tumors. Reduction of blood loss is a goal in liver surgery, and several technical developments have been introduced for this purpose. The aim of this prospective randomized study was to compare the use of the Cavitron Ultrasonic Surgical Aspirator (CUSA) with a radiofrequency-based bipolar hemostatic sealer versus CUSA with standard bipolar cautery (BC) in patients undergoing hepatic resection.<br> 　 　Methods: One hundred nine patients with liver tumors were randomized to undergo hepatic transection using CUSA with a bipolar sealer (Aquamantys 2.3 Bipolar Sealer) <br>(n = 55) or BC (n = 54). Blood loss during parenchymal transection and speed of transection were the primary endpoints, whereas the degree of postoperative liver injury and morbidity were secondary endpoints.<br> 　 　Results: Compared with the BC group, the bipolar sealer showed signifcantly lower blood loss during transection and blood loss divided by resection area (P = 0.0079 and 0.0008, respectively); signifcantly shorter transection time (P = 0.0025); signifcantly faster speed of transection (P < 0.0001); signifcantly fewer ties and ties divided by resection area required during transection (P < 0.0001); and, although not signifcant, less postoperative morbidity and a shorter hospital stay.<br> 　 　Conclusion: CUSA with a bipolar sealer is superior to CUSA with standard BC for various hepatectomy in terms of less blood loss and faster speed of transection, with no increase in morbidity.

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