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Background: Laparoscopic liver resection has become a safe and essential technique in the management of hepatic tumors. Multiple options for parenchymal transection techniques exist; however, none has emerged as superior. We aimed to compare operative characteristics and outcomes between bipolar-compression and ultrasonic devices used for parenchymal transection during laparoscopic liver resection.METHODS: Review of a prospective hepato-pancreato-biliary database from December 2002 to August 2009 identified 54 patients who underwent laparoscopic liver resection with parenchymal division using either a bipolar-compression (n=35) or an ultrasonic (n=19) device, at the operating surgeon’s discretion. Major vascular/biliary structures were divided by endoscopic stapling in both groups. Operative data, histology and 90-day complication rates were compared to investigate differences between parenchymal transection devices. ANOVA and the Pearson chi-squared test were used to compare the two groups. RESULTS: The two groups were not significantly different with regard to age, body mass index, parenchymal steatosis/inflammation, and number of Couinaud segments resected. A shorter median time of parenchymal transection was noted for the bipolar-compression (35 min; range: 20-65) vs. the ultrasonic device (55 min; range: 29-75), p<0.001. Shorter median total operative times (130 [70-180] vs. 180 [80-240] min; p=0.049) were also noted for the bipolar-compression device. When examining post-operative outcomes, no significant differences between device groups were noted for estimated blood loss, complications of any type, or for liver-specific complications (post-operative hemorrhage or bile leak). See Table.CONCLUSIONS: Bipolar-compression devices may offer an advantage of decreased transection time and total operative time over ultrasonic devices without a difference in post-operative complications during laparoscopic liver resection.
Comparison Between Device Groups of Operative Characteristics and Post-Operative Outcomes

Group (n)	Abnormal Parenchyma n (%)	Major Hepatectomy(≥3 Seg);n (%)	Median EBL, mL (Range)	Median Transection Time, min (Range)	Median Operative Time, min (Range)	Complications, any Type n (%)	Bile Leakn (%)
Bipolar-Compression (35)	28 (82%)	21 (60%)	100(20-1000)	35 (20-65)	130 (70-180)	9 (26%)	1 (1.8%)
Ultrasonic (19)	17 (89%)	11 (58%)	175 (50-700)	55 (29-75)	180 (80-240)	2 (11%)	0
p-value	0.48	0.88	0.58	<0.001	0.049	0.15	0.45