Background: Intraoperative blood loss and blood transfusions are important predictors of outcome in hepatic surgery. Controversies exist about methods for coagulation, while the dissection technique by Pean-clasia is still effective. Monopolar floating ball (Tissuelink-TM) (MFB), used for blunt liver dissection, seems effective but leads to tissue necrosis, which may represent a source of morbidity. The aim of this study was to compare in a prospective randomized trial, the vessel coagulation after Pean-clasia dissection obtained with bipolar forceps (BF) versus the MFB coagulation.
Methods: Seventy-six patients (58 men, 18 women; mean age: 64.7 yrs) scheduled for liver resection were randomized in two groups: Group A (MFB, n=38) and Group B (BF, n=38). The two groups were homogeneous in terms of tumors presentation, and background liver features. Blood loss (ml/cm2), blood transfusions, transection time (min/cm2), ligatures (number/cm2), drains amount, drains bilirubin levels at 3rd, 5th, and 7th postoperative day, postoperative morbidity and mortality were analysed.
Results: Mean resection area was 93.9 cm2 in group A and 79.8 cm2 in group B (P= 0.956). Mean Pringle time was 112 min in group A and 94 min in group B (P= 0.847). There were no significant differences in blood loss (mean 7.6 versus 7.2 ml/cm2; P = 0.162), blood transfusions (11.5% versus 16.5%; P = 0.450), transection time (mean 1.3 versus 1.3 min/cm2; P = 0.289), number of ligatures (mean 0.7 versus 0.7 /cm2; P = 0.200), drains amount (median 55 versus 66.7 ml; P = 0.451), and drains bilirubin levels (mean 1.9 versus 2.1 mg/dL; P = 0.664). Both the transection devices were equally safe, and no mortality or major morbidity was recorded.
Conclusion: Our preliminary data showed that the use of Pean-clasia with the MFB was safe, and minimized the blood loss during hepatic resection. However, the use of MFB offered no significant benefit over the BF technique.