Liver transection using the LigaSure sealing system.
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ABSTRACT:
SUBMITTER: Saiura A
PROVIDER: S-EPMC2518307 | biostudies-other | 2008
REPOSITORIES: biostudies-other
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Project description:BackgroundMinimizing blood loss is an important aspect of laparoscopic liver resection. Liver transection is the most challenging part of liver resection, but no standard method is available for this step at present. Herein, we have introduced the superficial precoagulation, sealing, and transection (SPST) method, a potentially "bloodless" and "ecofriendly" laparoscopic liver transection technique involving reusable devices: the VIO soft-coagulation system; VIO BiClamp (bipolar electrosurgical coagulation); Olympus SonoSurg (ultrasonic surgical system); and CUSA (ultrasonic aspirator). Furthermore, we have reported the short-term outcomes of laparoscopic liver transection with the SPST method.MethodsThe study included 14 consecutive patients who underwent laparoscopic partial liver resection with the SPST method at a single institution between August 2008 and June 2010.ResultsThe median operative time was 201 minutes (range, 97 to 332 min) and the median blood loss was 5 mL (range, 5 to 250 mL). There was no requirement for blood transfusion, no intraoperative complications, and no cases of conversion to open laparotomy. There were no liver transection-related complications such as postoperative bile leakage, bleeding, or infection. All surgical margins were negative, with a mean margin of 4.6 mm, and no local recurrence was observed at an average follow-up of 37.6 months.ConclusionsThe SPST method is a simple, efficient, and cost-effective surgical technique for laparoscopic liver resection. It is associated with low intraoperative blood loss and good short-term outcomes. We recommend that the SPST method should be used as a standard technique for laparoscopic liver transection (Supplemental Digital Content 1, http://links.lww.com/SLE/A103).
| S-EPMC4311999 | biostudies-literature
Project description:The Glissonean pedicle approach in liver surgery provides new knowledge of the surgical anatomy of the liver and advances the technique of liver surgery. The Glissonean pedicles are wrapped by a connective tissue referred to as the Glisson's capsule and include the hepatic artery, portal vein and bile duct. The Glissonean pedicles can be approached intrahepatically or extrahepatically. The extrahepatic approach at the hepatic hilus was referred to as the extra-fascial access by Couinaud. In summary, the secondary Glissonean pedicles are encircled and ligated at the hepatic hilus without liver dissection. The angle of approach should be over the hilar plate so that the surgeon does not have to consider any variations in the arteries or bile ducts. The tertiary branches can be approached through the hepatic hilus extrahepatically or intrahepatically on the border between the sections which are fed by the secondary Glissonean pedicles. This procedure is suitable for liver cancer without hilar invasion, particularly for hepatocellular carcinoma (HCC). Patients with HCC usually have liver dysfunction and HCC easily invades the peripheral portal vein; therefore, patients with HCC should only undergo small anatomical hepatectomies such as sectionectomy or segmentectomy. Any anatomical hepatectomy can be performed using this technique which allows simple, safe and easy liver resection. Liver surgeons should, therefore, know the fundamental concept of the Glissonean pedicle transection method.
| S-EPMC3233661 | biostudies-literature
Project description:A simple method of irreversibly sealing SU-8 microfluidic channels using PDMS is reported in this paper. The method is based on inducing a chemical reaction between PDMS and SU-8 by first generating amino groups on PDMS surface using N(2) plasma treatment, then allowing the amino groups to react with the residual epoxy groups on SU-8 surface at an elevated temperature. The N(2) plasma treatment of PDMS can be conducted using an ordinary plasma chamber and high purity N(2), while the residual epoxy groups on SU-8 surface can be preserved by post-exposure baking SU-8 at a temperature no higher than 95 °C. The resultant chemical bonding between PDMS and SU-8 using the method create an interface that can withstand a stress that is greater than the bulk strength of PDMS. The bond is permanent and is long-term resistant to water. The method was applied in fabricating SU-8 microfluidi-photonic integrated devices, and the obtained devices were tested to show desirable performance.
| S-EPMC3364813 | biostudies-other
Project description:BackgroundHemostasis is very important for a safe surgery, particularly in endoscopic surgery. Accordingly, in the last decade, vessel-sealing systems became popular as hemostatic devices. However, their use is limited due to thermal damage to organs, such as intestines and nerves. We developed a new method for safe coagulation using a vessel-sealing system, termed flat coagulation (FC). This study aimed to evaluate the efficacy of this new FC method compared to conventional coagulation methods.MethodsWe evaluated the thermal damage caused by various energy devices, such as the vessel-sealing system (FC method using LigaSure™), ultrasonic scissors (Sonicision™), and monopolar electrosurgery (cut/coagulation/spray/soft coagulation (SC) mode), on porcine organs, including the small intestine and liver. Furthermore, we compared the hemostasis time between the FC method and conventional methods in the superficial bleeding model using porcine mesentery.ResultsFC caused less thermal damage than monopolar electrosurgery's SC mode in the porcine liver and small intestine (liver: mean depth of thermal damage, 1.91 ± 0.35 vs 3.37 ± 0.28 mm; p = 0.0015). In the superficial bleeding model, the hemostasis time of FC was significantly shorter than that of electrosurgery's SC mode (mean, 19.54 ± 22.51 s vs 44.99 ± 21.18 s; p = 0.0046).ConclusionThis study showed that the FC method caused less thermal damage to porcine small intestine and liver than conventional methods. This FC method could provide easier and faster coagulation of superficial bleeds compared to that achieved by electrosurgery's SC mode. Therefore, this study motivates for the use of this new method to achieve hemostasis with various types of bleeds involving internal organs during endoscopic surgeries.
| S-EPMC7886768 | biostudies-literature
Project description:Blood loss and the requirement of blood transfusions during liver transection have been shown to correlate well with higher morbidity and mortality rates and a worse prognosis. Various devices for liver parenchymal transection have been developed to reduce intraoperative blood loss. The goal of this study is to evaluate the safety and effectiveness of BiClamp® forcep transection compared to a clamp crushing technique in patients undergoing liver resection.This study will include patients 18 years and older scheduled for hepatectomy with hepatic vascular exclusion who give informed consent. A sample size of 48 patients in each randomization arm will be calculated to detect a difference in the reduction of blood loss of approximately 200 ml (90% power and ??=?0.05 (two-tailed)). The primary efficacy endpoint of the trial will be the total intraoperative blood loss based on the randomized dissection technique. The statistical analysis is based on the intention-to-treat population. Patients will be followed up on for three months for complications and adverse events.This prospective, single-center, randomized controlled, single-blinded, two-group parallel trial is designed to assess the efficacy and safety of BiClamp forcep hepatectomy versus clamp crushing for parenchymal transection during elective hepatic resection.This trial was registered with Clinicaltrials.gov (identifier: NCT02197481 ) on 15 July 2014.
| S-EPMC4434524 | biostudies-literature
Project description:Liver transection is the most challenging part of liver resection due to the risk of massive blood loss which is associated with increased postoperative morbidity and mortality, as well as reduced long-term survival after resection of malignancies. Among the devices used for open parenchyma transection, ultrasonic dissection with bipolar cautery forceps is one of the most widely used technique worldwide. We identified four retrospective comparative studies and three randomized controlled trials dealing with the efficacy of ultrasonic dissector (UD) compared with other techniques including the historical clamp crushing technique. UD is associated with similar blood loss and slower resection time compared with water-jet or clamp crushing technique. However, it seems to be more precise in dissecting vessels. Its use does not impact on morbidity and hospital stay compared with other techniques. From an economic point of view, UD is the most expensive technique and may be a disadvantage for low centre volume. UD with bipolar cautery is one of the safest and the most efficient device for liver transection, even if its superiority over the clamp crushing technique has not been well established. It is considered as a standard technique for liver transection.
| S-EPMC2518292 | biostudies-other
Project description:Despite theoretical predictions that graphene should be impermeable to all gases, practical experiments on sealed graphene nanodrums show small leak rates. Thus far, the exact mechanism for this permeation has remained unclear, because different potential leakage pathways have not been studied separately. Here, we demonstrate a sealing method that consists of depositing SiO2 across the edge of suspended multilayer graphene flakes using electron beam-induced deposition. By sealing, leakage along the graphene-SiO2 interface is blocked, which is observed to result in a reduction in permeation rate by a factor of 104. The experiments thus demonstrate that gas flow along the graphene-SiO2 interface tends to dominate the leak rate in unsealed graphene nanodrums. Moreover, the presented sealing method enables the study of intrinsic gas leakage through graphene membranes and can enable hermetic graphene membranes for pressure sensing applications.
| S-EPMC6696884 | biostudies-literature
Project description:The objective was to evaluate 2 primary molar sealant strategies for publicly insured children using an "expected value of perfect information" (EVPI) approach. We converted a 10,000-observation tooth-level cost-effectiveness simulation model comparing 2 primary molar sealant strategies - always seal (AS) and standard care (SC) - with a 1,250-observation child-level model. Costs per child per restoration or extraction averted were estimated. Opportunity losses under the AS strategy were determined for children for whom SC was the optimal choice. We determined the EVPI by multiplying mean opportunity losses by the projected incident population of publicly insured 3-year-olds in the US over 10 years with costs discounted at 2%. All analyses were conducted under assumptions of high and low intrachild correlations between at-risk teeth. The AS strategy cost $43.68 over SC (95% CI: -$5.50, $92.86) per child per restoration or extraction averted under the high intrachild correlation assumption and $15.54 (95% CI $7.86, $23.20) under the low intrachild correlation. Under high intrachild correlation, mean opportunity losses were $80.28 (95% CI: $76.39, $84.17) per child, and AS was the optimal strategy in 31% of children. Under low correlation, mean opportunity losses were $14.61 (95% CI: $12.20, $17.68) and AS was the optimal strategy in 87% of children. The EVPI was calculated at $530,813,740 and $96,578,389 (for high and low intrachild correlation, respectively), for a projected total incident population of 8,059,712 children. On average, always sealing primary molars is more effective than standard care, but widespread implementation of this preventive approach among publicly insured children would result in large opportunity losses. Additional research is needed to identify the subgroups of publicly insured children who would benefit the most from this effective and potentially cost-saving public health intervention.
| S-EPMC4213251 | biostudies-literature
Project description:Right hepatectomy for hepatocellular carcinoma is the most common major operation in liver surgery; therefore, liver surgeons should know the fundamental surgical concept and techniques of the Glissonean pedicle approach. A J-shaped or reversed T laparotomy is performed in the right subcostal area. The Glissonean pedicle approach is performed at the hepatic hilus. In this approach, the right anterior and posterior Glissonean pedicles are encircled and ligated without liver dissection. The right hepatic artery, right portal vein and right hepatic duct in the hepatoduodenal ligament should be divided if the Glissonean pedicles cannot be approached easily. After confirming the border between the right and left liver, the liver parenchyma is dissected from the anterior surface of the liver to the anterior surface of the inferior vena cava (IVC). The V5 and V8 middle hepatic veins are divided and liver dissection is performed along the main middle hepatic vein. Finally, the anterior surface of the IVC and the trunk of the right hepatic vein are identified in the liver. This approach is widely known as the anterior approach described by Lai and Fan (World J Surg 20:314-8, 1996). However, this procedure had already been reported by Takasaki et al. (Shoukakigeka 7:1545-51, 1984) but since they did not report this procedure in English, their pioneering work on the anterior approach has not been recognized. The liver hanging maneuver described by Belghiti et al. (J Am Coll Surg 193:109-111, 2001) is also useful in right hepatectomy. Among the techniques used in right hepatectomy, the Glissonean pedicle approach, the anterior approach and the liver hanging maneuver are considered to be the most important.
| S-EPMC3233663 | biostudies-literature
Project description:The mitochondrial respiratory chain is organized within an array of supercomplexes that function to minimize the generation of reactive oxygen species (ROS) during electron transfer reactions. Structural models of supercomplexes are now known. Another recent advance is the discovery of non-OXPHOS complex proteins that appear to adhere to and seal the individual respiratory complexes to form stable assemblages that prevent electron leakage. This review highlights recent advances in our understanding of the structures of supercomplexes and the factors that mediate their stability.
| S-EPMC3416190 | biostudies-literature