1. What kind of energy devices should be used for laparoscopic liver resection? -Recommendations from a systematic review
- Author
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Brice Gayet, Juan Pekolj, Giulio Belli, Olivier Scatton, Raffaele Brustia, Go Wakabayashi, Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Institut Mutualiste de Montsouris (IMM)
- Subjects
medicine.medical_specialty ,Liver tumor ,Transection ,Blood Loss, Surgical ,[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery ,Resection ,ER Electronic resection ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,US Ultrasonic Scalpel ,Blood loss ,Stap Stapler Hepatectomy ,Hepatectomy ,Humans ,Medicine ,Laparoscopy ,ComputingMilieux_MISCELLANEOUS ,Study quality ,Hepatology ,medicine.diagnostic_test ,Hemostatic Techniques ,business.industry ,Energy Device ,HS Harmonic Scalpel ,[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,Evidence-based medicine ,medicine.disease ,LLR Laparoscopic Liver Resection ,Hemostasis, Surgical ,3. Good health ,Surgery ,Dissection ,Sealing Abbreviations: ED Energy Devices ,030220 oncology & carcinogenesis ,Hemostasis ,Liver Surgery ,Liver Tumor ,030211 gastroenterology & hepatology ,RFAD Radio Frequency Assisted Device ,business ,LS LigaSure - Abstract
Transection methods and hemostasis achievement have an impact on blood loss, and consequently on outcome and survival. However, no consensus exists on parenchymal transection or hemostasis techniques in laparoscopic liver resection (LLR). The aim of this review is to clarify the role of energy devices (ED) in LLR. ED is a generator of mechanic or electric energy transfer to an operating tool, used for transection, sealing or both. Searches were performed in PubMed, PubMed Central, Cochrane, Embase, Google Scholar in human or animal experimental models. Each study quality was graded following the GRADE system. From 1996 to 2014, 30 studies were found: five comparative, one prospective, two case-control, and 16 case series and some case reports, with level of evidence ranging from Moderate to Very Low. Since 2012, the Research and Development of new tools raised quicker than clinical studies could follow. The two main techniques emerged are blind transection versus sharp dissection: due to the low quality and heterogeneity of the studies, no firm conclusion can be drawn, but meticulous dissection of vessels usually never leads to vascular damage. As a matter of fact, ED, though efficient and reliable, cannot replace the basic skills of hepatic surgery: sharp dissection, vascular control and elective sealing.
- Published
- 2015
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