Optimum Hepatic Parenchymal Dissection to Prevent Bile Leak: A Comparative Study Using Electrosurgical and Stapling Devices in Swine

[Abstract] [Background] Bile leakage is a serious complication of liver resection, and its treatment is very time-consuming. In open liver resection, Glisson's sheaths are usually disconnected by ligation to the extent possible during the parenchyma dissection. However, in laparoscopic surgery, the ligation, suture, and hemostasis are more difficult than in open surgery. For this reason, in laparoscopic liver resection, liver parenchyma dissection is generally accomplished using electrosurgical or stapling devices. [Purpose] The purpose of this study was to verify the authenticity of electrosurgical devices attached an automatic irrigation function (AI) and stapling devices for laparoscopic liver parenchymal dissection. [Methods] Four devices were used for liver parenchymal dissection in laparoscopic hepatic wedge resection, in pigs: monopolar high-frequency electric cautery attached AI (MCI) (n=6), bipolar high-frequency electric cautery attached AI (BCI) (n=6), bipolar tissue sealing system (LigaSureTM) attached AI (BSI) and an endoscopic stapling device (ECHELON FLEXTM ENDOPATH(R)) (ES). In each group, burst pressures were tested using an electronic manometer, paying special attention to the location(s) of the first disruption(s). The dissected tissues were examined histologically. [Results] Pressures used in electrosurgical devices attach AI were significantly higher compared to pressures used in a ES (P