Comparison of liver parenchymal ablation and tissue necrosis in a cadaveric bovine model using the Harmonic Scalpel, the LigaSure, the Cavitron Ultrasonic Surgical Aspirator and the Aquamantys devices

Abstract

Objectives: The amount of tissue that is ablated or necrosed at the line of parenchymal transection is of clinical significance in the interpretation of resection margin status following hepatic resection. The aim of this study was to define the extent of parenchymal ablation and necrosis in liver tissue using the Harmonic Scalpel, the LigaSure, the Cavitron Ultrasonic Surgical Aspirator (CUSA) and the Aquamantys dissector ex vivo.

Methods: Mounted blocks of non-perfused bovine liver were transected using the Harmonic Scalpel, LigaSure, CUSA and Aquamantys devices. Outcome measures included parenchymal ablation (ablation band widths and weights) and tissue necrosis band widths along the line of transection. Each experiment was replicated five times.

Results: All devices were associated with parenchymal ablation (Harmonic Scalpel, 4.73 ± 1.62 mm; LigaSure, 4.55 ± 2.02 mm; CUSA, 7.16 ± 2.87 mm; Aquamantys, 4.75 ± 1.43 mm) and tissue necrosis (Harmonic Scalpel, 1.07 ± 0.46 mm; LigaSure, 1.36 ± 0.36 mm; CUSA, 0.81 ± 0.21 mm; Aquamantys, 0.81 ± 0.36 mm).

Conclusions: The Harmonic Scalpel, LigaSure, CUSA and Aquamantys devices were associated with bands of tissue loss along the hepatic parenchymal transection line in this benchtop cadaveric model. This should be taken into account in the interpretation of resection margin status following liver resection.

© 2012 International Hepato-Pancreato-Biliary Association.

Figures

Figure 1

Schematic demonstrating the benchtop cadaveric model

Figure 2

(a) Widths of bands of tissue ablated with the various devices. Comparisons between devices show: A vs. B, P = 0.868; A vs. C, P = 0.139; A vs. D, P = 0.986; B vs. C, P = 0.117; B vs. D, P = 0.832, and C vs. D, P = 0.128. (b) Percentage loss in tissue weight after ablation. The difference between outcomes with devices A and B is significant at P = 0.006. (c) Widths of tissue necrosis adjacent to the ablation zone. Comparisons between devices show: A vs. B, P = 0.047; A vs. C, P = 0.036; A vs. D, P = 0.133; B vs. C, P = 0.003; B vs. D, P = 0.006, and C vs. D, P = 0.897

Figure 3

Haematoxylin and eosin-stained sections (original magnification ×20) of necrotic bands following transection with the (a) Harmonic Scalpel™, (b) LigaSure™, (c) CUSA® and (d) Aquamantys® devices