Laparoscopic liver surgery: parenchymal transection using saline-enhanced electrosurgery

Abstract

Minimally invasive liver resection (MILR) has evolved considerably in the past decade. Safe hepatic parenchymal transection, has been one of the technical hurdles that has become evident during the growth of MILR. Advances in technology have now made safe liver transection a reality allowing resections of greater magnitude. In this review, the precoagulation approach is described in both methodology and technique. Using this method of liver transection, we have been able to perform MILR of all varieties and magnitudes, with favorable patient outcomes. A detailed description of one particular device will be highlighted to disseminate our experience and thus broaden the technical options for hepatobiliary surgeons wishing to offer their patients a minimally invasive therapy.

Keywords: laparoscopy; liver resection; parenchymal transection.

Figures

Figure 1.

TissueLink Endo SH2.0™ Sealing Hook (SH). Note similarity to laparoscopic hook cautery with added cable, IV tubing, and activation button on handpiece. Inset: hook tip with “toe” and “heel”. (Picture reproduced with permission from TissueLink Medical).

Figure 2.

Sealing Hook and suction during transection. Notice close proximity of the SH and suction apparatus.

Figure 3.

Sealing Hook isolating the intrahepatic left hepatic vein (LHV). Note the smooth transection plane, exposure, and lack of hemorrhage.