Laparoscopic nonanatomic hepatic resection employing the LigaSure device.

BACKGROUND: Advancements in technology have allowed laparoscopic surgery to expand into advanced procedures such as liver resection; however, the value and safety of laparoscopic liver surgery is still a topic for debate. This study was designed to evaluate the feasibility and outcome of laparoscopic nonanatomic hepatectomy using the LigaSure device in a swine model. METHODS: Nonanatomic hepatic lobe resection was performed in 3 groups comparing the open finger-fracture method, the open method with the LigaSure device, and the laparoscopic method with the LigaSure device. The cut surfaces of the liver were evaluated for bleeding and biliary leakage at the time of the operation. The animals were inspected 48 hours later for hemorrhage and evaluated with cholescintigraphy (hepatobiliary iminodiacetic acid [HIDA] scan) for biliary leakage, in addition to histological evaluation of liver specimens. RESULTS: No hemorrhage or biliary leakage was noted in the groups where the LigaSure device was used, whereas 1 animal from the open finger-fracture method sustained a bile leak observed on HIDA scan. The operative blood loss was considerably less in the groups where the LigaSure device was used, and the shortest operative time was observed in the laparoscopic group. CONCLUSIONS: The LigaSure device can be safely and effectively used to perform a laparoscopic nonanatomic hepatectomy.

Use of the LigaSure vessel sealing device in laparoscopic living-donor nephrectomy.

BACKGROUND: Laparoscopic living-donor nephrectomy has gained acceptance within the transplant community. The technique requires advanced laparoscopic techniques, and great care must be taken to ensure safety of the operation for the donor and transplantability of the donor kidney. Minimizing the risk of bleeding and trauma to the kidney are important features of a successful living-donor nephrectomy. Improved laparoscopic instrumentation has afforded greater safety and efficacy through technical advances. METHODS: The LigaSure device was used in 124 consecutive living-donor nephrectomies beginning in 1999. A transplant database was reviewed for operative statistics including intraoperative blood loss and operating time. RESULTS: The LigaSure device was used to dissect and seal all venous and arterial branches. Estimated blood loss was 90 +/- 53 mL. A suction device was required in only 40 (32%) of the cases. No patient experienced postoperative bleeding. There were two donor complications: one incisional hernia and one ileus. All kidneys functioned immediately upon reperfusion. CONCLUSIONS: The LigaSure device is an extremely effective tool for obtaining hemostasis by sealing both venous and arterial branches of the major renal vessels. This is also effective in sealing lymphatic tissues and thereby facilitating dissection. Avoiding the use of metallic clips simplified final division of the renal artery and vein. As with any laparoscopic instrument, the anatomic geometry of the operative field may limit use based upon port placement.