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Moll X, Fondevila D, García-Arnas F, Burdio F, Trujillo M, Irastorza RM, Berjano E, Andaluz A. Comparison of two radiofrequency-based hemostatic devices: saline-linked bipolar vs. cooled-electrode monopolar. Int J Hyperthermia 2022; 39:1397-1407. [DOI: 10.1080/02656736.2022.2140840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Xavier Moll
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Dolors Fondevila
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Félix García-Arnas
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Burdio
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Hospital del Mar, Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Macarena Trujillo
- Department of Applied Mathematics, BioMIT, Universitat Politècnica de València, Valencia, Spain
| | - Ramiro M. Irastorza
- Instituto de Física de Líquidos y Sistemas Biológicos (CONICET), La Plata, Argentina
- Departamento de Ingeniería Mecánica, Universidad Tecnológica Nacional, Facultad Regional La Plata, La Plata, Argentina
| | - Enrique Berjano
- Department of Electronic Engineering, BioMIT, Universitat Politècnica de València, Valencia, Spain
| | - Anna Andaluz
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
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Villamonte M, Burdío F, Pueyo E, Andaluz A, Moll X, Berjano E, Radosevic A, Grande L, Pera M, Ielpo B, Sánchez-Velázquez P. The impact of additional margin coagulation with radiofrequency in liver resections with subcentimetric margin: can we improve the oncological results? A propensity score matching study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 48:82-88. [PMID: 34148824 DOI: 10.1016/j.ejso.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/09/2021] [Accepted: 06/02/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Whereas the usefulness of radiofrequency (RF) energy as haemostatic method in liver surgery has become well established in the last decades, its intentional application on resection margins with the aim of reducing local recurrence is still debatable. Our goal was to compare the impact of an additional application of RF energy on the top of the resection surface, namely additional margin coagulation (AMC), on local recurrence (LR) when subjected to a subcentimeter margin. METHODS We retrospectively analyzed 185 patients out of a whole cohort of 283 patients who underwent radical hepatic resection with subcentimetric margin. After propensity score adjustment, patients were classified into two balanced groups according to whether RF was applied or not. RESULTS No significant differences were observed within groups in baseline characteristics after PSM adjustment. The LR rate was significantly higher in the Control than AMC Group: 12 patients (14.5%) vs. 4 patients (4.8%) (p = 0.039). The estimated 1, 3, and 5-year LR-free survival rates of patients in the Control and AMC Group were: 93.5%, 86.0%, 81.0% and 98.8%, 97.2%, 91.9%, respectively (p = 0.049). Univariate Cox analyses indicated that the use of the RF applicator was significantly associated with lower LR (HR = 0.29, 95% confidence interval 0.093-0.906, p = 0.033). The Control Group showed smaller coagulation widths than the AMC group (p < 0.001). CONCLUSIONS An additional application of RF on the top of the resection surface is associated with less local hepatic recurrence than the use of conventional techniques.
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Affiliation(s)
- María Villamonte
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Fernando Burdío
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain; Hospital del Mar Medical ResearchInstitute (IMIM), Barcelona, Spain.
| | - Eva Pueyo
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Ana Andaluz
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Moll
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Enrique Berjano
- BioMIT, Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain
| | | | - Luís Grande
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Miguel Pera
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Benedetto Ielpo
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Patricia Sánchez-Velázquez
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain; Hospital del Mar Medical ResearchInstitute (IMIM), Barcelona, Spain
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The impact of radiofrequency-assisted transection on local hepatic recurrence after resection of colorectal liver metastases. Surg Oncol 2017; 26:229-235. [DOI: 10.1016/j.suronc.2017.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/22/2017] [Accepted: 04/17/2017] [Indexed: 01/12/2023]
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Quesada R, Poves I, Berjano E, Vilaplana C, Andaluz A, Moll X, Dorcaratto D, Grande L, Burdio F. Impact of monopolar radiofrequency coagulation on intraoperative blood loss during liver resection: a prospective randomised controlled trial. Int J Hyperthermia 2016; 33:135-141. [PMID: 27633068 DOI: 10.1080/02656736.2016.1231938] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To evaluate the impact of using monopolar thermal coagulation based on radiofrequency (RF) currents on intraoperative blood loss during liver resection. MATERIALS AND METHODS A prospective randomised controlled trial was planned. Patients undergoing hepatectomy were randomised into two groups. In the control group (n = 10), hemostasis was obtained with a combination of stitches, vessel-sealing bipolar RF systems, sutures or clips. In the monopolar radiofrequency coagulation (MRFC) group (n = 18), hemostasis was mainly obtained using an internally cooled monopolar RF electrode. RESULTS No differences in demographic or clinical characteristics were found between groups. Mean blood loss during liver resection in the control group was more than twice that of the MRFC group (556 ± 471 ml vs. 225 ± 313 ml, p = .02). The adjusted mean bleeding/transection area was also significantly higher in the control group (7.0 ± 3.3 ml/cm2 vs. 2.8 ± 4.0 ml/cm2, p = .006). No significant differences were observed in the rate of complications between the groups. CONCLUSIONS The findings suggest that the monopolar electrocoagulation created with an internally cooled RF electrode considerably reduces intraoperative blood loss during liver resection.
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Affiliation(s)
- Rita Quesada
- a Cancer Research Group HBP , Fundación Instituto Mar de Investigaciones Médicas , Barcelona , Spain.,b Apeiron Medical , Valencia , Spain
| | - Ignasi Poves
- c General Surgery Department , Hospital del Mar , Barcelona , Spain
| | - Enrique Berjano
- d Department of Electronic Engineering , Universitat Politècnica de València , Valencia , Spain
| | - Carles Vilaplana
- e Clinical Chemistry , Laboratori de Referència de Catalunya, Hospital del Mar , Barcelona , Spain
| | - Anna Andaluz
- f Medicine and Surgery of Animals Department, Facultat de Veterinària , Universitat Autònoma de Barcelona , Bellaterra , Spain
| | - Xavier Moll
- f Medicine and Surgery of Animals Department, Facultat de Veterinària , Universitat Autònoma de Barcelona , Bellaterra , Spain
| | - Dimitri Dorcaratto
- g Hepatobiliary and Liver Transplant Surgical Unit , St. Vincent's University Hospital , Dublin , Ireland
| | - Luis Grande
- c General Surgery Department , Hospital del Mar , Barcelona , Spain
| | - Fernando Burdio
- c General Surgery Department , Hospital del Mar , Barcelona , Spain
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Quesada R, Poves I, Iglesias M, Berjano E, Grande L, Burdío F. Laparoscopic partial splenectomy for giant cyst using a radiofrequency-assisted device: a case report. Surg Case Rep 2016; 2:82. [PMID: 27558744 PMCID: PMC4996810 DOI: 10.1186/s40792-016-0206-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/23/2016] [Indexed: 02/06/2023] Open
Abstract
Background Although radiofrequency-assisted devices have sometimes been used in partial splenectomy, this is not a common technique. This report describes the first case of laparoscopic partial splenectomy using an RF-assisted device (Coolinside) which allows both coagulation and transection of the parenchyma and eventually the protective coagulation of the remnant side. Case presentation A 27-year-old woman was found to have a giant hydatic cyst measuring 12.0 × 14.0 × 16.6 cm that mainly occupied the lower pole of the spleen and retroperitoneal space. The patient underwent a laparoscopic partial splenectomy using an RF-based device designed to accomplish both the coagulation and dissection of the splenic tissue. The estimated blood loss was less than 200 mL. Conclusions Even though RF ablation has traditionally been used for hepatic parenchymal transection, it seems equally suited to partial splenectomy. This device seems to provide good results, minimizing blood loss during partial splenectomy; however, randomized trials will be necessary to see if the results are superior to those of other techniques.
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Affiliation(s)
- R Quesada
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona Doctor Aiguader 88, Barcelona, 08003, Spain.
| | - I Poves
- Unit of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - M Iglesias
- Department of Pathology, Hospital del Mar, Barcelona, Spain
| | - E Berjano
- Biomedical Synergy, Electronic Engineering Department, Universitat Politècnica de València, Valencia, Spain
| | - L Grande
- Unit of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - F Burdío
- Unit of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain
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Radiofrequency pancreatic ablation and section of the main pancreatic duct does not lead to necrotizing pancreatitis. Pancreas 2014; 43:931-7. [PMID: 24977335 DOI: 10.1097/mpa.0000000000000156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether radiofrequency ablation (RFA) of the pancreas and subsequent transection of the main pancreatic duct may avoid the risk of both necrotizing pancreatitis and postoperative pancreatic fistula (POPF) formation. METHODS Thirty-two rats were subjected to RFA and section of the pancreas over their portal vein. Animals were killed at 3, 7, 15, and 21 days (groups 0-3, respectively). Two additional control groups (sham operation and user manipulation only, respectively) of 15 days of postoperative period were considered. Postoperative complications, histological changes (including morphometric and immunohistochemical analysis), and incidence of POPF were evaluated. RESULTS A significant increase in serum amylase levels (P < 0.05) on the third postoperative day, which return to baseline levels in the following weeks, was noted in groups 0 to 3. Those groups showed a rapid atrophy of the distal pancreas by apoptosis with no signs of necrotizing pancreatitis or POPF. The distal pancreas in groups 1 to 3 compared with group 0 and control groups showed a significant increase of small islets (<1000 µm). CONCLUSIONS The rapid acinar atrophy of the distal pancreas after RFA and section of the pancreatic ducts in this model does not lead to necrotizing pancreatitis.
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Radiofrequency is a secure and effective method for pancreatic transection in laparoscopic distal pancreatectomy: results of a randomized, controlled trial in an experimental model. Surg Endosc 2013; 27:3710-9. [DOI: 10.1007/s00464-013-2952-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 03/21/2013] [Indexed: 01/19/2023]
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Dorcaratto D, Burdío F, Fondevila D, Andaluz A, Poves I, Martinez MA, Quesada R, Berjano E, Grande L. Laparoscopic Distal Pancreatectomy: Feasibility Study of Radiofrequency-Assisted Transection in a Porcine Model. J Laparoendosc Adv Surg Tech A 2012; 22:242-8. [DOI: 10.1089/lap.2011.0417] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Dimitri Dorcaratto
- General Surgery Department, Hospital del Mar, Barcelona, Spain
- Department of Surgery, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Fernando Burdío
- General Surgery Department, Hospital del Mar, Barcelona, Spain
- Department of Surgery, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Dolors Fondevila
- Department of Animal Medicine and Surgery, Veterinary Faculty, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Anna Andaluz
- Department of Animal Medicine and Surgery, Veterinary Faculty, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Ignasi Poves
- General Surgery Department, Hospital del Mar, Barcelona, Spain
| | | | - Rita Quesada
- General Surgery Department, Hospital del Mar, Barcelona, Spain
- Department of Biomedical Engineering, Universitat Politecnica de Catalunya, Barcelona, Spain
| | - Enrique Berjano
- Biomedical Synergy, Electronic Engineering Department, Universitat Politecnica de Valencia, Valencia, Spain
| | - Luis Grande
- General Surgery Department, Hospital del Mar, Barcelona, Spain
- Department of Surgery, Universitat Autonoma de Barcelona, Barcelona, Spain
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Ríos JS, Zalabardo JMS, Burdio F, Berjano E, Moros M, Gonzalez A, Navarro A, Güemes A. Single Instrument for Hemostatic Control in Laparoscopic Partial Nephrectomy in a Porcine Model Without Renal Vascular Clamping. J Endourol 2011; 25:1005-11. [DOI: 10.1089/end.2010.0557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Jorge Subirá Ríos
- Department of Urology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | - Enrique Berjano
- Biomedical Synergy, Electronic Engineering Department, Universidad Politécnica de Valencia, Valencia, Spain
| | - Manuel Moros
- Department of Pathology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Ana Gonzalez
- Department of Animal Pathology and Surgery, Veterinary Faculty, University of Zaragoza, Zaragoza, Spain
| | - Ana Navarro
- Department of Surgery A, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Antonio Güemes
- Department of Surgery A, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Martínez-Serrano MÁ, Grande L, Burdío F, Berjano E, Poves I, Quesada R. [Sutureless hepatic transection using a new radiofrequency assisted device. Theoretical model, experimental study and clinic trial]. Cir Esp 2011; 89:145-51. [PMID: 21292248 DOI: 10.1016/j.ciresp.2010.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 10/03/2010] [Accepted: 10/04/2010] [Indexed: 11/17/2022]
Abstract
The ideal instrument for performing hepatic transection should combine safe and rapid haemostasis in a single tool. We present a new multidisciplinary investigation designed to develop a hepatic transection device assisted by radiofrequency (RF); the investigation included: a computerised theoretical model, and experimental study and a clinical trial of this device. The theoretic modelling was performed by computer, based on the Finite Elements Method (FEM), with the objective of studying the distribution of electrical energy and temperature in the tissue, and to assess the effect of the characteristics of the instrument. The experimental study, based on an in vivo porcine model, suggested that the new instrument would allow the transection velocity of the hepatic parenchyma to be increased with lower bleeding per transection area compared with other techniques extensively used in liver surgery. These data should enable the first phase of clinical trial to be conducted, with preliminary results that suggest that the new device is safe and effective.
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Burdío F, Grande L, Berjano E, Martinez-Serrano M, Poves I, Burdío JM, Navarro A, Güemes A. A new single-instrument technique for parenchyma division and hemostasis in liver resection: a clinical feasibility study. Am J Surg 2010; 200:e75-80. [DOI: 10.1016/j.amjsurg.2010.02.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Revised: 02/15/2010] [Accepted: 02/15/2010] [Indexed: 11/25/2022]
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Burdío F, Berjano EJ, Navarro A, Burdío JM, Grande L, Gonzalez A, Cruz I, Güemes A, Sousa R, Subirá J, Castiella T, Poves I, Lequerica JL. Research and development of a new RF-assisted device for bloodless rapid transection of the liver: computational modeling and in vivo experiments. Biomed Eng Online 2009; 8:6. [PMID: 19296852 PMCID: PMC2672929 DOI: 10.1186/1475-925x-8-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 03/18/2009] [Indexed: 11/27/2022] Open
Abstract
Background Efficient and safe transection of biological tissue in liver surgery is strongly dependent on the ability to address both parenchymal division and hemostasis simultaneously. In addition to the conventional clamp crushing or finger fracture methods other techniques based on radiofrequency (RF) currents have been extensively employed to reduce intraoperative blood loss. In this paper we present our broad research plan for a new RF-assisted device for bloodless, rapid resection of the liver. Methods Our research plan includes computer modeling and in vivo studies. Computer modeling was based on the Finite Element Method (FEM) and allowed us to estimate the distribution of electrical power deposited in the tissue, along with assessing the effect of the characteristics of the device on the temperature profiles. Studies based on in vivo pig liver models provided a comparison of the performance of the new device with other techniques (saline-linked technology) currently employed in clinical practice. Finally, the plan includes a pilot clinical trial, in which both the new device and the accessory equipment are seen to comply with all safety requirements. Results The FEM results showed a high electrical gradient around the tip of the blade, responsible for the maximal increase of temperature at that point, where temperature reached 100°C in only 3.85 s. Other hot points with lower temperatures were located at the proximal edge of the device. Additional simulations with an electrically insulated blade produced more uniform and larger lesions (assessed as the 55°C isotherm) than the electrically conducting blade. The in vivo study, in turn, showed greater transection speed (3 ± 0 and 3 ± 1 cm2/min for the new device in the open and laparoscopic approaches respectively) and also lower blood loss (70 ± 74 and 26 ± 34 mL) during transection of the liver, as compared to saline-linked technology (2 ± 1 cm2/min with P = 0.002, and 527 ± 273 mL with P = 0.001). Conclusion A new RF-assisted device for bloodless, rapid liver resection was designed, built and tested. The results demonstrate the potential advantages of this device over others currently employed.
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Navarro A, Burdio F, Berjano EJ, Güemes A, Sousa R, Rufas M, Subirá J, Gonzalez A, Burdío JM, Castiella T, Tejero E, De Gregorio MA, Grande L, Lozano R. Laparoscopic blood-saving liver resection using a new radiofrequency-assisted device: preliminary report of an in vivo study with pig liver. Surg Endosc 2008; 22:1384-91. [DOI: 10.1007/s00464-008-9793-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Revised: 12/31/2007] [Accepted: 01/19/2008] [Indexed: 01/04/2023]
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