SEALIVE: the use of technical vessel-sealing devices for recipient hepatectomy in liver transplantation: study protocol for a randomized controlled trial

LigaSure versus monopolar cautery for recipient hepatectomy in liver transplantation: a propensity score-matched analysis

Background

Recipient hepatectomy during liver transplantation (LT) is one of the most challenging aspects of surgery due to the possibility of massive bleeding. This study aimed to compare and analyze the effectiveness between LigaSure and monopolar cautery in recipients.

Methods

We reviewed 187 recipients who underwent LT from March 2019 to June 2020. We compared the surgical outcomes of the 69 recipients who underwent recipient hepatectomy with LigaSure (LigaSure group) and 118 recipients who underwent with monopolar cautery. Propensity score matching (PSM) was performed using the nearest-neighbor method at a ratio of 1:1 based on 14 baseline characteristics and possible factors that influence postoperative bleeding.

Results

A total of 187 adult recipients were reviewed retrospectively. In the propensity score-matched analysis, The rates of bleeding and infectious complication were significantly lower in the LigaSure group than in the monopolar cautery group (3/69, 4.35% versus 13/69, 18.8%; P=0.015 and 1/69, 1.45% versus 9/69, 13.0%; P=0.017). The length of postoperative hospital stay was shorter in the LigaSure group (mean: 23.1±16.1 versus 39.6±58.2 days; P=0.024).

Conclusions

Recipient hepatectomy with LigaSure is associated with a short hospital stay due to low re-operation rates, postoperative bleeding, and secondary infection related to bleeding.

Efficacy of Lymphatic Sealing Using the LigaSure in Kidney Transplantation: A Pilot Study

BACKGROUND

Iliac vessel lymphatic ligation is critical in kidney transplantation, because it is associated with the occurrence of lymphocele. Lymphocele can also affect the renal graft. This study aimed to evaluate the efficacy of lymphatic sealing using LigaSure (an electrothermal bipolar sealing device) in kidney transplantation as compared with conventional silk-tie ligation.

METHODS

This retrospective study included 100 consecutive patients from a prospectively registered database who underwent kidney transplantation at Seoul St. Mary's Hospital, South Korea, between December 1, 2019 and November 12, 2020. Comorbidities, primary renal disease, transplantation variables, surgical variables, and posttransplantation outcomes were compared between conventional and LigaSure lymphatic ligations. Subgroup analyses were performed by anastomosis pattern.

RESULTS

The mean age of patients was 47.4 ± 12.40 (range, 24-73) years. The LigaSure and conventional groups comprised 50 (50%) patients. Hypertension history, number of anastomosed renal arteries, and anastomosis patterns differed significantly between groups (P < .05). No significant difference was found in postoperative outcomes. In the subgroup analysis, greater drain volume was found at postoperative day 1 in the end-to-end internal iliac artery-renal artery anastomosis group (P = .001) because the internal iliac artery dissection results in longer lymphatic ligation. Nevertheless, no differences in drain removal time (P = .528) or lymphocele incidence were found between subgroups.

CONCLUSION

LigaSure is expected to benefit from surgery time and will be identified in subsequent studies. LigaSure can be safely and comfortably used for iliac lymphatic ligation in kidney transplantation. In conclusion, LigaSure lymphatic ligation is superior to conventional lymphatic ligation in kidney transplantation.