BiClamp® vessel-sealing device for open hepatic resection of malignant and benign liver tumours: a single-institution experience

BACKGROUND

Intraoperative blood loss during hepatectomy worsens prognosis, and various tools have been used to improve perioperative safety and feasibility. We aimed to retrospectively evaluate the feasibility and safety of the BiClamp® device for open liver resection.

METHODS

We included 84 patients undergoing liver resection from a single centre, with all patients operated by the same surgical group. All hepatectomies were performed using BiClamp® (Erbe Elektromedizin GmbH, Tubingen, Germany), an electrosurgical device that simultaneously transects liver parenchyma and seals vessels <7 mm in diameter. We collected data on intraoperative blood loss, resection time, and perioperative complications, comparing cirrhotic and non-cirrhotic patients.

RESULTS

The 84 patients enrolled in this study included 56 cirrhotic and 28 non-cirrhotic patients. All patients underwent hepatectomy (30 major and 54 minor hepatectomies) using the BiClamp®, exclusively, and 54 patients required inflow occlusion (Pringle manoeuvre). Overall intraoperative blood loss (mean ± standard deviation) was 523.5 ± 558.6 ml, liver parenchymal transection time was 36.3 ± 16.5 min (range, 13-80 min), and the mean parenchymal transection speed was 3.0 ± 1.9 cm²/min. Twelve patients received perioperative blood transfusion. The cost of BiClamp® for each patient was 800 RMB (approximately 109€). There were no deaths, and the morbidity rate was 25%. The mean (standard deviation) hospital stay was 9.3 (2.3) days. Comparisons between cirrhotic and non-cirrhotic patients revealed no difference in blood loss (491.0 ± 535.7 ml vs 588.8 ± 617.5 ml, P = 0.598), liver parenchymal transection time (34.1 ± 14.8 min vs 40.9 ± 19.2 min, P = 0.208), mean parenchymal transection speed (3.3 ± 2.1 cm²/min vs 2.5 ± 1.3 cm²/min, P = 0.217), and operative morbidity (28.6% vs 14.3%, P = 0.147).

CONCLUSIONS

The reusable BiClamp® vessel-sealing device allows for safe and feasible major and minor hepatectomy, even in patients with cirrhotic liver.

TRIAL REGISTRATION

This trial was retrospectively registered and the detail information was as followed. Registration number: ChiCTR-ORC-17011873 (Chinese Clinical Trial Registry). Registration Date: 2017-07-05.

Is bipolar thermofusion an acceptable option for unseparated interlobar fissure division in pulmonary lobectomy?

OBJECTIVES

This study aimed to review the safety of a reusable sealing instrument, BiClamp(®), as an alternative to the mechanical stapler for interlobar fissure division in pulmonary lobectomy.

METHODS

A retrospective review was conducted of 95 patients who underwent pulmonary lobectomy performed by a single surgeon between November 2005 and March 2010. The patients were divided into two groups according to the period before and after introduction of the BiClamp(®): 29 patients who underwent fissure division with staples only (staple group) and 66 patients who underwent the same procedure mainly with the instrument (BiClamp(®) group).

RESULTS

There were 60 (63.2%) male and 35 (36.8%) female patients, with a mean ± SD age of 67.5 ± 10.8 years. Comparison of the characteristics of the two groups revealed that the BiClamp(®) group included significantly more cases of lobectomy by video-assisted thoracic surgery and far fewer completely lobulated lungs; 6 of 66 patients (9.1%) compared with 9 of 29 (31.0%) of the staple group. Except for 18 patients who underwent division using staples owing to thick parenchyma of the interlobar fissure, we attempted to divide the fissure of 42 patients in the BiClamp(®) group. Solo use of the BiClamp(®) was possible for 25 of 60 patients (41.7%) with an incomplete fissure. Eight patients (13.3%) needed one staple cartridge in combination with BiClamp(®), five (8.3%) needed two cartridges and four (6.7%) patients needed three (combined use). In most cases, except for right upper or middle lobectomy, the division of the interlobar fissure could be performed by sole use of the BiClamp(®). Incidence rates of prolonged air leakage and pneumonia were not significantly different between the two groups (respectively, 6.9 and 3.4% in the staple group vs 10.6 and 9.1% in the BiClamp(®) group).

CONCLUSIONS

The study results demonstrate that the division of the interlobar fissure in pulmonary lobectomy with BiClamp(®) is safe and feasible in most cases. While the results point out the limitation that division of the right upper or middle lobe may still be a challenge, they show the potential benefit of staple reduction. Less use of staples results in reduced medical costs and carbon dioxide emission, contributing to 'ecosurgery', which ultimately conserves the global environment.