Mitsuo Miyazawa, MD PhD FACS, Masayasu Aikawa, MD PhD, Yasuko Toshimitsu, MD PhD, Kojun Okamoto, MD PhD, Kenichirou Takase, MD, Katsuya Okada, MD, Shigeki Yamaguchi, MD PhD, Isamu Koyama, MD PhD. Saitama Medical University International Medical Center
Bleeding control is one of the many issues in which research is required to standardize laparoscopic hepatectomy (Lap H). At this hospital we use laparoscopic bipolar soft coagulation (BiClamp) as a method for hepatic parechymal transection to limit the Lap-H intraoperative bleeding as much as possible. A BiClamp is a clamp-style bipolar electrosurgical knife and can be used to allow liver parenchyma crushing-based parechymal transection. Sonoclot coagulation is possible while preventing the occurrence of sparks by holding the voltage below 200 Vp, supplying the tissue with only high-voltages, and preventing the charring of small vessels and hepatic tissue surrounding vessels. Sealing can also be done by clamping the large Glisson’s capsules and large vessels. We have conducted a laparoscopic lateral segmentectomy of the liver with a BiClamp and will report the results.
(Laparoscopic lateral segmentectomy of the liver with BiClamp) The positional relationship between the large vessels and tumor was determined with a laparoscopic echo. A hepatectomy line is set with an electrosurgical knife, 1 cm left of the falciform ligament as a proposed excision line. Taping is done on the hepatoduodenal ligament if the Pringle method is deemed necessary. Precoagulation is conducted along the hepatectomy line with cool-tip radio waves for parts that are away from the large Glisson’s capsules. Next, liver removal was continued by slowly crushing the liver parenchyma with a BiClamp and this was done twice in the same region to promote sonoclot coagulation. The tissue sealed with the BiClamp was cut with scissors so that 2/3 of the liver would remain. Two-thirds of the remaining side of the liver was severed with scissors so that more than 2 cm of the Glisson’s capsule to the left of the umbilical portion of the portal vein could be sealed. Without fully detaching the left hepatic veins, it was closed by autosuturing including the surrounding hepatic tissues, was severed, and the hepatectomy was completed. In this presentation we demonstrate how BiClamps are used to control bleeding using a video.
Program Number: P507