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British journal of surgery : BJS v.105 no.9, 2018년, pp.1119 - 1127  

Randomized clinical trial of stapler hepatectomy versus LigaSure™ transection in elective hepatic resection

Fritzmann, J.    (Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany   ); Kirchberg, J.    (Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany   ); Sturm, D.    (Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany   ); Ulrich, A. B.    (Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany   ); Knebel, P.    (Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany   ); Mehrabi, A.    (Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany   ); Büchler, M. W.    (Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany   ); Weitz, J.    (Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical  ); Reissfelder, C.   Rahbari, N. N.  
  • 초록  

    Background Previous studies have demonstrated stapler hepatectomy and use of various energy devices to be safe alternatives to the clamp‐crushing technique in elective hepatic resection. In this randomized trial, the effectiveness and safety of stapler hepatectomy were compared with those of parenchymal transection with the LigaSure™ vessel sealing system. Method Patients scheduled for elective liver resection at two tertiary‐care centres were randomized during surgery to stapler hepatectomy or transection with the LigaSure™ device. Total intraoperative blood loss was the primary efficacy endpoint. Transection time, duration of operation, perioperative complications and length of hospital stay were recorded as secondary endpoints. Results A total of 138 patients were analysed, 69 in the LigaSure™ and 69 in the stapler hepatectomy group. Baseline characteristics were well balanced between the groups. Mean intraoperative blood loss was significantly higher in the LigaSure™ group than the stapler hepatectomy group: 1101 (95 per cent c.i. 915 to 1287) versus 961 (752 to 1170) ml ( P = 0·028). The parenchymal transection time was significantly shorter in the stapler group ( P = 0·005), as was the total duration of operation ( P = 0·027). Surgical morbidity did not differ between the groups, nor did the grade of complications. Conclusion Stapler hepatectomy was associated with reduced blood loss and a shorter duration of operation than the LigaSure™ device for parenchymal transection in elective partial hepatectomy. Registration number: NCT01858987 ( http://www.clinicaltrials.gov ).


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