The Aquamantys® system as alternative for parenchyma division and hemostasis in liver resection: a clinical feasibility study

Introduction: The objective of this study was to evaluate the clinical feasibility of a new technique for liver resection based on a bipolar sealing device (Aquamantys®) that has shown high performance in the animal setting in both parenchymal ablation and tissue necrosis. Method: Fifteen patients with colorectal hepatic metastasis and twelve cirrhotic patients with hepatocellular carcinoma underwent partial hepatectomies using the proposed technique for both parenchyma division and hemostasis. Main outcome measures were blood loss per transection area and transection speed, and post-operative morbidity (biliary leakage, hemoperitoneum, liver abscesses, etc). Results: Twelve monosegmentectomies, eight bisegmentectomies and seven atypical resections were performed. No blood transfusion were required both intra-operatively and post-operatively. No mortality was observed. One biliary leakage occurred post-operatively and was treated conservatively. One liver abscess after 6-7 bisegmentectomies occurred and was successfully treated by ultrasound-guided drainage. The median blood loss per transection area 0.8 mL/cm2 (range 0.1-1.9 mL/cm2). Mean post-operative stay was 6 days (range 5-16 days). No statistically significant differences were found comparing resections in normal liver (secondary tumors) and cirrhotic liver. Conclusion: The proposed bipolar sealing device was shown to be safe and to achieve effective parenchymal division and hemostasis, resulting in reduced blood loss. Comparative trials are needed to confirm our preliminary results.