Tissue Management With Tri-Staple Technology in Major and Minor Laparoscopic Liver Resections

One of the most relevant technologic advancements in laparoscopic liver resection (LLR) is owing to the improved ability to safely secure and divide vascular and biliary structures and the liver parenchyma by the use of endostaplers. We compared, retrospectively, 35 LLRs with the Tri-Staple technology versus 57 LLRs without, during a 14-month period. Colorectal liver metastases were overall the main indication for LLR. Neither major hepatectomy nor left lateral sectionectomy was done in the nonstapled group. Mean surgical time and blood loss were similar, whereas the tumor number and size were significantly larger in the stapled group (P ≤ 0.01). The conversion rate was 0% and 3.5% (n = 2); and the morbidity rate was 9% (n = 3) and 12% (n = 7), respectively, in the stapled and nonstapled group (P = 0.8). No overall 3-month mortality was recorded. Endo GIA Reloads with Tri-Staple technology allow a proper division of the intrahepatic vessels and biliary structure. These devices in LLRs are safe and feasible, allowing major hepatectomy and complex cases as 2-staged procedures and laparoscopic living donor liver resections.Key words: Laparoscopic liver resection, Minimally invasive liver surgery, Endo-staplers, Tri-Staple technology, Laparoscopic living donor liver resectionThere has been exponential growth of reported experiences of laparoscopic liver resection (LLR) since the first procedure was performed in 1992, with more than 3000 published procedures available worldwide today.^1–7 Meticulous knowledge of surgical anatomy of the liver, improvements in perioperative care, development of newer instruments, enhanced diagnostic imaging, and advancement in laparoscopic skills are considered the major advances that have been achieved in this field.The indications for laparoscopic hepatic resection are usually the same as the standard approach, as previously advised by the Louisville Statement Consensus Conference.⁸ Although LLR was initially indicated for benign lesions, the recurrence pattern has been shown to be similar to that described for open resection of colorectal liver metastases (CRLM) and/or hepatocellular carcinoma, reporting outcomes at least as good as those reported for open surgery.^9–14In addition, laparoscopic living liver donor hepatectomy has demonstrated its potential role especially in left lateral sectionectomy procurement, where it looks to be more appropriate compared with laparoscopic-assisted techniques in right-lobe living liver donation.^15,16One of the most relevant technologic advancements in minimally invasive liver surgery is owing to the improved ability to safely secure and divide vascular and biliary structures and eventually the liver parenchyma. For this, endostaplers are playing a very important role.The Endo GIA Reloads with Tri-Staple technology (Covidien Europa, Dublin, Ireland) were introduced in 2010 and have been utilized for LLR at Ghent University Hospital since April 2011 as part of standard of care.The Department of General, Hepatobiliary, and Pancreatic Surgery at the Ghent University Hospital started a systematic program of laparoscopic liver surgery in 2004. Today, more than 60% of all resectional procedures are done by laparoscopy.The purpose of this study is to analyze the personal experience and overall results in major and minor LLR comparing stapled versus nonstapled groups.