| Objective:Hepatic resection remains the primary therapeutic approach for several malignant and benign liver diseases. Our previous retrospective analysis provided primary evidence for the efficacy and safety of BiClamp forceps for liver resection.The first section of the present study was to conduct a randomized controlled trial to evaluate the efficacy of BiClamp forceps for elective open liver resection. Since the introduction of the clamp-crushing technique in the 1980s, various techniques have been developed to improve parenchymal transection. However, there is no consensus on the ideal method of liver parenchymal division. The second section of the present study was to evaluate efficacy of the technology-assisted and clamp-crushing technique during liver surgery.Materials and methods: 1. From October 2014 to May 2016, 86 consecutive patientsscheduled to undergo hepatic resection were randomized to a BiClamp forceps group(n = 43) or a clamp-crushing technique group (n = 43). The primary efficacy endpoint of the trial was total intraoperative blood loss according to the randomized dissection technique. Secondary endpoints included operative time, liver transection time, transection speed, incidence and volume of intraoperative blood transfusion,reoperation, postoperative morbidity, mortality, length of postoperative hospital stay,total hospitalization cost. Trial Registration: ClinicaTrials.gov NCT02197481.2. Randomized controlled trials (RCTs) published in English from 1990 to 2017, that compared the clamp-crushing technique and any alternative method of hepatic transection were searched in the Pubmed / Medine/Google scholar/ EMBase and the Cochrane library.Results: Background characteristics of the two groups were closely matched. There were no significant differences between the BiClamp forceps group and clamp-crushing group in total intraoperative blood loss (339.81 ± 257.20 ml vs 376.73±303.67 ml, respectively; P = 0.545) or blood loss per transection area (5.35 ±3.27 ml/cm2 vs 5.44 ±3.02 ml/cm2, respectively; P = 0.609). Liver transection speed, the need of blood transfusion, morbidity, length of postoperative hospital stay, total hospitalization cost and liver function recovery were similar in the two groups.Multivariate logistic regression analysis identified major hepatectomy, multiple resections and liver transection time ≥30 min as significantly unfavorable factors for decreased intraoperative blood loss.2. Fourteenth RCTs evaluating 1258 patients were included. There was no significant difference between the technology-assistedand clamp-crushing technique for the incidence of overall morbidity (RR=0.92, 95%CI: 0.79-1.07, P=0.29), biliary leakage (RR=0.96, 95%CI: 0.67-1.38, P=0.84), mortality (RR=1.42, 95%CI:0.63-3.21, P=0.40) and transfusion rates (RR=1.42, 95%CI: 0.63-3.21, P=0.40) in liver resection. A randomised study showed that radiofrequency-assisted liver resection is associated with a higher rate of postoperative complications than clamp crushing.Conclusions: 1. BiClamp forcep liver parenchymal transection is aneffective and safe tool for experienced hepatobiliarysurgeons without increasing the total costs of hospitalizations.2. we could not draw a firm conclusion that the technology-assisted is superior to clamp-crushing technique in liver resection of transection and the advantage of the technology-assistedtechnique should be evaluatedfurther.Itmakes sense that we should choose appropriate liver transactionmethods and instruments according to our knowledgeof different instruments, combining two or moretechniques as necessary to minimize injury, improve efficacyand maintain cost effectiveness for patients. |
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