Radiofrequency-assisted hepatectomy using bipolar inline® multichannel radiofrequency device (ILMRD): Report of initial clinical experience

Background/Aims: Intraoperative bleeding is a major concern in liver surgery and traditionally portal triad clamping (PTC) has been applied to reduce blood loss. However, this benefit is counterbalanced by the adverse effects of warm ischemia-reperfusion liver injury. The ideal alternative would be to use modern energy devices that minimize bleeding, without needing PTC. One such novel device is the InLine® multichannel radiofrequency device (ILMRD, Resect Medical, Inc., Fremont, CA) that produces coagulative necrosis along the transection plane. Methodology: In the present paper we reviewed 24 consecutive hepatic resections (18 metastases, 5 hepatoma, 1 focal nodular hyperplasia) performed with aid of ILMRD. Statistical analyses were performed with Mann-Whitney and Fisher Exact tests. Results: The mean blood loss was 240ml (range 50-750ml) with only 2 patients requiring blood transfusions. For the first 8 cases the median PTC time was 16 minutes, and in the subsequent 16 cases, not only was there a significant decline in the median clamp time (0 min, p=0.026) but also in the frequency of PTC use (71% vs. 11%, p=0.008). A significant reduction in blood loss was seen when comparing the first 8 versus the subsequent 16 cases (median 350ml vs. 112ml, p=0.016). The median length of hospital and intensive care unit stay for the cohort were 7 and 1 days, respectively. There were no deaths and the major morbidity rate was 16.7%. Conclusion: The use of ILMRD is an innovative approach to minimize blood loss and PTC during parenchymal transection phase of hepatic resection.