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| Abstract |
Background : Bile leakage is a serious complication of liver resection, and its treatment is very time-consuming. In open liver resection, Glisson's sheaths are usually disconnected by ligation to the... extent possible during the parenchyma dissection. However, in laparoscopic surgery, the ligation, suture, and hemostasis are more difficult than in open surgery. For this reason, in laparoscopic liver resection, liver parenchyma dissection is generally accomplished using electrosurgical or stapling devices. Purpose : The purpose of this study was to verify the authenticity of electrosurgical devices attached an automatic irrigation function (AI) and stapling devices for laparoscopic liver parenchymal dissection. Methods : Four devices were used for liver parenchymal dissection in laparoscopic hepatic wedge resection, in pigs : monopolar high-frequency electric cautery attached AI (MCI) (n = 6), bipolar high-frequency electric cautery attached AI (BCI) (n = 6), bipolar tissue sealing system (LigaSure™) attached AI (BSI) and an endoscopic stapling device (ECHELON FLEX™ ENDOPATH®) (ES). In each group, burst pressures were tested using an electronic manometer, paying special attention to the location (s) of the first disruption (s). The dissected tissues were examined histologically. Results : Pressures used in electrosurgical devices attach AI were significantly higher compared to pressures used in a ES (P < 0.001). While thermal denaturation of the liver parenchyma occurred at approximately 2-3 mm of depth when bipolar high-frequency electric cautery was used for dissection, it reached up to more than 10 mm with monopolar high-frequency electric cautery. All of the first disruption points of stapling were at stapling line. Conclusions : Electrosurgical devices with an automatic irrigation function are useful devices to dissect the liver parenchyma.
【背景】術後胆汁漏は肝切除術の重大な合併症の一つであり，一旦発生すると治療に難渋する事も稀ではない．このため開腹下での肝切除においては，Glisson鞘は可能な限り結紮して閉鎖されている．しかし，腹腔鏡下では結紮，縫合の操作は開腹手術に比べ極めて時間を要する．このため腹腔鏡下では肝実質切離も電気手術器機による凝固あるいは吻合器によって行われているのが現状である．【目的】大動物(ブタ)を用いた肝切離において，電気手術器具あるいは吻合器での肝実質切離の安全性と胆汁漏の原因を検討する．【方法】4種類の器具①モノポラー高周波凝固器具に自動生理食塩水滴下装置を装着した器具(MCI)，②バイポーラ高周波凝固器具に自動生理食塩水滴下装置を装着した器具(BCI)，③バイポーラ血管シーリング装置(LigaSure™)に自動生理食塩水滴下装置を装着した器具(BSI)，④腹腔鏡下自動吻合器(ECHELON FLEX™ ENDOPATH®)(ES)をを用いて腹腔鏡下に楔状肝切除を行った．切離時間，術中出血量，胆管の耐圧力測定および組織学的に比較検討した．【結果】電気手術器機に比べ吻合器は切離時間は短く，出血量は多く，胆管耐圧力は低い結果であった．上記に関しては3種の電気手術器機間での違いは認められなかったが，組織学的にはモノポーラがボイポーラ電気手術器機に比べ，熱による肝実質障害が深い部分にまで及んでいた．【結語】電気手術器具に自動生理食塩水滴下装置を装着した器具での肝実質切離では高い胆管耐圧力が得られ結紮の必要はないと考えられる．show more
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