The role of vascular stapling devices in major hepatic resections has extended beyond control of inflow and outflow vessels, to application in hepatic parenchymal transection. We report use of stapling device in a right hemihepatectomy for a solitary 8 cm metastasis from a cloacogenic anal canal carcinoma in a 69 year old female. She underwent Nigro protocol for treatment of the primary, and follow-up biopsy showed no residual disease in the anal canal.
The right hepatic vein was divided outside the liver with US Surgical Endo GIATM vascular stapler after division of the short hepatic veins. Following ligation of the right hepatic artery, the extra-hepatic right portal vein and right hepatic duct were separately divided with the vascular stapler, staying to the right side of the gallbladder fossa. After intra-operative ultrasound to delineate the transection plane, the liver capsule was divided with electrocautery to a depth of one cm. The hepatic parenchymal slice was accomplished with sequential application of the Ethicon EZ45TM linear stapler, facilitated by pre-tunneling with a blunt Kelly clamp.
Estimated blood loss was 75 mL. No peri-operative blood transfusion was required, and there was no post-operative bile leak. Pringle clamp time was 5 minutes. Final pathological assessment confirmed tumor-free margins. The patient was discharged home on POD#5. Follow-up CT scan at 12 months showed no evidence of recurrence in the liver, however subsequent surveillance demonstrated pulmonary recurrence.
Stapled right hemihepatectomy technique is a safe, rapid, and hemostatic method of dividing the liver parenchyma.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Engstrom PF, Benson AB 3rd, Chen YJ, Choti MA, Dilawari RA, Enke CA, Fakih MG, Fuchs C, Kiel K, Knol JA, Leong LA, Ludwig KA, Martin EW Jr, Rao S, Saif MW, Saltz L, Skibber JM, Venook AP, Yeatman TJ. National Comprehensive Cancer Network. Anal canal cancer clinical practice guidelines in oncology. J Natl Compr Canc Netw 2005; 3:510–5
McEntee GP, Nagorney DM. Use of vascular staplers in major hepatic resections. Br J Surg. 1991; 78:40–1
Yanaga K, Nishizaki T, Yamamoto K, Taketomi A, Matsumata T, Takenaka K, Sugimachi K. Simplified inflow control using stapling devices for major hepatic resection. Arch Surg 1996; 131:104–6
Ramacciato G, Balesh AM, Fornasari V. Vascular endostapler as aid to hepatic vein control during hepatic resections. Am J Surg 1996; 172:358–62
Scudamore CH, Buczkowski A, Chung SW, Poostizadeh A. Stapler technique for extrahepatic vascular control during hepatic resection. J Invest Surg 1997; 10:59–61
Fong Y, Blumgart L. Useful Stapling Techniques in Liver Surgery. J Am Coll Surg. 1997; 185:93–100
Shapiro AM, Scudamore CH, Buczkowski AH, Chung SW, Patterson EJ. Surgical Staplers for Vascular Control of Hepatic Veins and Portal Structures in Major Hepatic Resection. Surg Technol Int 1998; VII:43–7
Wrightson WR, Edwards MJ, McMasters KM. The role of the ultrasonically activated shears and vascular cutting stapler in hepatic resection. Am Surg 2000; 66:1037–40
Holmin T, Zilling T. Human liver resection with the aid of a stapling device. Anticancer Res 2003; 23:1697–700
Wang W, Fan ST. Use of the Endo-GIA vascular stapler for hepatic resection. Asian J Surg 2003; 26:193–6
Kaneko H, Otsuka Y, Takagi S, Tsuchiya M, Tamura A, Shiba T. Hepatic resection using stapling devices. Am J Surg 2004; 187:280–4
Smith DL, Arens JF, Barnett CC Jr, Izzo F, Curley SA. A prospective evaluation of ultrasound-directed transparenchymal vascular control with linear cutting staplers in major hepatic resections. Am J Surg 2005; 190:23–9
Schemmer P, Friess H, Hinz U, Mehrabi A, Kraus T, Z’graggen K, Schmidt J, Uhl W, Buchler M. Stapler Hepatecomy is a safe dissection technique: Analysis of 300 patients. World Journal of Surgery 2006; 30:419–30
Balaa F, Gamblin TC, Tsung A, Marsh WJ, Geller DA. Right Hepatic Lobectomy Using the Staple Technique in 101 Patients. Journal of Gastrointestinal Surgery. doi: 10.1007/s11605-007-0236-6
Electronic supplementary material
About this article
Cite this article
Balaa, F.K., Gamblin, T.C., Heckman, J.T. et al. Right Hemihepatectomy for Metastatic Cloacogenic Carcinoma using the Staple Technique. Ann Surg Oncol 15, 233–234 (2008). https://doi.org/10.1245/s10434-007-9642-y
- Hepatic Resection
- Staple Technique
- Major Hepatic Resection
- Vascular Stapler
- Gallbladder Fossa