Laparoscopic Hepatic Transection Using Bipolar Radiofrequency Ablation (EnSeal)

Abstract

Hepatic parenchymal transection under laparoscopic conditions remains a formidable challenge without a defined optimal technique. Because of the unique technical challenges of laparoscopic liver resection, devices that can both coagulate and safely transect small vessels and bile ducts are an important adjunct to the use of endomechanical stapling devices. At present, the authors’ preferred energy device for laparoscopic hepatic parenchymal precoagulation transection (PCT) is the bipolar radiofrequency device (BRF, EnSeal; Ethicon Endo-Surgery, Cincinnati, OH). The device allows the surgeon to seal and transect small to large vessels and tissue bundles, and is approved for transection of blood vessels up to 7 mm in size. Bipolar radiofrequency energy uses a unique “line-of-sight” form of energy delivery which is described in detail herein. It is ideally suited for laparoscopic use, and has been tested and used in vivo in colorectal surgery, where it has been used to safely transect the inferior mesenteric artery and vein without incident. As with most energy devices, there is a short learning curve and a few caveats that should be considered when using the device, such as the avoidance of staples between the jaws. Overall, the bipolar radiofrequency device offers very secure vessel sealing and excellent ergonomics that provide both tissue sealing and cutting in one surgeon-controlled movement.

Contribution from the Department of Surgery, Roger Williams Medical Center, Providence, RI.