Efficiency of the LigaSure Vessel Sealing System for Recipient Hepatectomy in Liver Transplantation J.C. LaMattina, M. Hosseini, S.A. Fayek, B. Philosophe, and R.N. Barth ABSTRACT Background. Although the LigaSure device is widely used, its use in liver transplanta- tion, where compounding factors of portal hypertension, coagulopathy, and thrombocyto- penia exist, is poorly described. Methods. From October 1, 2011, to December 31, 2011, 6 patients underwent liver transplantation with recipient hepatectomy utilizing the LigaSure device. Outcomes using the device were compared with 6 contemporaneous patients in whom the device was not used. Results. Patient demographics, preoperative laboratory values, and Model for End- Stage Liver Disease scores were not different. Recipient hepatectomy was performed, on average, 43 minutes faster using the LigaSure device (P = .02). Although total operative time and intraoperative blood product usage were lower when the LigaSure was used, these differences did not attain statistical significance. Duration of stay and recipient readmission rates were similar. Conclusions. LigaSure vessel sealing is an efficient method for recipient hepatectomy in liver transplantation. Vessel sealing of caval, portal, and other structures can be safely performed in the setting of end-stage liver disease. T HE LIGASURE bipolar electrosurgical device was introduced into clinical practice 10 years ago. It has been shown to seal arteries up to 7 mm and veins up to 12 mm in a wide variety of clinical applications, and its use in hepatobiliary surgery is well reported. 1–6 Although this device is widely used in hepatic resections, transplant surgeons have been slow to incorporate this technology into the recipient hepatectomy procedure. This may, in part, be owing to concerns regarding the use of the device in patients with portal hypertension, coagulopathy, and thrombocytope- nia. Although there have been case reports of the use of the LigaSure in patients with portal hypertension, 7 only re- cently did Yao et al 8 report a randomized trial of esopha- gogastric devascularization in patients with portal hyperten- sion. The piggyback technique for liver transplantation requires division of numerous hepatocaval venous branches to preserve the recipient inferior vena cava. These venous branches can be difficult to access in the tight space between the liver and cava. Vessel sealing devices in these cases require small caliber jaws and compact handpieces. Futher- more, they must be able to seal vessels without significant thermal spread which could damage the vena cava. METHODS From October 1, 2011, to December 31, 2011, 6 patients underwent liver transplantation utilizing the LigaSure device (Covidien, Boul- der, Colo). The LigaSure small jaw hand-activated model was employed in all cases (instrument length, 19 cm; seal width, 1–3 mm; seal length, 16.5 mm; mean thermal spread, 2 mm). We retrospectively analyzed prospectively collected data to compare with a contemporaneous group in whom the LigaSure was not used. This study was conducted under institutional review board approval and protocols conform to the ethical guidelines of the 1975 Helsinki Declaration. Intraoperative and perioperative events were compared between the 2 groups. The primary outcomes of interest were perioperative patient and allograft survivals, intraop- From the Division of Transplantation (J.C.L., R.N.B.), Univer- sity of Maryland School of Medicine, the Department of Surgery (M.H.), Saint Agnes Hospital, Baltimore, Maryland, the Division of Abdominal Transplant (S.A.F.), Rush University Medical Cen- ter, Chicago, Illinois, and the Division of Transplantation (B.P.), Johns Hopkins Hospital, Baltimore, Maryland. Address reprint requests to John C. LaMattina, MD, Division of Transplantation, University of Maryland School of Medi- cine, 29 South Greene Street, Suite 200, Baltimore, MD 21201. E-mail: jlamattina@smail.umaryland.edu © 2013 by Elsevier Inc. All rights reserved. 0041-1345/–see front matter 360 Park Avenue South, New York, NY 10010-1710 http://dx.doi.org/10.1016/j.transproceed.2012.11.022 Transplantation Proceedings, 45, 1931–1933 (2013) 1931