Gyrus PlasmaKinetic bipolar coagulation device for liver resection Jeremy Tan, Andrew Hunt, Ruwan Wijesuriya, Luc Delriviere and Andrew Mitchell Transplant and Hepatobiliary Unit, Department of General Surgery, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia Key words Gyrus PlasmaKinetic bipolar coagulation device liver resection. Abbreviations AMI, acute myocardial infarction; CUSA, Cavitron Ultrasonic Surgical Aspirator; HCC, hepatocellular carcinoma; ICU, intensive care unit; UTI, urinary tract infection. Correspondence Dr Jeremy Tan, Transplant and Hepatobiliary Unit, Department of General Surgery, Sir Charles Gairdner Hospital, Western Australia. Email: jthtan1@gmail.com or jthtan2@netscape.net J. Tan MBBS, FRACS; A. Hunt B Med; R. Wijesuriya MBBS, MRCS, MS; L. Delriviere MA, MBBS, FRCS; A. Mitchell MBBS, FRACS Accepted for publication 6 September 2008. doi: 10.1111/j.1445-2197.2009.05091.x Abstract Background: Liver parenchymal transection can be associated with significant blood loss and morbidity. We present our initial experience with the Gyrus PlasmaKinetic coagulation device in liver parenchymal resection in both cirrhotic and non-cirrhotic patients. Methods: Liver resections were performed in 51 consecutive patients, from 20 July 2005 to 31 August 2007, using the Gyrus PlasmaKinetic coagulator. Requirement for blood transfusions, operating time, duration of hospital stay and major complications were evaluated initially for the group as a whole. Subsequently, the 11 patients with histologically confirmed cirrhosis (nine men, two women, median age 54 years, range 24–74 years) were compared with 40 patients without cirrhosis (25 men, 15 women, median age 57 years, range 24–87 years). Results: There were 34 men and 17 women. The median age was 56 (range 24–87 years). There were 48 open procedures and 3 laparoscopic procedures. There were 30 major resections (>2 segments) and 21 minor resections (one to two segments). The overall median operating time was 260 min (range 90–690). Length of stay had a median of 9 days, range 4–50 days. Twenty-one patients (41%) required a blood transfusion. Two biliary leaks were observed in non-cirrhotic patients initially before the settings of the Gyrus device were optimized. Conclusions: The Gyrus PlasmaKinetic coagulation device is a novel instrument for hepatic parenchymal transection in liver resection, which can be safely used in cirrhotic and non-cirrhotic patients. Introduction Hepatic parenchymal transection during liver resection has tradition- ally been performed using finger fracture, and clamp and crush techniques. Over recent years, there have been a number of adjunc- tive devices used to help in achieving the goals of accurate time- efficient transection, secure haemostasis and minimization of post-operative bile leaks. These devices include the LigaSure device, the harmonic scalpel, use of bipolar diathermy, argon beam coagu- lation, hydrojet dissector, Cavitron Ultrasonic Surgical Aspirator (CUSA) dissector and the TissueLink Floating Ball dissecting sealer. 1–5 The fact that there are so many different devices available implies that none of them alone is perfect. The aim of this study was to assess the safety and efficacy of a ‘next-generation’ bipolar diathermy device for hepatic parenchymal transection in liver resec- tions: the Gyrus PlasmaKinetic pulsed bipolar coagulation device (Gyrus Medical, Inc., Maple Grove, MN, USA). This is a device that delivers a uniform seal that can be used for vessels up to 7 mm. Thermal spread and sticking to tissues is reduced by a cooling period after each pulse as the impedance of the coagulated tissue increases. It has previously been used widely in gynaecological surgery, but its use for liver resection is relatively novel. 6 Methods Fifty-one patients who underwent liver resections using the Gyrus PlasmaKinetic pulsed bipolar coagulation device were evaluated. The study period was from 20 July 2005 to 31 August 2007. Patients were defined as ‘cirrhotic’ based on the histopathological findings of their resection specimen. Terminology for liver resection and anatomy is as per the Bris- bane 2000 terminology of the International Hepato-Pancreato- Biliary Association. 7 Post-operative mortality was defined as death within 30 days or within the same hospital admission as the initial surgery. Post-operative morbidity was measured in terms of compli- cations which increased length of stay. Length of stay, requirement for blood transfusion and operation time were also evaluated. ORIGINAL ARTICLE ANZJSurg.com © 2009 The Authors Journal compilation © 2009 Royal Australasian College of Surgeons ANZ J Surg 80 (2010) 182–185