Ex-situ Hepatic Transection with use of Electrocautery
Katharine Bittner1, Maria Carmen Mora1, Kyle Douglas1, Kaitlyn Wong1, Kevin P. Moriarty2, David B. Tashjian2, Michael V. Tirabassi2
1Baystate Medical Center, Springfield, MA, USA; 2Baystate Children's Hospital, Springfield, MA, USA
Background: The purpose of this study was to determine if monopolar electrocautery can be used to achieve hemostasis in an ex-situ liver transection model.
Methods: Following euthanasia of swine, the left hepatic lobe was incised in-situ to length 6cm and depth 1cm utilizing either monopolar electrocautery (ISC) or 10-blade (ISK). For ISC, the animal was grounded using a standard adhesive grounding pad. The liver was perfused with heparinized ice-cold lactated ringers, harvested, and placed into a container of slush set on a reusable non-contact grounding electrode pad. Ex-situ, the liver was incised with monopolar electrocautery (ESC) and re-perfused with heparinized whole pig blood (203±129mL/pig). Total blood loss from each liver parenchymal incision was quantified by weight via capture into absorptive gauze. Hematoxylin and eosin (H&E), and fluorescent staining with Phalloidin (F-actin) was performed.
Results: In all three re-perfused pig livers, ISK demonstrated the greatest blood loss. Data was normalized as a percentage of reperfused blood in each group (Figure 1E). H&E sections revealed fragmented margins, cell distortion, and elongated nuclei consistent with electrocautery injury (Figure 1A&C). Staining with Phalloidin revealed a zone of denatured actin corresponding to areas of electrocautery use (Figure 1B&D).
Conclusion: Monopolar electrocautery can effectively be performed in ex-situ liver transections using a non-contact grounding electrode pad. Incorporation of this technique in ex-situ liver procedures can potentially result in reduced blood loss.
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