Radiofrequency-Assisted Hepatectomy Using Bipolar Inline® Multichannel Radiofrequency Device (ILMRD): Report of Initial Clinical Experience

Background/Aims: Intraoperative bleeding is a major concern in liver surgery and traditionally portal triad clamping (PTC) has been applied to reduce blood loss. However, this benefit is counterbalanced by the adverse effects of warm ischemia-reperfusion liver injury. The ideal alternative would be to use modern energy devices that minimize bleeding, without needing PTC. One such novel device is the InLine (R) multichannel radiofrequency device (ILMRD, Resect Medical, Inc., Fremont, CA) that produces coagulative necrosis along the transection plane. Methodology: In the present paper we reviewed 24 consecutive hepatic resections (18 metastases, 5 hepatoma, 1 focal nodular hyperplasia) performed with aid of ILMRD. Statistical analyses were performed with Mann-Whitney and Fisher Exact tests. Results: The mean blood loss was 240ml (range 50-750ml) with only 2 patients requiring blood transfusions. For the first 8 cases the median PTC time was 16 minutes, and in the subsequent 16 cases, not only was there a significant decline in the median clamp time (0 min, p=0.026) but also in the frequency of PTC use (71% vs. 11%, p=0.008). A significant reduction in blood loss was seen when comparing the first 8 versus the subsequent 16 cases (median 350ml vs. 112ml, p=0.016). The median length of hospital and intensive care unit stay for the cohort were 7 and 1 days, respectively. There were no deaths and the major morbidity rate was 16.7%. Conclusion: The use of ILMRD is an innovative approach to minimize blood loss and PTC during parenchymal transection phase of hepatic resection.