Laparoscopic hepatectomy using clamp-crush technique with non- coagulation: a retrospective study

Abstract Background and aims There is no current consensus regarding the best practices for techniques and devices in laparoscopic hepatic parenchymal transection. To compare the safety, efficacy, and outcomes between coagulation and non-coagulation while using the clamp-crush technique in modern parenchymal transections. Methods The clinical outcomes of patients who underwent laparoscopic liver resection for hepatocellular carcinoma and liver metastasis by coagulation with a Biclamp (n=74) and non-coagulation with a Harmonic ACE (n=92), using the clamp-crush technique, were evaluated. Additionally, we checked the fluid collection at the cut surface by obtaining a CT scan 1 month post-hepatectomy. Results There were no statistically significant differences in patient characteristics between the groups, except a history of liver resection, and the operative duration and frequency of the Pringle maneuver being shorter and more in the non-coagulated group. The non-coagulation group had significantly lower postoperative serum AST, ALT, and total bilirubin levels, except for serum ALT on the first postoperative day, regardless of the significantly higher preoperative serum AST and ALT levels (P 3 cm in diameter was significantly less in the non-coagulated group. Conclusions The clamp-crush technique with non-coagulation may improve the clinical outcomes of laparoscopic hepatectomy, including postoperative fluid collection at the cut liver surface.