Open Access

Rationality and necessity of vascular stapler application during liver resection (Review)

  • Authors:
    • Er-Lei Zhang
    • Zhi-Yong Huang
    • Xiao-Ping Chen
  • View Affiliations

  • Published online on: March 17, 2021     https://doi.org/10.3892/etm.2021.9929
  • Article Number: 498
  • Copyright: © Zhang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Liver resection (LR) is the primary treatment method for patients with hepatocellular carcinoma (HCC). Improving surgical safety and reducing surgical morbidity and mortality is important for patients receiving LR. Various devices have been developed to facilitate vascular transection to reduce intraoperative blood loss, which is considered to be a predictor of poor surgical outcomes in patients undergoing LR. Vascular staplers have been widely applied for the division of major vascular and biliary structures in the process of LR; however, when and how to use these tools remains controversial. This review aims to report the rationality and necessity of using vascular staplers in vessel transection during liver surgery. Due to the risk of intraoperative and postoperative hemorrhage and biliary fistula, the process of transection of the portal pedicle and hepatic vein is a crucial step during LR. Stapling represents a vascular dissection technique that is widely used in laparoscopic LR and has then been popularized in open LR. Advocates argue that stapler transection methods provide several advantages, including diminished blood loss, fewer transfusion requirements and shorter operative times. However, other studies have failed to demonstrate those benefits when using these tools compared with the simple clamp‑crushing technique. Using the stapler vascular transection method resulted in smaller surgical margins and similar surgical outcomes compared with those of the clamp‑crushing vascular transection method. However, the intraoperative use of vascular staplers may significantly increase the financial burden of liver resection for patients with HCC, while not improving short‑ and long‑term outcomes. Therefore, it has been suggested that vascular staplers should not be routinely used in LR. The current review discussed the above points and recommended that the stapling transection of the portal pedicle and hepatic vein should be applied during laparoscopic LR in a rational manner. However, the suturing ligation method should be routinely used in open LR.
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May-2021
Volume 21 Issue 5

Print ISSN: 1792-0981
Online ISSN:1792-1015

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Spandidos Publications style
Zhang E, Huang Z and Chen X: Rationality and necessity of vascular stapler application during liver resection (Review). Exp Ther Med 21: 498, 2021
APA
Zhang, E., Huang, Z., & Chen, X. (2021). Rationality and necessity of vascular stapler application during liver resection (Review). Experimental and Therapeutic Medicine, 21, 498. https://doi.org/10.3892/etm.2021.9929
MLA
Zhang, E., Huang, Z., Chen, X."Rationality and necessity of vascular stapler application during liver resection (Review)". Experimental and Therapeutic Medicine 21.5 (2021): 498.
Chicago
Zhang, E., Huang, Z., Chen, X."Rationality and necessity of vascular stapler application during liver resection (Review)". Experimental and Therapeutic Medicine 21, no. 5 (2021): 498. https://doi.org/10.3892/etm.2021.9929