Outcomes of simple saline-coupled bipolar electrocautery for hepatic resection

Table 1 Characteristics of patients undergoing liver resection n (%)

Baseline characteristic		BIP (n = 75)	CUSA + BIP (n = 53)	CLAMP (n = 252)	P value
Age1 (yr)		54.1 (17-81)	50.7 (16-85)	53.7 (19-81)	0.256
Sex	Male	47 (62.67)	33 (62.26)	155 (61.51)	0.981
Cause of surgery	HCC	38 (50.67)	20 (37.74)	121 (48.02)	0.868
	Other malignancy	14 (18.67)	9 (16.98)	43 (17.06)
	Benign tumour	8 (10.66)	10 (18.87)	29 (11.51)
	Intrahepatic stone	12 (16.00)	11 (20.75)	47 (18.65)
	Others	3 (4.00)	3 (5.66)	12 (4.76)
Child-Pugh	A	56 (74.67)	41 (77.36)	210 (83.33)	0.196
	B	19 (25.33)	12 (22.64)	42 (16.67)
ICG-R15	< 15	67 (89.33)	46 (86.79)	219 (86.90)	0.849
	≥ 15	8 (10.67)	7 (13.21)	33 (13.10)
Background liver	Normal	31 (41.33)	31 (58.49)	130 (51.58)	0.359
	Chronic hepatitis	24 (32.00)	12 (22.64)	61 (24.21)
	Cirrhosis	20 (26.67)	10 (18.87)	61 (24.21)
Level of surgeon	Chief doctor	31 (20.67)	29 (27.36)	127 (25.20)	0.069
	Deputy director doctor	56 (37.33)	40 (37.74)	226 (44.84)
	Attending doctor	63 (42.00)	37 (34.90)	151 (29.96)
Type of resection	Extended	13 (17.33)	8 (15.09)	35 (13.89)	0.347
	Hemihepatectomy
	Hemihepatectomy	33 (44.00)	20 (37.74)	108 (42.85)
	Lobectomy	29 (38.67)	21 (39.62)	92 (36.51)
	Segmentectomy	0	4 (7.55)	13 (5.16)
	Wedge resection	0	0	4 (1.59)
Tumor	Yes	60 (80.00)	39 (73.58)	193 (76.59)	0.689
Tumor condition	Size, < 30 mm	14 (23.33)	7 (17.95)	56 (29.02)	0.300
	≥ 30 mm	46 (76.67)	32 (82.05)	137 (70.98)
	Single	36 (60.00)	31 (79.49)	115 (59.59)	0.059
	Multiple	24 (40.00)	8 (20.51)	78 (40.41)
	Superficial	36 (60.00)	28 (71.79)	141 (73.06)	0.151
	Deep	24 (40.00)	11 (28.21)	52 (26.94)

¹P analysis of variance (F). HCC: Hepatocellular carcinoma; BIP: Bipolar coagulation; CUSA: Cavitron ultrasonic surgical aspirator; CLAMP: Conventional clamp crushing; ICG-R15: Indocyanine green retention rate at 15 min.

Table 2 Surgical outcomes n (%)

Outcome		BIP (n = 75)	CUSA+BIP (n = 53)	CLAMP (n = 252)	P value
Blood loss1	≤ 1000 mL	73 (97.33)	48 (90.57)	192 (76.19)	< 0.001
	> 1000 mL	2 (2.67)	5 (9.43)	60 (23.81)
Intraoperative transfusion1		12 (16.00)	7 (13.21)	117 (46.43)	< 0.001
Blood loss (mL) median2		315 (50-1800)	328 (50-2000)	583 (50-5000)	< 0.001
Transfusion of RBC (mL) median		37 (0-800)	56 (0-1200)	69 (0-2800)	< 0.001
Operative time (min) median		315 (105-965)	335 (80-730)	265 (60-590)	< 0.001

¹P (χ²);

²Variables are expressed as median (minimum-maximum). P: Multiple samples rank sum test (H). BIP: Bipolar coagulation; CUSA: Cavitron ultrasonic surgical aspirator; CLAMP: Conventional clamp crushing.

Table 3 The differences in indexes between the groups n (%)

BIP (A), CUSA + BIP (B), CLAMP (C)		(A vs B)	(B vs C)	(A vs C)
		P value	P value	P value
Blood loss, > 1000 mL		0.973	< 0.001	< 0.001
Intraoperative transfusion		0.662	< 0.001	< 0.001
Blood loss (mL), median		0.670	< 0.001	< 0.001
Transfusion of RBC (mL), median		0.731	< 0.001	< 0.001
Operative time (min), median		0.409	< 0.001	< 0.001
Complications	Yes	0.773	0.016	0.015
Abdominal infection		1.000	0.153	0.130
Bile leak		0.635	0.260	0.108
Ascites		0.760	0.149	0.014

BIP: Bipolar coagulation; CUSA: Cavitron ultrasonic surgical aspirator; CLAMP: Conventional clamp crushing; RBC: Red blood cell.

Table 4 Postoperative complications n (%)

Complication	BIP	CUSA + BIP	CLAMP	P value
	(n = 75)	(n = 53)	(n = 252)
Yes	23 (30.67)	15 (28.30)	117 (46.43)	0.007
Abdominal infection	2 (2.67)	1 (1.89)	22 (8.73)	0.035
Bile leak > 2 wk	1 (1.33)	1 (1.89)	18 (7.14)	0.039
Acute liver failure	1 (1.33)	0	2 (0.79)	0.710
Return to operating room	0	1 (1.89)	3 (1.19)	0.577
Respiratory failure	0	1 (1.89)	2 (0.79)	0.448
Bleeding > 500 mL within 24 h	1 (1.33)	1 (1.89)	7 (2.78)	0.725
Hyperbilirubinemia	3 (4.00)	5 (9.43)	8 (3.17)	0.181
Sepsis	0	0	2 (0.79)	1.000
Ileus	0	0	3 (1.19)	1.000
Pulmonary embolism	1 (1.33)	0	1 (0.40)	0.561
Hepatorenal syndrome	0	0	1 (0.40)	1.000
30-d postoperative death	1 (1.33)	0	2 (0.79)	0.710
Deep venous thrombosis	0	0	1 (0.40)	1.000
Pleural effusion	4 (5.33)	3 (5.66)	24 (9.52)	0.370
Wound infection	16 (21.33)	12 (22.64)	50 (19.84)	0.884
Wound dehiscence	0	0	2 (0.79)	1.000
Pneumonia	2 (2.67)	2 (3.77)	16 (6.35)	0.359
Hepatic insufficiency	7 (9.33)	2 (3.77)	20 (7.94)	0.432
Ascites	1 (1.33)	2 (3.77)	29 (11.51)	0.002
Atelectasis	1 (1.33)	1 (1.89)	3 (1.19)	0.928

BIP: Bipolar coagulation; CUSA: Cavitron ultrasonic surgical aspirator; CLAMP: Conventional clamp crushing.

Table 5 Laboratory values and hospital stay n (%)

Recovery evaluation		BIP	CUSA+BIP	CLAMP1	P value
		(n = 75)	(n = 53)	(n = 251)
TB (μmol/L)	Pre-	15.2 (4.3-360.7)	15.5 (4.9-313.9)	13.5 (3.5-358.9)	0.425
	Day 1	26.5 (4.3-292.1)	23.4 (4.3-292.3)	25.9 (5.5-321.4)	0.771
	Day 3	22.1 (3.9-215.4)	18.3 (6.6-422.0)	21.9 (5.6-294.6)	0.325
	ΔTB2	6.4 (-189.9-160.3)	2.9 (-135.3-261.9)	6 (-137.7-156.9)	0.585
ALT (μmol/L)	Pre-	32 (11-337)	48 (10-579)	36 (7-984)	0.187
	Day 1	314 (21-1616)	279 (32-1760)	200 (16-3449)	< 0.001
	Day 3	136 (17-1717)	135 (27-2246)	130 (10-1114)	0.272
	ΔALT2	85 (-174-1691)	84 (-449-2183)	84 (-808-1065)	0.388
AST (μmol/L)	Pre-	35 (14-261)	40 (6-531)	33 (8-698)	0.693
	Day 1	323 (43-1591)	294 (20-3182)	247 (14-3750)	0.109
	Day 3	88 (15-1404)	59 (20-2388)	72 (12-940)	0.143
	ΔAST2	38 (-133-1372)	24 (-510-2350)	31 (-617-853)	0.168
ALB (g/L)3	Pre-	37.5 ± 6.1	40.9 ± 5.3	39.4 ± 5.8	0.003
mean ± SD	Day 1	26.9 ± 5.6	29.4 ± 4.3	26.2 ± 4.9	< 0.001
	Day 3	27.2 ± 4.3	29.9 ± 4.8	27.5 ± 4.3	< 0.001
	ΔALB2	10.3 ± 6.0	11.0 ± 6.2	12.0 ± 5.9	0.078
Hospital stay (d) mean ± SD		16.6 ± 7.4	15.3 ± 9.2	16.5 ± 9.6	0.666

¹One case in group C who died from massive bleeding and multiple organ failure was excluded;

²Δtotal bilirubin (TB, μmol/L) = TB (day 3 - pre-), Δalanine transaminase (ALT, μmol/L) = ALT (day 3 - pre-), Δaspertate aminotransferase (AST, μmol/L) = AST (day 3 - pre-), Δalbumin (ALB, g/L) = ALB (pre- - day 3);

³Variables are expressed as mean ± SD, PANOVA (F). Pre-: Pre-operation; BIP: Bipolar coagulation; CUSA: Cavitron ultrasonic surgical aspirator; CLAMP: Conventional clamp crushing.