Tendean Michael, Mambu Toar D B, Tjandra Ferdinand, Panelewen Jimmy
Digestive Surgery Division, Department of Surgery, Faculty of Medicine, SamRatulangi University, Prof.dr.R.D. Kandou General Hospital, Indonesia.
Ann Med Surg (Lond). 2020 Nov 18;60:491-497. doi: 10.1016/j.amsu.2020.11.039. eCollection 2020 Dec.
Several modalities are used to improve the outcome of liver resection surgery. Laser-based surgery may become promising option; therefore we aim to report our experience regarding the efficacy and safety of Thulium-Doped Fiber Laser (TDFL) 1940 nm in liver parenchyma resection.
A cross sectional study in which patients with pre-existing liver pathology during July 2019 and July 2020 were randomly assigned to receive liver resection using TDFL integrated with raman laser emitting at 1940 nm and 1470 nm wavelength. Data on estimated blood loss during liver transection, liver transection speed, morbidity rate, and postoperative variables including complications, length of hospital stay (days), and mortality were analyzed.
A total of 17 consecutive liver resections were performed, among them are 7 major and 11 minor hepatectomies. The Multipulse TM+1470 were used on 8 procedures consisted of 1 major and 7 minor hepatectomies, the mean amount of blood loss during operation and liver transection was 628.13 ± 141.31 mL and 294.63 ± 94.81 ml, respectively. The mean liver transection speed was 1.52 ± 0.27 cm/min. No biliary leak, post-hepatectomy-liver failure, and mortality were reported.
TDFL provided by Multipulse TM+1470 is an effective and safe tool for liver surgery, providing good hemostasis and allowing for safe and effective exposure of vascular. Further study with larger samples might be needed proved the efficacy and safety of TDFL in liver surgery.
有多种方法可用于改善肝切除手术的效果。基于激光的手术可能成为一种有前景的选择；因此，我们旨在报告我们关于掺铥光纤激光器（TDFL）1940纳米在肝实质切除术中的疗效和安全性的经验。
一项横断面研究，将2019年7月至2020年7月期间患有肝脏疾病的患者随机分配接受使用与发射1940纳米和1470纳米波长的拉曼激光集成的TDFL进行肝切除。分析了肝切开术中估计失血量、肝切开速度、发病率以及包括并发症、住院天数和死亡率在内的术后变量的数据。
共进行了17例连续肝切除术，其中7例为大肝切除术，11例为小肝切除术。在8例手术中使用了多脉冲TM + 1470，包括1例大肝切除术和7例小肝切除术，手术期间和肝切开时的平均失血量分别为628.13±141.31毫升和294.63±94.81毫升。平均肝切开速度为1.52±0.27厘米/分钟。未报告胆漏、肝切除术后肝功能衰竭和死亡情况。
多脉冲TM + 1470提供的TDFL是一种用于肝脏手术的有效且安全的工具，具有良好的止血效果，并能安全有效地暴露血管。可能需要更大样本的进一步研究来证明TDFL在肝脏手术中的疗效和安全性。
