Vascular endostapler as aid to hepatic vein control during hepatic resections.

Significant hemorrhage during hepatic resections for malignancies can result in increased mortality due to liver failure or acute blood loss. Massive hemorrhage is often related to loss of control or injury to the hepatic veins or inferior vena cava. Prevention or reduction of intraoperative blood loss, through improved surgical techniques and increased operator experience, can significantly reduce postoperative morbidity and mortality. Although the use of continuous or intermittent clamping of the portal triad structures (Pringle maneuver) has reduced the incidence of bleeding during hepatic transections, the hepatic vein ligation step of liver resections continues to be a possible source of major blood loss. Because of its safety, rapidity, and ease of application, the EndoGIA 30V vascular stapler is presented as an efficient means for controlling and dividing the major hepatic veins. In skilled hands, this stapling device can contribute to a reduction in incidence and risk of major intraoperative bleeding during hepatectomy. The critical factor to ensuring postoperative morbidity reduction, however, is the surgeon's experience in major hepatic resection procedures.