01.01 Ex-situ Hepatic Transection with Use of Electrocautery

K. Bittner1, M. C. Mora1, K. Douglas1, K. Wong1, D. Tashjian2, K. Moriarty2, M. Tirabassi2  1Baystate Medical Center,Springfield, MA, USA 2Baystate Children’s Hospital,Springfield, MA, USA

Blood loss is an important factor affecting perioperative outcomes in patients undergoing ex-situ split liver transplantation. The purpose of this study was to determine if monopolar electrocautery can be used to achieve hemostasis in an ex-situ liver transection model. 


Following euthanasia of Yorkshire swine utilized from an IACUC-approved study, a midline laparotomy was performed. The left hepatic lobe was incised twice to length 6cm and depth 1cm utilizing either monopolar electrocautery (in-situ cautery, ISC) or a 10 blade (in-situ knife, ISK). For ISC, the animal was grounded using a standard adhesive grounding pad. Vascular inflow and outflow to the liver was controlled. The liver was then perfused with heparinized ice-cold lactated ringers.  Next, the liver was harvested, transferred to a sterile back table, and placed into a container containing slush solution. The container was set on a draped reusable non-contact grounding electrode pad.  Ex-situ, the liver was incised with monopolar electrocautery (ex-situ cautery, ESC) and was then re-perfused with heparinized whole pig blood (203±129mL/pig). After re-perfusion, total blood loss from each liver parenchymal incision was quantified by weight via capture into absorptive gauze. Hematoxylin and eosin (H&E), and fluorescent staining with Phalloidin (F-actin) on liver samples were performed to compare the effects of ISC and ESC. 

In all three re-perfused pig livers, ISK demonstrated the greatest blood loss. In 2/3 pigs, ESC resulted in less bleeding versus ISC.  As each pig had a different amount of blood reperfused, data was normalized as a percentage of reperfused blood for each pig (Figure 1E). In ESC and ISC, H&E sections of livers revealed fragmented margins, cell distortion, and elongated nuclei consistent with electrocautery injury (Figure 1A&C). Staining with Phalloidin in both groups revealed a zone of denatured actin corresponding to areas of electrocautery use (Figure 1B&D). 

Monopolar electrocautery can effectively be performed in ex-situ liver transections using a commercially available non-contact grounding electrode pad.  Incorporation of this technique in ex-situ liver procedures can potentially result in reduced blood loss after transplantation.