Intrahepatic Cholangiocarcinoma

Left Hepatectomy with Minimal Blood Loss Using a new Electrocautery (Radiofrequency Bipolar Hemostatic Sealer)

A 64 year old female Jehovah’s Witness patient presented with abdominal fullness and both right and left sided lower quadrant pain. A CT scan revealed a left sided hepatic mass that was 5 X 4 X 3 cm in size. Our surgeons were comfortable scheduling her for a left hepatectomy as they believed they could remove the tumor without excessive bleeding. The case involved doing a left hepatectomy and the pathology report confirmed a moderately differentiated adenocarcinoma most consistent with intrahepatic cholangiocarcinoma. The estimated blood loss was only 50 mLs. The tumor margins were negative. Her hemoglobin levels before and after surgery were 13.1 and 12.5 g/dL, respectively. Two weeks later she was walking and eating normally with a good appetite and no weight loss.

One of the methods used to achieve blood conservation is a relatively new method of electrocautery called a radiofrequency bipolar hemostatic sealer. This new device uses saline irrigation combined with bipolar (as opposed to unipolar) cautery, which seals blood vessels to stop bleeding. Traditional unipolar cautery burns blood vessels at a much higher temperature (up to 400 °C), whereas this new cautery seals them using a lower temperature (100 °C), achieved by the saline irrigation.

Our group at Johns Hopkins has shown that this type of cautery is associated with a 50-60% decrease in both overall bleeding and transfusion requirements. We published these findings in theJournal of Orthopaedic Surgical Research, 2014 Jul 5;9(1):50. Although the study we published was performed in orthopedic spine surgery patients, based on the knowledge we gained from this study, we now use this cautery method for Jehovah’s Witness patients whenever possible to reduce blood loss. In the case described above, we were able to perform what is typically a high-blood loss procedure with minimal bleeding.