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World J Gastroenterol. Aug 21, 2016; 22(31): 7091-7098
Published online Aug 21, 2016. doi: 10.3748/wjg.v22.i31.7091
Application of stapling devices in liver surgery: Current status and future prospects
Dian-Bo Yao, Shuo-Dong Wu
Dian-Bo Yao, Shuo-Dong Wu, Second Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Author contributions: Yao DB and Wu SD analyzed the literature and wrote the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shuo-Dong Wu, MD, PhD, Second Department of General Surgery, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Heping District, Shenyang 110004, Liaoning Province, China. wushuodong1949@163.com
Telephone: +86-24-96615-31211 Fax: +86-24-96615-31211
Received: March 21, 2016
Peer-review started: March 22, 2016
First decision: May 27, 2016
Revised: June 7, 2016
Accepted: June 15, 2016
Article in press: June 15, 2016
Published online: August 21, 2016
Processing time: 146 Days and 19.2 Hours
Abstract

The liver is a vascular-rich solid organ. Safe and effective dissection of the vessels and liver parenchyma, and control of intraoperative bleeding are the main concerns when performing liver resection. Several studies have confirmed that intraoperative blood loss and postoperative transfusion are predictors of postoperative morbidity and mortality in liver surgery. Various methods and instruments have been developed during hepatectomy. Stapling devices are crucial for safe and rapid anastomosis. They are used to divide hepatic veins and portal branches, and to transect liver parenchyma in open liver resection. In recent years, laparoscopic liver surgery has developed rapidly, and is now preferred by many surgeons. Stapling devices have also been gradually introduced in laparoscopic liver surgery, from dividing vascular and biliary structures to parenchymal transection. This may be because staplers make manipulation more simple, rapid and safe. Even in single incision laparoscopic surgery, which is recognized as a new minimally invasive technique, staplers are also utilized, especially in left lateral hepatectomy. For safe application of stapling devices in liver surgery, more related designs and modifications, such as application of a suitable laparoscopic articulating liver tissue crushing device, a staple line reinforcement technique with the absorbable polymer membrane or radiofrequency ablation assistance, are still needed. More randomized studies are needed to demonstrate the benefits and find broader indications for the use of stapling devices, to help expand their application in liver surgery.

Keywords: Staplers; Liver resection; Laparoscopy

Core tip: Stapling devices are crucial for safe and rapid anastomosis in gastrointestinal surgery. They have been gradually introduced in open hepatectomy and laparoscopic liver surgery for dividing vascular and biliary structures and parenchymal transection. Staplers make manipulation more simple, rapid and safe. Even in single incision laparoscopic surgery, staplers are also utilized, especially in single incision laparoscopic left lateral hepatectomy. More related designs and modifications are still needed for safe application of stapling devices in liver surgery, and more randomized studies are needed to demonstrate the benefits and find broader indications for the use of stapling devices.