Background : The disposable bipolar sealer combined radiofrequency (RF) energy and saline (Aquamantys®) has been used to reduce perioperative bleeding during liver resection, especially for cut-surface management. Herein, we analyzed the frequency of cut-surface complications such as bleeding, bile leakage and abscess before and after using the disposable bipolar irrigated sealer.

Methods : From Jan 2021 to Oct 2023, 177 patients underwent liver resection by single surgeon. Among these patients, 168 patients who underwent liver resection without biliary reconstruction were included in this study. The patients were categorized into 2 groups according to the era of Aquamantys® use (group1: no use of Aquamantys®, group 2: use of Aquamantys®). The surgical outcomes including cut-surface complications were compared between groups.

Results : During study period, overall cut-surface complications occurred in 20 patients (11.9%). Bile leakage and cut-surface abscess occurred in 9.5 and 4.8 % patients, respectively. In comparison between groups, group 2 had a higher rate of cut-surface complications (28.9 vs 5.7 %, p<0.001). Incidence rates of bile leakage and cut-surface abscess were significantly higher in Group 2 (bile leakage, 26.7 vs 3.3 %, p< 0.001; cut-surface abscess, 11.1 vs 2.4 %, p=0.019). Although there was no statistical significance, incidence rate of delayed bile leakage was higher in group 2 (50 vs 25 %, p=0.383).

Conclusions : Aquamantys® is effective in reducing perioperative bleeding during liver resection but might be associated with an increased rate of cut-surface complications. It should be used with caution during cut-surface management during liver surgery.