Hemostasis in minimally invasive liver surgery.

Two cases are reviewed here that highlight the utility of minimally invasive surgery (MIS) techniques in major surgery procedures involving the liver. They also demonstrate specific operative procedures once thought beyond the scope of the MIS surgeon, but they are now standard in expert hands. Improved methods for attaining hemostasis is one of the key reasons surgeons are able to accomplish these increasingly difficult procedures via minimally invasive techniques. Examples of these newer techniques include vessel coaptation via ultrasonic cavitation, and the sealing of smaller vessels via topical agents, such as thrombin and fibrin glue. Even a relatively small amount of bleeding may prompt conversion of MIS to an open procedure, with its attendant risks and inevitable increased costs. Hence, hemostatic tools and agents take on even greater importance.