Since 1985, the Cincinnati Children’s Hospital Medical Center transplant team has performed more than 600 liver transplants, including living-related donor transplants, as well as split liver and reduced-size liver transplants. These procedures have been performed on a variety of pediatric patients including children weighing less than three kilograms. This makes their program one of the largest pediatric liver transplant programs in North America — both in terms of total transplants performed and ongoing activity.
Cincinnati Children’s experience with these types of procedures is extensive, but the hospital is always searching for new technologies and ways to improve on existing techniques. Recently, Dr. Jaimie Nathan, Associate Professor, University of Cincinnati Department of Surgery, was the first surgeon to use a “right-sized,” 3mm vessel sealer to perform a pediatric liver transplant. The instrument was developed by JustRight Surgical, a company devoted to the miniaturization of surgical tools designed specifically for use in pediatric patients.
Pediatric liver transplant may become necessary in children with biliary atresia, a congenital anomaly of the bile duct. Approximately one-third of these patients will require a transplant within the first year of life. Most will need a transplant by the time they are teenagers. Liver transplantis especially difficult in an infant where surgery is complicated by the physical size of the patient. “I need to gently dissect the liver off the retrohepatic vena cava, tying off several small vessels in a very tight space,” explained Dr. Nathan “The dissection capability of the JustRight Sealer along with the hemostatic control of vessel sealing facilitates these types of procedures significantly over previously available technologies.”
Dr. Nathan used the 3mm JustRight Sealer for the first time to remove the native liver of an 8-month-old, 17 pound patient suffering from biliary atresia. Removal began with dissection of the hepatic hilum. The dissection was carried down to the hepatic artery, followed by dissection of the portal vein. After arterial and portal vein dissection, the anterior face of inferior vena cava was exposed. The 3mm JustRight Sealer was used to complete the dissection of the anterior face of the retrohepatic vena cava, sealing all the small vessels that emanate from the liver directly into the vena cava.
The procedure went well and Dr. Nathan was able to use the dissection and sealing capability of the device throughout the case. He commented after the surgery that, “The ability of the 3mm Sealer to negotiate very tight spaces in an infant and its consistent control of vasculature are substantial benefits to using this technology in transplant surgery.”
Dr. Nathan’s dedication to providing the best care with as minimal impact as possible for this very sick patient is what lead him to search for the most innovative equipment. He is the first surgeon to use the FDA approved JustRight 3mm Sealer for a liver transplant. He estimated the use of the 3mm sealer saved 45 minutes of operative time, greatly reducing the time this young patient needed to be under general anesthesia. In addition, Dr. Nathan sought out the safest possible instrument. JustRight Surgical’s Vessel Sealing System is not only the smallest in the world, it is also the only electrosurgical device cleared by the FDA for use in children. This increased safety is due to a highly efficient, low-power vessel sealing technology that permanently fuses vessels while using significantly less energy.
Procedures such as these completed by Dr. Nathan show that the 3mm JustRight Sealer can be used safely and effectively in complex procedures in very tight spaces where dissection as well as sealing capability are required. There is a clear benefit in terms of reduced surgery time and consistent hemostatic control.