ORIGINAL RESEARCH article
Front. Oncol.
Sec. Surgical Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1616876
Comparison of perioperative outcomes of open (CUSA) versus laparoscopic (LOTUS) major hepatectomy -revisited. First evaluation of efficacy and safety of AEON TM stapler
Provisionally accepted
Aali Jan Sheen1*
Affan Iqbal1
Minas Baltatzis2Panagiotis Stathakis1Jenifer Barrie1Ajith Kumar Siriwardena1
Saurabh Jamdar1- 1Manchester University NHS Foundation Trust (MFT), Manchester, United Kingdom
- 2Salford Royal NHS Foundation Trust, Salford, England, United Kingdom
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In 2019, preliminary data matching 20 laparoscopic (using LOTUS) with 20 open (using CUSA) cases demonstrated the feasibility and improved outcomes of laparoscopic major liver resections using the LOTUSTM liver blade. This updated study presents a larger comparison between open and laparoscopic major hepatectomies and, for the first time, evaluates the safety of the endovascular stapler AEON™ (Lexington Medical, Massachusetts, USA).All consecutive patients who underwent liver resections, both open and laparoscopic, from January 2020 to June 2023 were identified from a prospectively maintained database. Propensity score matching was performed to identify matched open and laparoscopic cases, which were compared for intra-and post-operative short-term outcomes. The LOTUSTM ultrasonic energy device was used for transection in laparoscopic cases, whereas CUSA was used in open procedures. AEON was introduced in 2021 and compared with the previously used stapler.The initial sample of 116 patients was narrowed to 86 after applying 1:1 matching. The median age was 63 years (range 27-83). Laparoscopic cases showed reduced hospital stay (mean 7.8 vs. 14.7 days; p = 0.025), increased Pringle time (48.5 vs. 33 minutes; p = 0.010), and reduced transfusion requirements (0 vs. 4 units; p = 0.035). Comparing AEON™ with Endo-GIA showed no statistical differences, though AEON™ showed a possible trend toward reduced transection time overall (56 vs. 69 minutes; p = 0.300) and in laparoscopic cases (56 vs. 71 minutes; p = 0.295).The LOTUS liver blade continues to demonstrate safety and efficacy in laparoscopic liver resections.Transection time has improved compared to the earlier study, likely reflecting increased experience.
Keywords: LOTUS liver energy, Laparoscopic liver resection, AEON endovascular stapler, Major hepatectomy, Propensity score matching
Received: 23 Apr 2025; Accepted: 24 Jun 2025.
Copyright: © 2025 Sheen, Iqbal, Baltatzis, Stathakis, Barrie, Siriwardena and Jamdar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Aali Jan Sheen, Manchester University NHS Foundation Trust (MFT), Manchester, M13 9WL, United Kingdom
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