USE OF THE AQUAMANTYS BIPOLAR SEALER FOR MANAGEMENT OF TRAUMATIC SOLID ORGAN INJURY
Mastriani, KS, Jones, MA, Bynoe RP, Watson, CM. Palmetto Health Richland, USC Department of Surgery,
Columbia, SC.
Background: Management of traumatic solid organ injuries has long been difficult, as they are resistant to
traditional methods of attaining hemostasis. Inadequate management of injury to liver, spleen and pancreas
results in significant morbidity and mortality in trauma patients, as well as a significant financial burden to the
hospital and/or patient. The Aquamantys is a bipolar cauterization tool, which uses a combination of
radiofrequency and saline to attain hemostasis in a process of transcollation. This has been demonstrated to
diminish blood loss in orthopedic and solid organ oncologic resections. Should the benefits demonstrated in
elective cases translate to traumatic injury, this has the potential to change the management of injury to the liver,
pancreas, and spleen.
Objective: Determination whether the Aquamantys can be effectively used for management of solid organ injury
in trauma patients.
Methods: Retrospective review performed of 5 cases of blunt abdominal injury over a 3 month period, managed
by laparotomy by one surgeon. Of the patients reviewed, 4 liver injuries, one pancreatic and one splenic injury
were managed using the Aquamantys bipolar sealer.
Results: Of the five patients reviewed, there were primarily blunt mechanisms responsible for the solid organ
injuries. After management with transcollation, several factors were followed to determine whether further
hemorrhage was incurred. Three of the patients had closed-suction drains placed, which demonstrated only small
amounts of sero-sanguinous output in each case. Two of the patients had non-solid organ injuries requiring a
return to OR after resuscitation, which allowed re-examination of the area that had been managed for
hemorrhage. Visual inspection yielded confirmation of hemostasis. One of the patients required management of
pancreatic hemorrhage; an eventual development of distal pancreatic necrosis necessitated distal necrosectomy.
One of the patients with splenic laceration developed transient thrombocytosis, but this resolved within two
weeks. Overall, the Aquamantys appeared to yield adequate results in hemostasis of solid organ injury. Further
investigation would help determine how this method compares to the current standards of solid organ hemostasis,
such as the argon beam coagulator.