Introduction: 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.
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: Patient 1 had a Grade II splenic laceration and a large mesenteric rent requiring small bowel
resection; hemodynamic instability necessitated an open abdomen during resuscitation. On return to
OR, splenic laceration could be re-examined and was found to be appropriately hemostatic. The second
patient had a Grade III periportal liver laceration initially managed non-operatively. Bilateral vertebral
artery injuries necessitated anti-coagulation with intravenous heparin, resulting in development of
massive hepatic hematoma and anemia. Aggressive angioembolization failed to manage the
hemorrhage, surgical intervention using transcollation yielded hemostatic results. Closed suction drains
left at closure demonstrated no evidence of further bleeding. Patient 3 was taken to the OR for
management of what was thought to be a strangulated ventral hernia, however entering the abdomen
revealed diffuse metastatic ovarian cancer. Iatrogenic injury to the exceedingly friable liver tissue
occurred, resulting in significant hemorrhage and a 15cmx10cm deep cleft. The Aquamantys was used
to attain hemostasis; closed suction drains demonstrated no evidence of rebleeding, and the patient
demonstrated no post-operative drop in hemoglobin. Patient 4 was a bicyclist versus auto; at
laparotomy, the patient was found to have a mid-body injury to the pancreas and associated diffuse
pancreatic hemorrhage, and two actively bleeding liver lacerations. Open abdomen during resuscitation
allowed for re-examination of the area. Liver hemostasis endured well and no further interventions
were needed for bleeding. Eventual necrosis of the distal pancreas necessitated resection. Patient 5
was involved in roll-over MVC, and was found on CT scan to have a Grade IV liver laceration and a Grade
III splenic laceration with active extravasation. Splenectomy was performed; liver lacerations involving
both the left and right lobes of the liver were managed using the Aquamantys. After an initial dilutional
drop, her hemoglobin remained stable and she required no post-operative transfusions.
Conclusions: Management of hepatic, splenic, and pancreatic injuries has been riddled with
complications associated with leakage of secretions or persistent hemorrhage. The new technology of
the transcollation of the Aquamantys can be safely used in managing these injuries, and may be able to
be reduce the rates of these complications.