Comparison of Perioperative Outcomes of Open (CUSA) Versus Laparoscopic (LOTUS) Major Hepatectomy: First Evaluation of Efficacy and Safety of AEON Stapler

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Comparison of Perioperative Outcomes of Open (CUSA) Versus Laparoscopic (LOTUS) Major Hepatectomy: First Evaluation of Efficacy and Safety of AEON Stapler

Affan Iqbal, Minas Baltatzis, Panagiotis Stathakis, Jenifer Barrie, Ajith Kumar Siriwardena, Saurabh Jamdar, Aali Jan Sheen
Manchester University NHS Foundation Trust, Manchester, UK

Frontiers in Oncology, July 2025

7.8 vs. 14.7 days
Hospital stay (lap vs. open)
p = 0.025
Statistical significance
86
Matched patients
Key finding: First published evaluation of AEON safety in major hepatic resection. Laparoscopic cases showed reduced hospital stay (mean 7.8 vs. 14.7 days, p = 0.025) and increased Pringle time (48.5 vs. 33 minutes, p = 0.010).

Abstract

Introduction: 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 LOTUS 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).

Methods: 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 LOTUS 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.

Results: The initial sample of 116 patients was narrowed to 86 after applying 1:1 matching. The median age was 63 years (range 27 to 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 blood loss.

*Abstract text reproduced from the original publication with attribution to the authors and publisher. All rights remain with the respective copyright holders. Reproduced here for informational and educational purposes in accordance with applicable open-access licensing or fair use principles. For the definitive version, refer to the original publication via the link provided.

Clinical Relevance: This is the first published evaluation of AEON safety in major hepatic resection. For hepatobiliary surgeons considering laparoscopic approaches to major hepatectomy, this propensity-matched data from a high-volume tertiary center provides outcome evidence specific to vascular transection with AEON.
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