HPB Surgery

For more than 100 years, we’ve shared a common commitment with you– helping patients live longer, healthier lives. We recognize the immense responsibility that comes with treating hepato-pancreato-biliary disease. More complexity requires more options. We are honored to offer a full suite of surgical products for liver and pancreas procedures.

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HPB surgeons know to expect the unexpected

Our portfolio of products and comprehensive educational programs help prepare OR teams for the twists and turns of complex HPB procedures. Because in the heat of the moment, the way you respond to challenges—and the tools you reach for to do it—can make all the difference.

HPB surgeons know to expect the unexpected
The most comprehensive portfolio that can be used for liver and pancreas

The Most Comprehensive Portfolio That Can Be Used for Liver and Pancreas

We continuously invest in innovation that can address the key challenges that impact liver and pancreas case outcomes.

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HPB Professional Education Courses

Ethicon offers a wide range of regionally-based professional courses including in-person courses, digital learning and hands-on experience.

Parterning with IHPBA and AHPBA

Parterning with IHPBA and AHPBA

These modules are an exciting new resource now available on the myHPB platform. They emphasize recognizing procedure and patient-specific key decision-making points during preoperative planning. They also feature expert surgeons describing their “slowing down” moments during standard procedures.

Featured HPB Products

NEUWAVE™ Microwave Ablation System

NEUWAVE™ Microwave Ablation System

A minimally invasive option for soft tissue lesions in the liver.*1 When unexpected disease presents during procedures, the NEUWAVE Microwave Ablation System has the flexibility you need. It’s a target ablation tool for small to large lesions, and may facilitate resections.

HARMONIC® HD 1000i Shears

HARMONIC® HD 1000i Shears

HARMONIC HD 1000i Shears is designed for procedures like hepatectomy and partial hepatectomy to enable surgical efficiency through improved dissection, hemostasis and multi-functionality. HARMONIC® Technology allowed for less intraoperative blood loss and fewer surgical complications during liver resections.

ECHELON FLEX™ GST System

ECHELON FLEX™ GST System

The ECHELON FLEX GST System†† had 88% less tip movement on thick tissue compared to Endo GIA™.‡‡ ETHICON gold reloads provided the lowest rate of postoperative pancreatic fistula in tissue with a thickness of less than 12mm.\\

SURGICEL® Powder Absorbable Hemostat

SURGICEL® Powder Absorbable Hemostat

Managing continuous oozing bleeding in liver resection.2 SURGICEL Powder Absorbable Hemostat** penetrates through the blood to stop bleeding at the source, for efficient control of continuous oozing on broad surfaces.3,4

Videos

Additional Videos

Laparoscopic Liver Resection using HARMONIC® HD 1000i Shears
Laparoscopic Liver Resection using HARMONIC® HD 1000i Shears
03:24
Posterior Liver Dissection using HARMONIC® HD 1000i Shears
Posterior Liver Dissection using HARMONIC® HD 1000i Shears
01:26
Whipple using HARMONIC FOCUS®+ Long Shears
Whipple using HARMONIC FOCUS®+ Long Shears
10:43
HARMONIC FOCUS®+ Long Shears Sealing
HARMONIC FOCUS®+ Long Shears Sealing
00:35

Supporting Documentation

Hepatectomy Sales Aid with HARMONIC® Technology

SURGICEL® Powder HPB Procedure Sales Aid

References

* Ex-vivo data available in probe Instructions For Use. See PL-000006, PL-000009, PL-000026, PL-000050, PL-000239, PL-000240 and PL000243. 

†Based on a pre-clinical study.

‡ vs. Pringle Maneuver in a prospective randomized controlled trial comparing Pringle Maneuver (n=80) vs. liver resection with Harmonic scalpel (n=80). Hanyong S et al. A prospective randomized controlled trial: comparison of two different methods of hepatectomy. EJSO 2015; 41:243-248.

§ Narrowest jaw, thinnest shaft, greater articulation and the stability of a powered firing for enhanced visibility, broader angles of approach, greater angles of reach, better maneuverability and improved access compared to Endo GIA™ Curved Tip Reload with Tri-Staple™ Technology.

** SURGICEL® Powder Absorbable Hemostat is not cleared for use in Laparoscopic Procedures.

†† System components include ECHELON FLEX™ Powered Plus Stapler and ENDOPATH ECHELON™ Reloads with Gripping Surface Technology.

‡‡ Benchtop testing on porcine stomach tissue. Distal tip motion measurement during the firing cycle showed a median of 88% and a range of reduction of 71% to 95% in tip movement for Powered Echelon Flex™ vs. Endo GIA™ (n=19). Based on similar design features between Powered Echelon Flex and subsequent powered ECHELON Devices, no significant difference in performance is expected (C2389).

\\ ECHELON™ ENDOPATH Gold Reloads vs other Ethicon and Medtronic reloads in pancreatic tissue with a thickness of less than 12mm. Kim H, Jang J, Son D, et al. Optimal stapler cartridge selection according to the thickness of the pancreas in distal pancreatectomy. Medicine. 2016. 95(35):4441-4447.

1. Laeseke et al. Multiple-Antenna Microwave Ablation: Spatially Distributing Power Improves Thermal Profiles and Reduces Invasiveness. Journal of Interventional Oncology. 2009; 2(2):105-112. Brace et al. Simultaneous Activation of Multiple Microwave Antennas Improves Circularity and Ablation Zone Volume Compared to Sequentially Overlapping Ablations. Presented at conference with accompanying poster, WCIO 2014.

2. SURGICEL® Powder versus Competitive Powdered Hemostats. Final Report, PSE Accession No. 16-0006, Project No. 16438.

3. Surface energy/tension analysis among ORC Aggregate, ORC Fine Fiber, and Arista. Ethicon, Inc.

4. SURGICEL® Powder versus ARISTA™ AH. Final Report, PSE Accession No. 15-0120, Project No. 16438.

SURGICEL® Powder Absorbable Hemostat Essential Product Information

INDICATIONS
SURGICEL® Powder (oxidized regenerated cellulose) is used adjunctively in surgical procedures to assist in the control of capillary, venous, and small arterial hemorrhage when ligation or other conventional methods of control are impractical or ineffective.

CONTRAINDICATIONS
• Do not inject or place SURGICEL® Powder into an open blood vessel. Do not use to treat bleeding from large defects in arteries or veins.
• SURGICEL® Powder should not be used to control hemorrhage from large arteries or veins.
• When SURGICEL® Powder is used to help achieve hemostasis in, around, or in proximity to foramina in bone, areas of bony confine, the spinal cord, or the optic nerve and chiasm, it must always be removed after hemostasis is achieved since it will swell and could exert unwanted pressure.
• SURGICEL® Powder should not be used for implantation in bone defects, such as fractures, since there is a possibility of interference with callus formation and a theoretical chance of cyst formation.

WARNINGS
• Closing with SURGICEL® Powder in a contaminated wound without drainage may lead to complications and should be avoided.
• SURGICEL® Powder should not be impregnated with anti-infective agents or with other materials such as buffering or hemostatic substances. 
• SURGICEL® Powder is dry and there may be difficulties in precise delivery under certain circumstances. Unintentional device placement may result in powder scattering and device migration that may increase the risk of adhesion formation. 
• Although SURGICEL® Powder is bactericidal against a wide range of pathogenic microorganisms, it is not intended as a substitute for systemically administered therapeutic or prophylactic antimicrobial agents to control or to prevent postoperative infections.
• Do not attempt to trim the applicator tip.

PRECAUTIONS
• SURGICEL® Powder should not be used in conjunction with autologous blood salvage circuits, because its fragments may pass through the transfusion filters of blood-scavenging systems.
• Use only as much SURGICEL® Powder (oxidized regenerated cellulose) as is necessary and apply only where needed for hemostasis. Remove any excess before surgical closure in order to facilitate absorption and to minimize the possibility of foreign body reaction.
• In urological procedures, minimal amounts of SURGICEL® Powder should be used and care must be exercised to prevent plugging of the urethra, ureter, or a catheter by dislodged portions of the product.
• Since absorption of SURGICEL® Powder could be prevented in chemically cauterized areas, its use should not be preceded by application of silver nitrate or any other escharotic chemicals.
• If SURGICEL® Powder is used temporarily to line the cavity of open wounds, it should be removed by irrigation with sterile water or saline solution after bleeding has stopped.
• Precautions should be taken in otorhinolaryngologic surgery to ensure that none of the material is aspirated by the patient (e.g., controlling hemorrhage after tonsillectomy and controlling epistaxis).
•This applicator tip is not intended for laparoscopic or other endoscopic use.

ADVERSE EVENTS 
• Paralysis and nerve damage have been reported when other SURGICEL® products were used around, in, or in proximity to foramina in bone, areas of bony confine, the spinal cord, and/or the optic nerve and chiasm. 
• Blindness has been reported in connection with surgical repair of a lacerated left frontal lobe when other SURGICEL® products were placed in the anterior cranial fossa (see WARNINGS and PRECAUTIONS).
• Foreign body reactions have been reported with other products from the SURGICEL® Family of Absorbable Hemostats.
• Burning has been reported when other SURGICEL® products were applied after nasal polyp removal. Headache, burning, stinging, and sneezing in epistaxis and other rhinological procedures, and stinging when SURGICEL® product was applied on surface wounds (varicose ulcerations, dermabrasions, and donor sites) have also been reported.
• For more information and technical questions, call 1-800-795-0012.  

EVICEL® Fibrin Sealant (Human) IMPORTANT SAFETY INFORMATION

Indication
EVICEL® Fibrin Sealant (Human) is indicated as an adjunct to hemostasis for use in patients undergoing surgery, when control of bleeding by standard surgical techniques (such as suture, ligature, or cautery) is ineffective or impractical.

Contraindications
▪ Do not inject directly into the circulatory system. Intravascular application of EVICEL® may result in life-threatening thromboembolic events.
▪ Do not use in individuals known to have anaphylactic or severe systemic reaction to human blood products.
▪ Do not use for the treatment of severe or brisk arterial bleeding.
▪ Do not use EVICEL® for spraying in endoscopic or laparoscopic procedures where the minimum recommended distance from the applicator tip to the target site cannot be ensured.

Warnings and Precautions
▪ Life-threatening air or gas embolism has occurred with the use of spray devices employing a pressure regulator to administer EVICEL®. This event appears to be related to the use of the spray device at pressures higher than recommended and/or at distances closer than recommended to the surface of the tissue.
▪ Monitor changes in blood pressure, pulse, oxygen saturation, and end-tidal CO2 when spraying EVICEL® because of the possibility of gas embolism.
▪ To reduce the risk of potentially life-threatening gas embolism, spray EVICEL® using only pressurized CO2 gas at the pressures and distances recommended for the specific tips.
▪ Use EVICEL® spray application only if it is possible to accurately judge the spray distance, especially during endoscopic or laparoscopic procedures.
▪ Prior to applying EVICEL®, dry surface areas of the wound by standard techniques (e.g. intermittent application of compresses, swabs, use of suction devices). Prepare and administer EVICEL® according to the instructions and with only devices recommended for this product.
▪ May carry a risk of transmitting infectious agents, e.g. viruses, the variant Creutzfeldt-Jakob disease (vCJD) agent and theoretically, the Creutzfeldt-Jakob disease (CJD) agent.

The most common adverse reactions reported in clinical trials are peripheral edema, abdominal abscess, infection, hematoma, incision site hemorrhage, vascular graft occlusion, postoperative wound complication and decreased hemoglobin.

SURGICEL Essential Product Information

INDICATIONS
SURGICEL® Absorbable Hemostat (oxidized regenerated cellulose) is used adjunctively in surgical procedures to assist in the control of capillary, venous, and small arterial hemorrhage when ligation or other conventional methods of control are impractical or ineffective. SURGICEL® ORIGINAL, SURGICEL® FIBRILLAR™, SURGICEL® NU-KNIT®, and SURGICEL® SNoW™ Absorbable Hemostats can be cut to size for use in endoscopic procedures.

PRECAUTIONS
Use only as much SURGICEL® Absorbable Hemostat as is necessary for hemostasis, holding it firmly in place until bleeding stops. Remove any excess before surgical closure in order to facilitate absorption and minimize the possibility of foreign body reaction.
In urological procedures, minimal amounts of SURGICEL® Absorbable Hemostat should be used and care must be exercised to prevent plugging of the urethra, ureter, or a catheter by dislodged portions of the product. 
Since absorption of SURGICEL® Absorbable Hemostat could be prevented in chemically cauterized areas, its use should not be preceded by application of silver nitrate or any other escharotic chemicals.
If SURGICEL® Absorbable Hemostat is used temporarily to line the cavity of large open wounds, it should be placed so as not to overlap the skin edges. It should also be removed from open wounds by forceps or by irrigation with sterile water or saline solution after bleeding has stopped.
Precautions should be taken in otorhinolaryngologic surgery to assure that none of the material is aspirated by the patient.  (Examples: controlling hemorrhage after tonsillectomy and controlling epistaxis.)
Care should be taken not to apply SURGICEL® Absorbable Hemostat too tightly when it is used as a wrap during vascular surgery (see Adverse Reactions section of the complete product package insert).

ADVERSE EVENTS 
“Encapsulation” of fluid and foreign body reactions have been reported. 

There have been reports of stenotic effect when SURGICEL® Absorbable Hemostat has been applied as a wrap during vascular surgery. 

Paralysis and nerve damage have been reported when SURGICEL® Absorbable Hemostat was used around, in, or in proximity to foramina in bone, areas of bony confine, the spinal cord, and/or the optic nerve and chiasm. 

Blindness has been reported in connection with surgical repair of a lacerated left frontal lobe when SURGICEL® Absorbable Hemostat was placed in the anterior cranial fossa. 

Possible prolongation of drainage in cholecystectomies and difficulty passing urine per urethra after prostatectomy have been reported. 

For more information, please consult your doctor or for product quality and technical questions, call 1-800-795-0012.  

For complete product information including indications, contraindications, warnings, precautions, and adverse reactions, please reference the individual product package inserts.