Do the risks of Cell Saver during Lipo360 outweigh the benefit?

Question

A lot of Plastic Surgeons in Miami recommend cell saver during lipo360 and it is mandatory with a 2nd round of lipo and/or if your HGB is less than 12. I understand the need for cellsaver if you are undergoing sx for a ruptured AAA or large orthopedic case but wonder if it is warranted with liposuction. QUESTION: 1 - are there any risks associated such as sepsis or HIT? 2 - do the risks outweigh the benefit? 3 - does the lidocaine in the solution pose a threat or is it completely washed out?

Elan Reisin, MD, FACS · Answer

Honestly, if cell saver is offered to you or discussed I would run away! I have never and will never need to offer transfusion for elective procedure . If I did , it would mean that it is more than elective , but necessary. I cannot imagine the need for cell saver for liposuction or any other procedure unless I’m performing a risky elective procedure

Jason Emer, MD · Answer

These are questions that should be asked to your surgeon because each patient is different and you need to know answers related to your specific case. Of course, a medical clearance is necessary before surgery and will determine if you are eligible. See an expert. Best, Dr. Emer.

Kenneth Hughes, MD · Answer

I have not found cell saver to be necessary or useful in these procedures.  The surgery can be shortened or the number of procedures reduced.In general, 12 is adequate for surgery if attention to hemostasis is meticulous.  This is dependent upon a host of factors including the amount of surgery performed, the cause of the anemia if present, and the treatment necessary to improve that anemia.  In an otherwise healthy person without anemia or other consuming disease, there is usually nothing that needs to be done.  The HgB does not have to be artificially elevated for surgery.  Lipo can be performed for most individuals with a hemoglobin above 10 or 11.

S. Alexander Earle, MD, FACS · Answer

That is a bit misleading based on how you asses the risks associated with cell saver. Each surgery proposes unavoidable risks. Cell saver is vital to patients with low HGB or Patients who essentially want to feel better after surgery. Blood loss occurs during all liposuction cases but the blood loss should never be substantial where cell saver is mandatory. Each Liposuction case begins with tumescent solution which contains epinephrine that causes blood vessels to vasoconstrict which reduces blood loss. Dr. S. Alexander Earle

Double Board Certified Plastic Surgeon
Pure Plastic Surgery

Double Board Certified Plastic Surgeon 
Pure Plastic Surgery

Daniel Barrett, MD · Answer

Dear Lady63,
cell saver is a great thing for some surgeries but in case of liposuction it is not frequently used. But every plastic surgeon has his own protocol which he uses. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

Mats Hagstrom, MD (license on probation) · Answer

The use of the cell saver has been well documented to have benefits that outweigh the risks for patients who are at risk for needing blood transfusions from elective surgical procedures.That is not a question that it’s usually brought up. That’s the purpose of the device. The question is do these procedures have enough blood loss to ever need blood transfusions?If they do then the use of a cell saver is very appropriate.My practice is devoted exclusively to liposuction and fat transfer procedures and has been for the last 10 years. As far as I know only one of my patients has gotten a blood transfusion. That patient had an underlying bleeding disorder that was not disclosed to me during the consultation. She later admitted to knowing she had a bleeding disorder. Fat transfer generally causes minimal bleeding. Liposuction however can cause substantial blood loss if precautions are not taken. The best way to minimize blood loss for liposuction is to use high volumes Of tumescent solution and wait at least 15 minutes before doing the liposuction after the placement of this numbing solution. This solution contains a drug called epinephrine. It causes blood vessels to vasoconstrict In the sense shutting down the blood supply to the tissues while we’re doing surgery.Epinephrine takes time to activate. I do these procedures with patients awake so it’s mandatory to use lots of numbing solution containing epinephrine and waiting appropriate amount of time for patient comfort reasons. This makes my blood loss very low during liposuction. This includes cases of removing 5 L of fat. When surgery is done in a formal operating room under general anesthesia time is of the essence from a cost saving perspective as well as the benefit of the patient. Surgeons generally do not stop and wait 15 minutes for the epinephrine to kick in.Doing so however, as an immense benefit to the patient in terms of minimizing blood loss, decreasing bruising and speeding up recovery.I’m also a firm believer that Tumescent Solution should be used in fairly high quantities in the area being fat grafted even though this area doesn’t tend to bleed all that much. The primary reason for this is the vasoconstrict the veins minimizing the chance of a fat embolism even if grafting is not done in the muscle.These are my thoughts. My opinion is mine and only mine and I’m sure other providers may have different views on the topic. Liposuction including fat transfer simply shouldn’t be a high blood loss procedure.Best,Mats Hagstrom MD

Do the risks of Cell Saver during Lipo360 outweigh the benefit?

Answers (6)

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