Abstract
Background: Advanced laparoscopic procedures have necessitated the development of new technology for vascular control. Suture ligation can be time-consuming and cumbersome during laparoscopic dissection. Titanium clips have been used for hemostasis, and recently plastic clips and energy sources such as ultrasonic coagulating shears and bipolar thermal energy devices have become popular. The purpose of this study was to compare the bursting pressure of arteries sealed with ultrasonic coagulating shears (UCS), electrothermal bipolar vessel sealer (EBVS), titanium laparoscopic clips (LCs), and plastic laparoscopic clips (PCs). In addition, the spread of thermal injury from the UCS and the EBVS was compared. Methods: Arteries in three size groups (2–3, 4–5 and 6–7 mm) were harvested from freshly euthanized pigs. Each of the four devices was used to seal 16 specimens from each size group for burst testing. A 5-Fr catheter was placed into the open end of the specimen and secured with a purse-string suture. The catheter was connected to a pressure monitor and saline was infused until there was leakage from the sealed end. This defined the bursting pressure in mmHg. The ultrasonic shears and bipolar thermal device were used to seal an additional 8 vessels in each size group, which were sent for histologic examination. These were examined with hematoxylin and eosin stains, and the extent of thermal injury, defined by coagulation necrosis, was measured in millimeters. Analysis of variance was performed and, where appropriate, a Tukey’s test was also performed. Results: The EBVS’s mean burst pressure was statistically higher than that of the UCS at 4 or 5 mm (601 vs 205 mmHg) and 6 or 7 mm (442 vs 175 mmHg). EBVS had higher burst pressures for the 4 or 5-mm group (601 mmHg) and 6 or 7-mm group (442 mmHg) compared with its pressure at 2 or 3 mm (128 mmHg) (p = 0.0001). The burst pressures of the UCS and EBVS at 2 or 3 mm were not significantly different. Both clips were statistically stronger than the thermal devices except at 4 or 5 mm, in which case the EBVS was as strong as the LC (601 vs 593 mmHg). The PC and LC were similar except at 4 or 5 mm, where the PC was superior (854 vs 593 mmHg). The PC burst pressure for 4 or 5 mm (854 mmHg) was statistically higher than that for vessels 2 or 3 mm (737 mmHg) but not different from the 6 or 7 mm pressure (767 mmHg). Thermal spread was not statistically different when comparing EBVS and UCS at any size (EBVS mean = 2.57 mm vs UCS mean = 2.18 mm). Conclusions: Both the PC and LC secured all vessel sizes to well above physiologic levels. The EBVS can be used confidently in vessels up to 7 mm. There is no difference in the thermal spread of the LigaSure vessel sealer and the UCS.
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SL Goldstein KL Harold A Lentzner (2002) ArticleTitleComparison of thermal spread after ureteral ligation with the ultrasonic shears and ligaSure system. J Laparoendo Adv Surg Tech 12 61–63 Occurrence Handle10.1089/109264202753486957
BT Heniford BD Matthews (2001) Basic instrumentation for laparoscopic surgery. FL Greene BT Heniford (Eds) Minimally invasive cancer management. Springer-Verlag New York 36–14
BT Heniford BD Matthews RF Sing C Backus B Pratt FL Greene (2001) ArticleTitleInitial results with an electrothermal bipolar vessel sealer. Surg Endosc 15 799–801
N Katkhouda E Mavor MH Friedlander et al. (2001) ArticleTitleUse of fibrin sealant for mesh fixation in laparoscopic extraperitoneal inguinal hernia repair. Ann Surg 233 18–25 Occurrence Handle10.1097/00000658-200101000-00004 Occurrence Handle1:STN:280:DC%2BD3MzltlWqsA%3D%3D Occurrence Handle11141220
JS Kennedy PL Stranahan KD Taylor JG Chandler (1998) ArticleTitleHigh-burst-strength feedback controlled bipolar vessel sealing. Surg Endosc 12 876–878
H Spivak WS Richardson JG Hunter (1998) ArticleTitleThe use of bipolar cautery, laparoscopic coagulating shears, and vascular clips for hemostasis of small and medium-sized vessels. Surg Endosc 12 183–185 Occurrence Handle10.1007/s004649900627 Occurrence Handle1:STN:280:DyaK1c7ktVelug%3D%3D Occurrence Handle9479741
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Harold, K., Pollinger, H., Matthews, B. et al. Comparison of ultrasonic energy, bipolar thermal energy, and vascular clips for the hemostasis of small-, medium-, and large-sized arteries . Surg Endosc 17, 1228–1230 (2003). https://doi.org/10.1007/s00464-002-8833-7
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DOI: https://doi.org/10.1007/s00464-002-8833-7