Document Detail


Effectiveness of the ultrasonic coagulating shears, LigaSure vessel sealer, and surgical clip application in biliary surgery: a comparative analysis.
MedLine Citation:
PMID:  11565773     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Advancements in laparoscopic surgery are often dictated by the limitations of technical instrumentation. Energy sources other than electrosurgery have become popular with the promise of quick and effective vascular control. With their success surgeons have begun using these on structures other than blood vessels with little or no data establishing their efficacy or safety. This study evaluates alternative energy sources in sealing ductal structures for possible use in liver or gallbladder surgery. After elective cholecystectomy cystic ducts (n = 45) were resealed ex vivo with surgical clips (n = 14), ultrasonic coagulating shears (n = 16), or electrothermal bipolar vessel sealer (n = 15), and bursting pressures were measured. Nineteen additional human cystic ducts were randomized to seal by ultrasonic coagulating shears (n = 9) or electrothermal bipolar vessel sealer (n = 10) and fixed in 10 per cent buffered formalin for histologic evaluation of thermal spread (mm). After this nine adult pigs were randomized to laparoscopic ligation and transection of the common bile duct using surgical clips (n = 3), ultrasonic coagulating shears (n = 3), or electrothermal bipolar vessel sealer (n = 3). The animals underwent necropsy for assessment of seal integrity on the sixth postoperative day. In the ex vivo study the mean cystic duct bursting pressure was 621 mm Hg with surgical clips and 482 mm Hg with the electrothermal bipolar vessel sealer (P = 0.39). The mean cystic duct bursting pressure after ultrasonic coagulating shears was 278 mm Hg, which was statistically less than surgical clips (P = 0.007) and electrothermal bipolar vessel sealer (P = 0.02). The mean thermal spread was 3.5 mm for ultrasonic coagulating shears and 13.4 mm for electrothermal bipolar vessel sealer (P = 0.0002). All animals undergoing ligation and transection of the common bile duct with ultrasonic coagulating shears and electrothermal bipolar vessel sealer developed bile peritonitis by postoperative day 6 as a result of seal leak. All animals undergoing surgical clip ligation and transection of the common bile duct maintained seal integrity. The mean common bile duct pressure above the surgical clip was 12 mm Hg (range 10-14). In conclusion the acute ex vivo study demonstrated a significant difference in the cystic duct bursting pressure between surgical clips and ultrasonic coagulating shears and between electrothermal bipolar vessel sealer and ultrasonic coagulating shears. The ultrasonic coagulating shears and electrothermal bipolar vessel sealer failed to maintain seal integrity in the in vivo animal study. Given the failure of the ultrasonic coagulating shears and electrothermal bipolar vessel sealer in the animal model these energy sources should not be used for transection of the cystic duct or major hepatic ducts during hepatobiliary surgery.
Authors:
B D Matthews; B L Pratt; C L Backus; K W Kercher; G Mostafa; A Lentzner; E H Lipford; R F Sing; B T Heniford
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Publication Detail:
Type:  Evaluation Studies; In Vitro; Journal Article    
Journal Detail:
Title:  The American surgeon     Volume:  67     ISSN:  0003-1348     ISO Abbreviation:  Am Surg     Publication Date:  2001 Sep 
Date Detail:
Created Date:  2001-09-21     Completed Date:  2001-10-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  901-6     Citation Subset:  IM    
Affiliation:
Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
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MeSH Terms
Descriptor/Qualifier:
Animals
Bile Ducts / surgery*
Biomechanics
Common Bile Duct / surgery
Cystic Duct / physiology,  surgery
Electrocoagulation / instrumentation*
Humans
Laparoscopy*
Ligation
Postoperative Complications
Surgical Instruments*
Swine
Ultrasonics*
Comments/Corrections
Comment In:
Am Surg. 2002 Jul;68(7):652   [PMID:  12132753 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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