Document Detail


Use of an electrothermal bipolar tissue sealing system in lung surgery.
MedLine Citation:
PMID:  16376100     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We evaluated the validity of an electrothermal bipolar tissue sealing system (LigaSure, Valleylab Inc., USA) in lung surgery.
METHODS: Our study was divided into two phases.
EXPERIMENTAL: We performed sutures of pulmonary vessels and bronchi and lung wedge resections by LigaSure in 28 lungs of adult pigs; subsequently, we quantitated the sealing capacity of the system detecting the burst pressure for each anatomical structure. Clinical: LigaSure was used in 36 patients undergoing lung surgery. We performed 23 thoracotomic procedures in 16 patients (19 wedge resections, 2 segmentectomies, and 2 fissure separations), and 20 thoracoscopic procedures (13 wedge resections, 5 bullectomies, and 2 adherence dissections).
RESULTS:
EXPERIMENTAL: Bronchi and vessels were divided into seven groups (diameter: 1-7 mm); 10 burst pressure measurements for each group were performed. A total of 84 wedge resections were performed; lung specimens were divided into seven groups (weight: 0.2-1.4 g). The percentage of bronchial sutures resistant to the pneumatic critical pressure (60 mmHg) was 100% in the 1-mm and 2-mm groups. No bronchi with 6-mm or 7-mm diameter reached the critical pressure. All pulmonary vessel sutures were resistant to the critical hydrostatic pressure (150 mmHg). The average burst pressure of wedge resection margins was higher than the critical pressure, and the percentage of suture margins resistant to the critical pressure decreased from 95% (0.2-g group) to 68% (1.4-g group). Histology confirmed the sealing of vessels, with a mean depth of thermal injury limited to 1.1mm. Clinical: In all patients, hemostasis obtained by LigaSure was effective, with minimal perioperative bleeding. The mean operating time was 77.2 min (range: 60-97) for thoracotomies and 60.3 min (range: 46-80) for thoracoscopies. The mean drainage duration was 3.1 days (range: 1-8). Two patients had prolonged air leaks (>7 days). The mean postoperative stay was 7.3 days (range: 5-13) for thoracotomies and 4.6 days (range: 1-6) for thoracoscopies.
CONCLUSIONS: Use of LigaSure in lung surgery appears feasible and easy. It provides satisfactory hemostasis and air-leak prevention; results are comparable to those of stapling devices, but this system seems to have a better benefit/cost ratio. Larger series are needed to confirm these data.
Authors:
Mario Santini; Giovanni Vicidomini; Alfonso Baldi; Giuseppe Gallo; Paolo Laperuta; Luigi Busiello; Maria Pia Di Marino; Vincenzo Pastore
Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2006-01-11
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  29     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-01-23     Completed Date:  2006-05-25     Revised Date:  2014-07-29    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  226-30     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Animals
Biomechanical Phenomena
Electrocoagulation / instrumentation,  methods*
Female
Hemostasis, Surgical / instrumentation,  methods*
Humans
Lung Diseases / surgery*
Male
Middle Aged
Models, Animal
Pulmonary Surgical Procedures / instrumentation,  methods*
Suture Techniques
Swine
Thoracic Surgery, Video-Assisted / methods
Thoracotomy / methods
Treatment Outcome
Wound Healing

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


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