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"In Vitro" Evaluation of Energy-Based Sealing of Graft Side Branches in Bypass Surgery

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Abstract

Introduction

Our objective was to compare the in vitro efficacy of electrothermal bipolar [EB] vessel sealing and ultrasonic harmonic scalpel [HS] versus mechanical interruption, with conventional ties or surgical clips (SC), in sealing saphenous vein (SV) collaterals, during its eventual preparation for bypass surgery.

Methods

Experimental in vitro study on 30 segments of SV. Each fragment included two collaterals at least 2 mm in diameter. One of them was sealed by ligation with 3/0 silk ties (control) and the other one with EB (n = 10), HS (n = 10) or medium-6 mm SC (n = 10). After incorporation in a closed circuit with pulsatile flow, the pressure was progressively increased until causing rupture. Collateral diameter, burst pressure, leak point, and histological study were recorded.

Results

Burst pressure was higher for SC (1320.20 ± 373.847 mmHg) as compared with EB (942.2 ± 344.9 mmHg, p = 0.065), and especially with HS (637.00 ± 320.61 mmHg, p = 0.0001). No statistically significant difference between EB and HS was found, and bursting always happened at supraphysiological pressures. The leak point for HS was always detected in the sealing zone (10/10), while for EB and SC, it occurred in the sealing zone only in 6/10(60%) and 4/10(40%), respectively (p = 0.015).

Conclusions

Energy delivery devices showed similar efficacy and safety in sealing of SV side branches. Although bursting pressure was lower than with tie ligature or SC, non-inferiority efficacy was shown at the range of physiological pressures in both, EB and HS. Due to their speed and easy handling, they may be useful in the preparation of the venous graft during revascularization surgery. However, remaining questions about healing process, potential spread of tissue damage and sealing durability, will require further analysis.

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Acknowledgements

PI20/01171 funded by Instituto de Salud Carlos III (ISCIII) and co-funded by the European Union.

Funding

The following study has obtained a public funding PI20/01171 by Instituto de Salud Carlos III (ISCIII) and co-funded by the European Union.

Author information

Authors and Affiliations

  1. Department of Vascular Surgery, Hospital Universitari i Politècnic La Fe, Valencia, Spain

    Manuel Miralles & Ignacio Sánchez-Nevárez

  2. Department of Surgery, Facultad de Medicina, Universidad de Valencia (UV), Valencia, Spain

    Manuel Miralles

  3. Department of Vascular Surgery, Hospital de Manises, Valencia, Spain

    Moisés Falcón

  4. Department of Vascular Surgery, Hospital Universitario de La Ribera, Alzira, Valencia, Spain

    Lucía Requejo

  5. Hemostasia, Thrombosis, Arteriosclerosis and Vascular Biology, Instituto de Investigación Sanitaria IIS La Fe, Valencia, Spain

    Manuel Miralles, Emma Plana & Pilar Medina

  6. Department of Vascular Surgery, Hospital Universitari del Mar, Barcelona, Spain

    Albert Clará

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  1. Manuel Miralles
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Contributions

MM designed the study. MF performed the experiments. IS-N and MM supervised the analysis. MM, MF, IS-N, EP, PM, LR and AC contributed to the writing of the manuscript.

Corresponding author

Correspondence to Moisés Falcón.

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Conflict of interest

The authors declare that we have no conflict of interest.

Ethical approval

While carrying out this study, all the standards established according to the Ethical Requirements of the journal have been complied with.

Informed consent

Informed consent has been obtained from the patients and relatives from whom all the venous fragments used during this study have been collected.

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Miralles, M., Falcón, M., Requejo, L. et al. "In Vitro" Evaluation of Energy-Based Sealing of Graft Side Branches in Bypass Surgery. World J Surg 47, 2888–2896 (2023). https://doi.org/10.1007/s00268-023-07107-0

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  • DOI: https://doi.org/10.1007/s00268-023-07107-0

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