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Evaluation of the LigaSure™ Vessel Sealing System for bowel transection and intestinal anastomosis—an experimental study in a porcine model

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Abstract

Background

The purpose of the present study is to assess the value of the LigaSure™ Vessel Sealing System (LVSS) as a means for bowel transection and intestinal anastomosis.

Methods

We compared the LVSS for (1) transecting bowel and (2) creation of an intestinal anastomosis with standard methods such as stapler (S) and hand-sewn (HS) in a porcine model. For each study arm, i.e., bowel transection and anastomosis creation, both the small bowel and colon were examined. In total, ten transections and ten anastomoses were performed for each. Burst and anastomotic leak pressures were compared.

Results

In the study arm 1, LVSS achieved lowest burst pressures in both small bowel (LVSS 39.8 ± 3.6 mmHg, S 81.9 ± 3.9, HS 111.9 ± 14.7 mmHg, p < 0.0001) and colon transections (LVSS 21.5 ± 2.6 mmHg, S 79.5 ± 4.9, HS 91.0 ± 5.2 mmHg, p < 0.0001). There was no difference in burst pressures between S and HS in both small bowel and colon transections. In the study arm 2, LVSS showed the lowest anastomotic leak pressures for small bowel (LVSS 26.4 ± 2.6 mmHg, S 52.1 ± 6.2, HS 87.4 ± 7.0 mmHg, p < 0.0001) and colonic anastomoses (LVSS 16.9 ± 1.3 mmHg, S 55.9 ± 4.3, HS 74.4 ± 4.4 mmHg, p < 0.0001). Furthermore, small bowel and colonic anastomoses using S demonstrated significantly lower leak pressures than HS anastomosis p < 0.001 and p = 0.004, respectively.

Conclusions

The LVSS achieves significantly lower burst pressures and anastomotic leak pressures for bowel transection and intestinal anastomosis than S and HS techniques. However, due to the achieved pressure levels of 39.8 ± 3.6 mmHg, LVSS appears to be a sufficient stand-alone method for bowel transection. Whether it can be used to perform intestinal anastomosis warrants further research in a survival model.

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Author information

Authors and Affiliations

  1. Department of General Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Tobias Gehrig, A. T. Billeter, A. L. Wekerle, M. Shevchenko & B. P. Müller-Stich

  2. Department of Pathology, University of Heidelberg, Im Neuenheimer Feld 220/221, 69120, Heidelberg, Germany

    K. Brand

  3. Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Tobias Gehrig

Authors
  1. Tobias Gehrig
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  2. A. T. Billeter
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  3. A. L. Wekerle
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  4. M. Shevchenko
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  5. K. Brand
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  6. B. P. Müller-Stich
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Corresponding author

Correspondence to Tobias Gehrig.

Ethics declarations

The study was approved by the German Committee on Animal Care, Regierungspräsidium Karlsruhe, and the medical faculty ethics committee at University of Heidelberg (approval code 35-9185.81/G-91/08). All animals received humane care in compliance with the national research council’s criteria for humane care, as outlined in the guide for the care and use of laboratory animals prepared by the National Institute of Health (NIH Publication 86-23, revised 1985).

Disclosures and freedom of investigation

The authors have no financial (interests) or other disclosures relating to state. No external funds were used to perform the evaluation, and all of the tested technology was separately purchased to complete the study. In addition, the authors had full control of the design of the study, methods used, outcome measurements, analysis of data, and production of the written report.

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Gehrig, T., Billeter, A.T., Wekerle, A.L. et al. Evaluation of the LigaSure™ Vessel Sealing System for bowel transection and intestinal anastomosis—an experimental study in a porcine model. Langenbecks Arch Surg 401, 381–387 (2016). https://doi.org/10.1007/s00423-016-1406-3

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  • DOI: https://doi.org/10.1007/s00423-016-1406-3

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