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Implementation of a novel efficacy score to compare sealing and cutting devices in a porcine model

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Abstract

Background

In general surgery, minimally invasive laparoscopic procedures have been steadily increasing over the last decade. The application of advanced bipolar and ultrasonic energy devices for sealing and cutting of blood vessels plays a vital role in routine clinical procedures. The advantages of energy-based instruments are enhanced sealing capability combined with both fast sealing time and minimal thermal injury. The purpose of this study was to compare the safety and efficacy profiles of nine laparoscopic sealing and cutting devices in a porcine model, with a new scoring system.

Methods

Comparative studies in a porcine model were performed to assess vessel sealing, burst pressure, thermal spread, maximum heat, sealing/cooling time, and compression strength over the full jaw. Nine different devices from five manufacturers were tested in this study. The sealing and cutting devices (SCD) score has been developed to enable standardized comparisons of various devices. For this purpose, the most important parameters were identified through a consensus approach.

Results

All sealed vessels with different devices could withstand a median pressure of more than 300 mmHg (range 112–2046 mmHg). The time for the sealing procedure was 7.705 s (range 5.305–18.38 s) for the ultrasonic and 7.860 s (range 5.08–10.17 s) for the bipolar devices. The ultrasonic instruments reached a median temperature of 218.1 °C (range 81.3–349.75 °C) and the bipolar devices a temperature of 125.5 °C (range 94.1–133.35 °C). The tissue reached a median temperature of 61.9 (range 47.1–80.6 °C) after ultrasonic sealing and 76.7 °C (range 63.1–94.2 °C) after bipolar sealing. The median SCD score was 10.47 (range 7.16–13.72).

Conclusion

All the instruments used seemed safe for use on the patient. The SCD score allows an indirect comparability of the instruments.

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Acknowledgements

We thank Covidien, Ethicon, Olympus, Martin, and ERBE for providing the generator and the instruments and Mr. Glier (Ethicon) for helping with and providing the burst pressure measurement device. We would also like to thank Testo for supporting and providing the thermal imaging camera and Tekscan, CMV Hoven GmbH, for the pressure measurement device.

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Author notes

  1. Lea Brecht and Markus Wallwiener have contributed equally to this work.

Authors and Affiliations

  1. Department for Internal Medicine, St. Josef’s Hospital, Heidelberg, Germany

    Lea Brecht

  2. Department for Gynaecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany

    Markus Wallwiener, Sarah Schott, Christoph Domschke, Christine Dinkic, Michael Golatta, Florian Schuetz, Herbert Fluhr, Christof Sohn & Joachim Rom

  3. Department of Pathology, University of Heidelberg, Heidelberg, Germany

    Albrecht Stenzinger

  4. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany

    Marietta Kirchner

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  1. Lea Brecht
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Correspondence to Joachim Rom.

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Disclosures

No financial support was obtained. Mrs. Brecht, Prof. Wallwiener, Prof. Sohn, Prof. Schuetz, Prof. Domschke, Prof. Fluhr and Drs. Sarah Schott, Dinkic, Golatta, Stenzinger, Kirchner, and Rom have no conflicts of interest or financial ties to disclose.

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Brecht, L., Wallwiener, M., Schott, S. et al. Implementation of a novel efficacy score to compare sealing and cutting devices in a porcine model. Surg Endosc 32, 1002–1011 (2018). https://doi.org/10.1007/s00464-017-5778-4

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