Advertisement

Surgical Endoscopy

, Volume 22, Issue 2, pp 534–538 | Cite as

Comparison of four energy-based vascular sealing and cutting instruments: A porcine model

  • Benjamin Person
  • David A. Vivas
  • Dan Ruiz
  • Michael Talcott
  • James E. Coad
  • Steven D. Wexner
Article

Abstract

Aim

To compare the safety and efficacy of four energy-based vascular sealing and cutting instruments.

Methods

Blood vessels of various types and diameters were harvested from four pigs using four instruments: Harmonic ACE™ (Ethicon Endo-Surgery, Cincinnati, OH), LigaSure™ V and LigaSure Atlas™ (Valleylab, Inc., Boulder, CO; a division of Tyco Healthcare), and EnSeal™ vessel fusion system (SurgRx, Inc. Redwood City, CA). The diameters of the vessels, speed and adequacy of the cutting and sealing process, and bursting pressures were compared. An additional set of specimens was sealed and left in situ for up to 4 h after which the vessels were harvested and histopathologically analyzed for the degree of thermal injury.

Results

The bursting pressures were significantly higher with EnSeal™ compared to all other instruments (p < 0.0001). The sealing process was significantly shorter with Harmonic ACE™ and significantly longer with LigaSure Atlas™ (p <0.0001). The mean seal width was larger with the LigaSure Atlas™ compared to the other instruments, and it was smaller with EnSeal™ and Harmonic ACE™. Less radial adventitial collagen denaturation was present with EnSeal™ and LigaSure™ V than with the other two instruments; there were no significant differences in collagen denaturation although proximal thermal injury to the smooth muscle in the media of the vessel wall was less common with LigaSure Atlas™ than with the other instruments; however, the numbers were too small for statistical analysis.

Conclusions

The bursting pressures with EnSeal™ were significantly higher than with all the other instruments. Harmonic ACE™ was the fastest sealing instrument and LigaSure Atlas™ was slowest. EnSeal™ created less radial thermal damage to the adventitial collagen of the vessels and LigaSure Atlas™ created less thermal damage to the media of the vessels. The clinical significance of these findings is unknown.

Keywords

Vascular sealing Energy-based Bursting pressure Thermal injury Porcine model 

Notes

Disclosures

–Research grant provided by SurgRx Inc., Redwood City, California

–SurgRx Inc. provides educational grant support to the Department of Colorectal Surgery at Cleveland Clinic Florida

–Ethicon Endosurgery Inc. provides educational grant support to the Department of Colorectal Surgery at Cleveland Clinic Florida

–Ethicon Endosurgery Inc., SurgRx Inc., and Tyco Healthcare Inc. provide financial support for Cleveland Clinic Florida educational programs

–Dr. Talcott is a consultant and owns stock at SurgRx Inc.

References

  1. 1.
    Kennedy JS, Stranahan PL, Taylor KD, Chandler JG (1998) High-burst-strength, feedback-controlled bipolar vessel sealing. Surg Endosc 12:876–878CrossRefPubMedGoogle Scholar
  2. 2.
    Harold KL, Pollinger H, Matthews BD, Krecher KW, Sing RF, Heniford BT (2003) Comparison of ultrasonic energy, bipolar thermal energy, and vascular clips for the hemostasis of small-, medium-, and large-sized arteries. Surg Endosc 17:1228–1230CrossRefPubMedGoogle Scholar
  3. 3.
    Landman J, Kerbl K, Rehman J, Andreoni C, Humphrey PA, Collyer W, Olweny E, Sundaram C, Clayman RV (2003) Evaluation of a vessel sealing system, bipolar electrosurgery, harmonic scalpel, titanium clips, endoscopic gastrointestinal anastomosis vascular staples and sutures for arterial and venous ligation in a porcine model. J Urol 169:697–700CrossRefPubMedGoogle Scholar
  4. 4.
    Bubenik LJ, Hosgood G, Vasanjee SC (2005) Bursting tension of medium and large canine arteries sealed with ultrasonic energy or suture ligation. Vet Surg 34:289–293CrossRefPubMedGoogle Scholar
  5. 5.
    Marcello PW, Roberts PL, Rusin LC, Holubkov R, Schoetz DJ (2006) Vascular pedicle ligation techniques during laparoscopic colectomy. A prospective randomized trial. Surg Endosc 20:263–269Google Scholar
  6. 6.
    Matthews BD, Pratt BL, Backus CL, Krecher KW, Mostafa G, Lentzner G, Lipford EH, Sing RF, Heniford BT (2001) Effectiveness of the ultrasonic coagulating shears, LigaSure vessel sealer, and surgical clip application in biliary surgery: a comparative analysis. Am Surg 67:901–906PubMedGoogle Scholar
  7. 7.
    Carbonell AM, Joels CS, Krecher KW, Matthews BD, Sing RF, Heniford BT (2003) A comparison of laparoscopic bipolar vessel sealing devices in the hemostasis of small-, medium-, and large-sized arteries. J Laparoendosc Adv Surg Tech 13:377–380CrossRefGoogle Scholar
  8. 8.
    Richter S, Kollmar O, Schilling MK, Pistorius GA, Menger MD (2006) Efficacy and quality of vessel sealing: Comparison of a reusable with a disposable device and effects of clamp surface geometry and structure. Surg Endosc 20:890–894CrossRefPubMedGoogle Scholar
  9. 9.
    Diamantis T, Knotos M, Arvelakis A, Syroukis S, Koronarchis D, Papalois A, Agapitos E, Bastounis E, Lazaris AC (2006) Comparison of monopolar electrocoagulation, bipolar electrocoagulation, Ultracision, and Ligasure. Surg Today 36:908–913CrossRefPubMedGoogle Scholar
  10. 10.
    Targarona EM, Balaque C, Marin J, Neto RB, Martinez C, Garriga J, Trias M (2005) Energy sources for laparoscopic colectomy: A prospective randomized comparison of conventional electrosurgery, bipolar computer-controlled electrosurgery and ultrasonic dissection. Operative outcome and costs analysis. Surg Innov 12:339–344CrossRefPubMedGoogle Scholar
  11. 11.
    National Research Council (1996) Guide for the Care and Use of Laboratory Animals. National Academy, Washington (DC)Google Scholar
  12. 12.
    Available at: http://www.jnjgateway.com/home.jhtml?loc=USENG&page=viewContent&contentId=09008b9880a2d1f7&parentId=09008b9880a2ba17. Accessed on March 26, 2007
  13. 13.
    Available at: http://www.ligasure.com/pages/seal.htm. Accessed on March 26, 2007
  14. 14.
    Available at: http://www.surgrx.com/technology.html. Accessed on March 26, 2007

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Benjamin Person
    • 1
  • David A. Vivas
    • 1
  • Dan Ruiz
    • 1
  • Michael Talcott
    • 2
  • James E. Coad
    • 3
  • Steven D. Wexner
    • 1
  1. 1.Department of Colorectal SurgeryCleveland ClinicWestonUSA
  2. 2.Division of Comparative MedicineWashington University, St. Louis School of MedicineWashingtonUSA
  3. 3.Department of PathologyRobert C. Byrd Health Sciences Center of West Virginia UniversityPAUSA

Personalised recommendations