Skip to main content
SpringerLink
Log in

Efficacy and quality of vessel sealing

Comparison of a reusable with a disposable device and effects of clamp surface geometry and structure

  • Original Article
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

During the past few years, a variety of energy-based techniques for vessel ligation have been introduced. With the use of a porcine model and different devices for bipolar vessel sealing (BiClamp and LigaSure), we studied the impact of different clamp surface structures on the efficacy and quality of vessel sealing.

Methods

Eight Swabian Hall pigs underwent splenectomy, nephrectomy, salpingo-oophorectomy, and small bowel resection with the use of bipolar vessel sealing devices designed for open and laparoscopic surgery. Vessel sealing with clamps with a smooth (nonstructured) surface (BiClamp for open surgery and LigaSure for laparoscopic surgery) was compared to that of clamps with a structured (grooved, wafer-like) surface (BiClamp for laparoscopic surgery and LigaSure for open surgery). Measurements of sealed vessels (2- to 7-mm diameter) included the seal failure rate, instrument sticking, and heat-associated morphological vascular wall alterations.

Results

Analysis of seal failures did not reveal significant differences between the different devices for both open [BiClamp, 17.9% (17/95); LigaSure, 15.5% (11/71)] and laparoscopic surgery [BiClamp, 2.8% (1/36); LigaSure, 8.6% (3/35)]. Comparing all data of structured versus smooth clamp surfaces, the seal failure rate was lower using clamps with a structured (11.2%) compared to a smooth surface (15.4%). Instrument sticking and thermal spread were found to be significantly increased after sealing with structured surfaces, regardless of whether devices designed for open (p < 0.05 and p < 0.001, respectively) or laparoscopic surgery (p < 0.001 and p < 0.01, respectively) were used.

Conclusion

Clamps with a structured surface seem to be superior to those with a smooth surface for successful bipolar vessel sealing, as indicated by an increase of thermal spread. However, the more pronounced instrument sticking represents an undesired side effect and should encourage the search for more inert materials to further improve the sealing procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Belli G, Fantini C, Ciciliano F, D’Agostino A, Barberio M (2003) Pancreaticoduodenectomy in portal hypertension: use of the LigaSure. J Hepatobiliary Pancreat Surg 10: 215–217

    Article  PubMed  Google Scholar 

  2. Campbell PA, Cresswell AB, Frank TG, Cuschieri A (2003) Real-time thermography during energized vessel sealing and dissection. Surg Endosc 17: 1640–1645

    Article  PubMed  CAS  Google Scholar 

  3. Dubuc-Lissoir J (2003) Use of a new energy-based vessel ligation device during laparoscopic gynecologic oncologic surgery. Surg Endosc 17: 466–468

    Article  PubMed  CAS  Google Scholar 

  4. Harold KL, Pollinger H, Matthews BD, Kercher 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: 1228–1230

    Article  PubMed  CAS  Google Scholar 

  5. Heniford BT, Matthews BD, Sing RF, Backus C, Pratt B, Greene FL (2001) Initial results with an electrothermal bipolar vessel sealer. Surg Endosc 15: 799–801

    Article  PubMed  CAS  Google Scholar 

  6. Kennedy JS, Stranahan PL, Taylor KD, Chandler JG (1998) High-burst-strength, feedback-controlled bipolar vessel sealing. Surg Endosc 12: 876–878

    Article  PubMed  CAS  Google Scholar 

  7. Klioze SD, Poppas DP, Rooke CT, Choma TJ, Schlossberg SM (1994) Development and initial application of a real time thermal control system for laser tissue welding. J Urol 152: 744–7481

    PubMed  CAS  Google Scholar 

  8. 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: 697–700

    Article  PubMed  Google Scholar 

  9. Levy B, Emery L (2003) Randomized trial of suture versus electrosurgical bipolar vessel sealing in vaginal hysterectomy. Obstet Gynecol 102: 147–151

    Article  PubMed  Google Scholar 

  10. Palazzo FF, Francis DL, Clifton MA (2002) Randomized clinical trial of LigaSure versus open haemorrhoidectomy. Br J Surg 89: 154–157

    PubMed  CAS  Google Scholar 

  11. Presthus JB, Brooks PG, Kirchhof N (2003) Vessel sealing using a pulsed bipolar system and open forceps. J Am Assoc Gynecol Laparosc 10: 528–533

    Article  PubMed  Google Scholar 

  12. Romano F, Caprotti R, Franciosi C, De Fina S, Colombo G, Sartori P, Uggeri F (2003) The use of LigaSure during pediatric laparoscopic splenectomy: a preliminary report. Pediatr Surg Int 19: 721–724

    Article  PubMed  Google Scholar 

  13. Romano F, Caprotti R, Franciosi C, De Fina S, Colombo G, Uggeri F (2002) Laparoscopic splenectomy using LigaSure. Preliminary experience. Surg Endosc 16: 1608–1611

    Article  PubMed  CAS  Google Scholar 

  14. Schulze S, Krisitiansen VB, Fischer Hansen B, Rosenberg J (2002) Sealing of cystic duct with bipolar electrocoagulation. Surg Endosc 16: 342–344

    Article  PubMed  CAS  Google Scholar 

  15. Sengupta S, Webb DR (2001) Use of a computer-controlled bipolar diathermy system in radical prostatectomies and other open urological surgery. ANZ J Surg 71: 538–540

    Article  PubMed  CAS  Google Scholar 

  16. Shamiyeh A, Schrenk P, Tulipan L, Vattay P, Bogner S, Wayand W (2002) A new bipolar feedback-controlled sealing system for closure of the cystic duct and artery. Surg Endosc 16: 812–813

    Article  PubMed  CAS  Google Scholar 

  17. Shigemura N, Akashi A, Nakagiri T (2002) New operative method for a giant bulla: sutureless and stapleless thoracoscopic surgery using the LigaSure system. Eur J Cardiothorac Surg 22: 646–648

    Article  PubMed  Google Scholar 

  18. Sigel B, Dunn MR (1965) The mechanism of blood vessel closure by high frequency electrocoagulation. Surg Gynecol Obstet 121: 823–831

    PubMed  CAS  Google Scholar 

  19. Spivak H, Richardson WS, Hunter JG (1998) The use of bipolar cautery, laparosonic coagulating shears, and vascular clips for hemostasis of small and medium-sized vessels. Surg Endosc 12: 183–185

    Article  PubMed  CAS  Google Scholar 

  20. Strasberg SM, Drebin JA, Linehan D (2002) Use of a bipolar vessel-sealing device for parenchymal transection during liver surgery. J Gastrointest Surg 6: 569–574

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Janine Becker and Elisabeth Gluding for excellent technical assistance. The study was supported by ERBE Elektromedizin (Tübingen, Germany).

Author information

Authors and Affiliations

  1. Clinic of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, D-66421, Homburg/Saar, Germany

    S. Richter, O. Kollmar, M. K. Schilling & G. A. Pistorius

  2. Institute for Clinical & Experimental Surgery, University of Saarland, D-66421, Homburg/Saar, Germany

    M. D. Menger

Authors
  1. S. Richter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. O. Kollmar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. K. Schilling
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. A. Pistorius
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. D. Menger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. D. Menger.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Richter, S., Kollmar, O., Schilling, M.K. et al. Efficacy and quality of vessel sealing. Surg Endosc 20, 890–894 (2006). https://doi.org/10.1007/s00464-005-0380-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-005-0380-6

Keywords

Search

Navigation