Experience with a New Energy Source for Tissue Fusion in Pediatric Patients

Abstract

Options for effective techniques for vessel and tissue sealing in infants and children are limited because of the size and limited intracorporeal space of many pediatric patients. We evaluated a new energy source, the ForceTriad (Covidien, West Windsor, NJ) LigaSure, which delivers both mono- and bipolar energy in a 5-mm format and allows for tissue fusion and vessel sealing and division. This report documents our experience with this device. A database review was performed, looking for all cases that were performed in children using the ForceTriad LigaSure as the main source of hemostasis and tissue fusion. Two different handpieces were used a fine Maryland dissector-type instrument with no cutting blade, and a sealer/cutter, both in a 5-mm format. A total of 60 cases were performed in children from September 2006 to September 2007, using the ForceTriad. The two most common cases were Nissen fundoplication (40 cases; weight: 8.5-95 kg [average,40.7]; operating room [OR] time: 15-70 min [average, 32]; average days to full feeds: 2) and lung lobectomy (11)cases (weight: 4.6-63 kg [average, 27.3]; OR time: 60-180 min [average, 123]; average hospital days: 3.1). Other procedures included, excision of choledochal cyst (3), aortopexy, closure of bronchopleural fistula, nephrectomy(1), thymectomy (1), parathyroid adenoma excision (1), total colectomy (2), and intestinal duplication resection(2). There were no failures of vessel or tissue fusion and no operative complications. A delayed hydropneumothorax developed in 1 lung resection and spontaneously resolved. The ForceTriad provides a safe, effective energy source in a 5-mm format. As compared to previous versions of the LigaSure, there was less sticking, a quicker seal, and no tissue-fusion failures.