Abstract
Three electrosurgical tissue-sealing devices (EnSeal ETSDRC-01, LigaSure LS1500 and Thunderbeat TB-0535PC) were compared regarding sealing time (ST), maximum working temperature (WTmax) and the total (MTZtotal) as well as the collateral microscopic thermal injury zone (MTZcollat) using laparoscopic handpieces 5 mm in diameter on four types of tissue (liver, mesentery, cross striated muscle and spleen) in an in vivo porcine model. LigaSure had the lowest mean ST in spleen, mesentery, muscle and liver, followed by Thunderbeat and EnSeal with significant differences between all types of tissues and devices. The significantly lowest mean WTmax was obtained for EnSeal in mesentery, muscle and liver. LigaSure and EnSeal operated at the lowest temperature in spleen without a significant difference between them. Thunderbeat produced significantly higher temperature peaks in all cases. The lowest mean MTZtotal was caused by LigaSure and EnSeal in spleen, mesentery and muscle without significant differences between them, followed by the significantly higher values of Thunderbeat. Nevertheless, Thunderbeat produced the significantly lowest mean MTZtotal in the liver. EnSeal produced the lowest mean MTZcollat in the liver, followed by LigaSure and Thunderbeat showing significant differences. EnSeal and LigaSure produced the lowest mean MTZcollat in the spleen, mesentery and muscle without significant differences between them, followed by the significantly higher values of Thunderbeat. Based on the results of this study, Thunderbeat seems to be more invasive to tissue integrity (even without the activation of the ultrasonic scissor function) than EnSeal or LigaSure, that operate at lower temperatures and were found to cause negligible collateral thermal damage.
Highlights
The continuously expanding toolkit of electrosurgical devices has recently become an essential accessory of everyday surgical practice in both minimally invasive and open surgical procedures (Sran et al, 2016)
LigaSure was found to be the fastest compared to Thunderbeat and EnSeal; likewise, LigaSure had the shortest sealing time compared to EnSeal in another study (Lamberton et al, 2008)
The dissection time which includes tissue separation in addition to sealing time was shorter using Thunderbeat compared to LigaSure and EnSeal (Milsom et al, 2012)
Summary
The continuously expanding toolkit of electrosurgical devices has recently become an essential accessory of everyday surgical practice in both minimally invasive and open surgical procedures (Sran et al, 2016). A few publications have already evaluated the safety, efficacy, and versatility of electrosurgical systems (Landman et al, 2003; Lamberton et al, 2008; Person et al, 2008; Dunay et al, 2012; Milsom et al, 2012; Seehofer et al, 2012; Okhunov et al, 2018), most of the results cannot be compared objectively due to the different experimental conditions and test methods used. Surgeons can only select the safest and most effective devices for different tissue types based on the results of standardised comparative tests. The aim of this study was to examine and compare sealing time (ST), maximum working temperature (WTmax) and the total (MTZtotal) as well as the collateral microscopic thermal injury zone (MTZcollat) of the three systems available at the University of Veterinary Medicine, Budapest and the County Teaching Hospital of Kecskemet, used in different tissue types under standardised conditions
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