Use of Energy Devices in Thoracoscopy: Quantification of Lung-Sealing Capacity

Abstract

Purpose: The use of stapling devices in pediatric thoracoscopic surgery is limited due to the decreased maneuverability of 12-mm instruments in a child's chest. The goal of this study is to quantify the ability of 5-mm energy devices to seal lung tissue in the nonsurvival swine model. Methods: Nine 10-kg female swine were divided into three nonsurvival groups. Group A (n = 3): Left thoracotomy with use of a 12-mm stapler (US Surgical Corporation, Norwalk, Connecticut). Group B (n = 3): Left thoracoscopy with use of the LigaSure LS1000 (Valleylab, Boulder, Colorado) 5-mm instrument. Group C (n = 3): Left thoracoscopy with use of the Ultracision LCS-K5 (Ethicon Endo-Surgery, Cincinnati, Ohio) 5-mm instrument. Biopsy specimens of the lingula of the lung were taken. At the end of the procedure, seal burst pressures were recorded. Results: Average burst pressure (mm Hg): A, staples 43.5 (43-44); B, LigaSure 44.9 (40.2-53.6); C, harmonic 37.5 (30-46.4). Average seal length (mm): A, staples 30 (30-30); B, LigaSure 27 (21.4-30); C, harmonic 26 (22-27). Average biopsy weight (g): A, staples 0.52 (0.51-0.53); B, LigaSure 1.78 (1.69-2.14); C, harmonic 1.58 (0.3-1.66). The standard deviations for the pressures were as follows: A, staples 0.5; B, LigaSure 7.54; C, harmonic 8.29. No statistically significant differences between the burst pressures were determined by the t test (A vs. B, P = .78; A vs. C, P = .33). There was 80% power to detect a difference in the means of 25 mm Hg for the LigaSure (A) and of 27 mm Hg for the harmonic (B). Conclusion: Both the LigaSure and the harmonic scalpel can effectively seal normal lung tissue from air leaks in the nonsurvival swine model.