LigaSureTM Vessel Sealing System Research Articles

Perioperative Outcomes of LigaSure Versus Standard Ligature Technique Among Overweight and Obese Women Undergoing Abdominal Hysterectomy: A Randomized Clinical Trial

Objective: To investigate differences in perioperative outcomes of the LigaSure™ vessel sealing system (LVSS) compared with the standard ligature technique (suture) among overweight and obese women...

Evaluation of the LigaSure(™) Vessel Sealing System for bowel transection and intestinal anastomosis-an experimental study in a porcine model.

The purpose of the present study is to assess the value of the LigaSure™ Vessel Sealing System (LVSS) as a means for bowel transection and intestinal anastomosis. We compared the LVSS for (1) transecting bowel and (2) creation of an intestinal anastomosis with standard methods such as stapler (S) and hand-sewn (HS) in a porcine model. For each study arm, i.e., bowel transection and anastomosis creation, both the small bowel and colon were examined. In total, ten transections and ten anastomoses were performed for each. Burst and anastomotic leak pressures were compared. In the study arm 1, LVSS achieved lowest burst pressures in both small bowel (LVSS 39.8 ± 3.6 mmHg, S 81.9 ± 3.9, HS 111.9 ± 14.7 mmHg, p < 0.0001) and colon transections (LVSS 21.5 ± 2.6 mmHg, S 79.5 ± 4.9, HS 91.0 ± 5.2 mmHg, p < 0.0001). There was no difference in burst pressures between S and HS in both small bowel and colon transections. In the study arm 2, LVSS showed the lowest anastomotic leak pressures for small bowel (LVSS 26.4 ± 2.6 mmHg, S 52.1 ± 6.2, HS 87.4 ± 7.0 mmHg, p < 0.0001) and colonic anastomoses (LVSS 16.9 ± 1.3 mmHg, S 55.9 ± 4.3, HS 74.4 ± 4.4 mmHg, p < 0.0001). Furthermore, small bowel and colonic anastomoses using S demonstrated significantly lower leak pressures than HS anastomosis p < 0.001 and p = 0.004, respectively. The LVSS achieves significantly lower burst pressures and anastomotic leak pressures for bowel transection and intestinal anastomosis than S and HS techniques. However, due to the achieved pressure levels of 39.8 ± 3.6 mmHg, LVSS appears to be a sufficient stand-alone method for bowel transection. Whether it can be used to perform intestinal anastomosis warrants further research in a survival model.

A new operative strategy for refractory microcystic lymphangioma

The optimal management of microcystic lymphatic malformations (LMs) in children has not been established. We describe how we used the Ligasure™ Vessel Sealing System (LVSS) to achieve partial resection of refractory microcystic LMs in a 1-year-old boy. The child was admitted in respiratory distress caused by infection and swelling of cervical LMs. The LMs had been diagnosed prenatally, but had not decreased in size despite three treatments with OK-432 sclerotherapy. We performed direct dissection of the microcystic LMs using the LVSS with minimal intraoperative blood loss or lymphatic leakage. The LMs were resected as completely as possible without damage to the jugular vein or major nerves. His postoperative course was uneventful. Histological examination revealed complete sealing of the lymphovascular channels with obliterated lumens. Resection using the LVSS is effective and easy to perform for partial resection of microcystic LMs. We recommend the combination of initial OK-432 injection therapy and subsequent partial resection using the LVSS for refractory microcystic LMs.

Comparison of two different transection techniques in liver surgery—an experimental study in a porcine model

Postoperative morbidity and mortality after liver resection is closely related to the degree of intraoperative blood loss; the majority of which occurs during transection of the liver parenchyma. Many approaches and devices have therefore been developed to limit bleeding, but none has yet achieved perfect results up to now. The aim of this standardized chronic animal study was to compare the safety and efficacy of the LigaSure™ Vessel Sealing System (LVSS) with the stapler technique, which is one of the modern techniques for transecting the parenchyma in liver surgery. Sixteen pigs underwent a left liver resection (LLR). Eight pigs received a LLR by means of an Endo GIA, whereas the other eight pigs underwent liver parenchymal transection followed by simultaneous sealing by the LVSS. The operating time, transection time, blood loss during transection, and time of hemostasis were measured on the day of LLR (postoperative day 0/POD 0). Animals were re-explored on postoperative day 7 (POD 7) and the transection surface of remnant liver was observed for fluid collection (hematoma, biloma, and abscess), necrosis, and other pathologies. A biopsy was taken from the area of transection for histopathological examination. All animals survived until POD 7. Operating time and transection time of the liver parenchyma on POD 0 was significantly shorter in the stapler group. There was no significant difference between the two groups in terms of blood loss during transection, time of hemostasis and number of sutures for hemostasis on POD 0, morbidity rate, as well as the histopathological examination on POD 7. Furthermore, the material costs were significantly higher in the stapler group than in the LVSS group. In this standardized chronic animal study concerning transection of the parenchyma in liver surgery, LVSS seems not only to be safe, but also comparable with the stapler technique in terms of morbidity and mortality. Additionally, LVSS significantly reduces material costs. However, the transection time is significantly longer for LVSS than for the stapler resection technique.

Laparoscopic ovariectomy in dogs: a comparison of the LigaSure™ and the SonoSurg™ systems

The objective of this study was to evaluate the surgical times for removal of ovaries, and the frequency of intra-operative complications with two different instruments used for canine laparoscopic ovariectomy. A randomised prospective clinical study. Laparoscopic ovariectomy was performed under general anaesthesia on 10 healthy female dogs admitted for elective ovariectomy. Each ovary was randomly assigned to removal by use of either a SonoSurg™ ultrasonic surgical device (Olympus), or a LigaSure™ vessel-sealing system (Valleylab/Covidien). Surgical time for removal of each ovary was measured and the frequency of intra-operative complications was recorded. A follow-up was made by interview with the owners, 2·5 years after surgery. The two techniques did not statistically differ with regard to surgical time, or frequency of complications. All owners were very satisfied with the procedure. Both the SonoSurg™ and the LigaSure™ devices appear to be effective, safe and easy to use when performing laparoscopic ovariectomy in dogs.

Closure of the Cystic Duct During Laparoscopic Cholecystectomy in Children Using the LigaSure Vessel Sealing System

The goal of the present study was to evaluate the efficacy of the LigaSure(™) Vessel Sealing System (LVSS) when used for cystic duct closure during laparoscopic cholecystectomy in children and adolescents. The laparoscopic cholecystectomy was performed beginning with visualization of Calot's triangle, and dissection of Calot's triangle was achieved using a monopolar cautery device. Once the cystic duct was exposed, sealing was performed proximally and distally, and the cystic duct was divided midway using the LVSS. The procedure was completed in the standard fashion. The closure of the cystic duct was performed in seven cases of simultaneous cholecystectomy and splenectomy and in 15 cases of microlaparoscopic cholecystectomy. The patients' ages ranged from 7 to 21 years (average = 14.5 years), and body weight ranged from 42 to 83 kg (average = 58 kg). There was no bile leakage noted, and the closure of the cystic duct was sufficient in all cases. We noted one case of common bile duct obstruction on postoperative day 1. In this case, an exploration of the biliary tree was performed by laparotomy. No direct injury to the common bile duct was found during exploration, but thermal changes were detected in the surrounding tissues as a result of transmitted thermal energy caused by bipolar cautery device. The closure of the cystic duct using the LVSS is feasible and effective in laparoscopic cholecystectomy in children. However, it is important to keep a safe distance from other intra-abdominal structures when using thermal energy devices to prevent thermal collateral damage.

Comparison of Two Different Energy-Based Vascular Sealing Systems for the Hemostasis of Various Types of Arteries: A Porcine Model—Evaluation of Ligasure ForceTriad™

The ForceTriad™ generator has been recently developed. This new electrosurgical generator would demonstrate improved quality and efficiency in blood vessel sealing. To compare currently available 10-mm laparoscopic electrosurgical devices with the LigaSure™ Vessel Sealing System and ForceTriad generator (Valleylab, Inc., a division of Tyco Healthcare) for use in vessel sealing. Blood vessels of various types and diameters were harvested from alive four pigs using three instruments: LigaSure Atlas™ with LigaSure Vessel Sealing Generator (LSAt), LigaSure Atlas with ForceTriad Generator (LSAtFT), and Endoclip™ II (Autosuture, USSC; a division of Tyco Healthcare). A total of 100 arteries were processed by removal of fatty and connective tissue from the adventitia before sealing. An additional set of specimens was sealed and histopathologically analyzed after being stained with hematoxylin and eosin. The mean burst pressure was significantly higher with LSAtFT compared to LSAt (P < 0.01). The sealing process was significantly shorter with LSAtFT (P < 0.05). With regard to the degree of thermal injury, adventitial collagen denaturation and proximal thermal injury to the smooth muscle in the media of the vessel wall were less common with LSAtFT; however, the numbers were too small for statistical analysis. Both the LSAt and LSAtFT secured all vessel sizes to well above physiologic levels. The LSAtFT could be used more confidently in vessels up to 7 mm. Our findings indicate that LSAtFT could be a safer and more efficient instrument for advanced laparoscopic surgery.

Thoracoscopic Lung Biopsies in Heaves-Affected Horses Using a Bipolar Tissue Sealing System

To validate the use of the LigaSure™ Vessel Sealing System (LVSS) to perform thoracoscopic lung tissue biopsies in heaves-affected horses. Prospective clinical study. Heaves-affected horses (n=12). Lung biopsies (n=34) were collected with the LVSS (2-4 biopsies/horse) in horses with and without clinical signs of heaves. Thoracoscope (13th intercostal space [ICS]) and 2 instruments (between the 12-15th ICS) portals were used. Selected clinical and arterial blood gas variables were monitored. Postoperative pneumothorax was evaluated. Depth of thermal injury to the surrounding tissue and representativeness of the biopsies were determined. Mean surgical time was 22.9±8.0 minutes. The complication rate was 5.6%, and primarily related to a focal inadequate sealing of the biopsy margin. Five horses in exacerbation required intraoperative intranasal O(2) . Mean PaO(2) was significantly lower in heaves-affected horses with clinical signs compared with those without clinical signs. Postoperative pneumothorax was detected radiographically after 20 of the 34 procedures. One horse with clinical signs of heaves developed a fatal tension pneumothorax 5 days postoperatively despite close radiographic monitoring. Thoracoscopic lung biopsy using LVSS is a rapid and effective technique to harvest peripheral lung tissues from heaves-affected horses. Although the complication rate was tolerable, tension pneumothorax was a potential life-threatening complication because of incomplete lung sealing. LVSS can be used with relative safety to perform thoracoscopic lung biopsy, but close postoperative monitoring is necessary to avoid tension pneumothorax.

EComment: The use of the LigaSure™ vessel-sealing system is effective for preventing postoperative chylothorax following esophagogastrectomy

eComment: The use of the LigaSure™ vessel-sealing system is effective for preventing postoperative chylothorax following esophagogastrectomy

Clinical application of LigaSureTM vessel-sealing system for radical gastrectomy

Objective To examine the practicability and security of the LigaSureTM vessel-sealing system in radical gastrcctomy.Methods Seventy patients of stage Ⅰ～Ⅲ gastric cancer undergone radical gastrectomy were analyzed retrospectively.Thirty-five radical gastrectomy were performed with LigaSureTM vessel-sealing system,the other 35 eases were performed without LigaSureTM.The operative duration,volume of intraoperative hemorrhage,and postoperative complications were analyzed.Results There were significant difference in both operative duration[(159.9±24.7)min vs(172.6±23.7)min,P＜0.05]and volume of intraoperative hemorrhage[(335.7±40.3)ml vs(371.7±43.2)ml,P＜0.01].There was no significant difference in the postoperative complications between LigaSureTM group and conventional method group.All patients recovered without severe postoperative complications.Conclusion Radical resection of gastric cancer using LigaSureTM instead of conventional hand tie method appears to he shorten operative duration,decreased volume of intraoperative hemorrhage.And the technique is convenient and safe. Key words: Stomach neoplasm; Radical resection; Vessel-sealing system

Thyroid surgery: Use of the LigaSure Vessel Sealing System versus conventional knot tying

Background The aim of this work is to compare the use of conventional knot tying vs. LigaSure™ Vessel Sealing System (Valley Lab, Boulder, CO) in patients undergoing thyroid surgery. We hypothesized that use of the LigaSure would reduce operating time while resulting in a similar rate of complications. Methods This study was conducted in Endocrine Surgery Unit, Mansoura University Hospital on patients who underwent thyroid surgery from January 1, 2006 to December 31, 2006. One hundred and ten patients were operated upon by the same team of surgeons using conventional knot tying in 55 and the LigaSure in 55 patients for hemostasis. The medical records of the patients enrolled were reviewed and compared regarding age, sex, histopathological diagnosis, type of operation performed (lobectomy vs. subtotal thyroidectomy vs. total thyroidectomy), operating time, estimated intraoperative blood loss, postoperative complications, length of incision, hospital stay and cost, postoperative pain and outcome evaluation. Results The two groups had similar demographics, thyroid pathology, types of operations and complication rates. The LigaSure group had lower operating times, lower intraoperative blood loss, less postoperative pain and early pain-free return to normal activity and return to work. Conclusion The LigaSure Vessel Sealing System was as safe as conventional knot tying for thyroidectomy, with the benefit of reduced operating time, postoperative pain severity and early pain-free return to normal activity and return to work.

Laparoscopic Splenectomy: Ligasure Versus EndoGIA: A Comparative Study

Laparoscopic splenectomy (LS) is considered the gold standard for the treatment of hematologic disease of the spleen. Intraoperative bleeding is the main complication and main cause of conversion during LS. In this paper, we present our experience with 112 LS procedures, comparing two different techniques and instruments for spleen dissection and hilar vascular control. We have performed a total of 112 LS procedures in 9 years in two affiliated university hospitals. There were 48 males and 64 females (median age, 32.8 years). Indications were as follows: idiopathic thrombocytopenic purpura (ITP) in 42 patients, hereditary spherocitosis in 28, 6 with beta-talassemia, 1 with hemolitic anemia, 27 with lymphoma, 2 with leukemia, 3 with splenic cysts, and 3 PPT cases. Associated procedures were present in 25 cases (17 cholecystectomy and 4 liver/lymphnodal biopsies + lysis of adhesions). Patients were divided in two groups according to the method of dissection and hilar section (group 1, endostapler + monopolar coagulation with 38 patients; group 2, the Ligasure Vessel Sealing System (Valleylab, Boulder, CO) with 74 patients). Groups were well matched according to age, indications, spleen sizes, and procedures associated. Conversion rates (10 cases, 9%; 5 in each group), postoperative hospital stay (median 4 days in each group), and intra- and postoperative complications were similar in the 2 groups without any mortality in each group, while intraoperative blood loss (loss of 100 mL in 55 patients in group 2, 78%; and in 21 patients in group 1, 52%), transfusion rates (8 patients in group 1 versus 4 patients in group 2), and operative mean time (150 minutes in group 1 versus 125 minutes in group 2) were minor in the Ligasure Vessel Sealing System group, with a statistical significance. The approach to spleen dissection and hilum section was safe and efficacy in each case, otherwise the use of Ligasure results in a gain of time. Furthermore the average intraoperative bleeding and average transfusion rates of this series were lower in group 2.

Clinical Study of Laparoscopically Assisted Vaginal Hysterectomy with LigaSureTM Vessel Sealing System

Clinical Study of Laparoscopically Assisted Vaginal Hysterectomy with LigaSureTM Vessel Sealing System

The Use of the Ligasure Vessel Sealing System in Parotid Gland Surgery

To evaluate the role of the Ligasuretrade mark Vessel Sealing System (LVSS; Valleylab, Boulder, CO) in parotid surgery. A prospective study was conducted on 12 consecutive patients undergoing superficial parotidectomy, performed by using the LVSS device as the primary means of ligation. Inclusion criteria included parotid mass with no preoperative suspicion of malignancy, and no extension to the deep lobe of the parotid gland. Efficacy of hemostasis, cut-closure time, and postoperative complications were assessed. Results were compared with a historical control group, including cases on which the LVSS was not available. LVSS proved effective in providing ligation and hemostasis. There was a mean time gain of 52 minutes, compared with our historical control group. No postoperative bleeding, seroma, salivary fistula, or Frey syndrome were observed. One case of transient facial weakness occurred, which was completely resolved within 6 months. LVSS is a safe device for parotid gland surgery, providing sufficient hemostasis and reducing operative time. B-2.

How we do it: Application of LigasureTM Vessel Sealing System in patients undergoing total laryngectomy and radical neck dissection

Keypoints• The LigasureTM Vessel Sealing System (LVSS) provides haemostasis by denaturating collagen and elastin from the vessel wall and surrounding connective tissue.• LVSS is efficient for ligation of vessels of up to 7 mm in diameter, and these seals can withstand a minimum of three times normal systolic pressure.• LVSS delivers a precise amount of energy, according to the grasped tissue's density resulting in limited thermal injury to adjacent tissues.• We report the efficacy of the LVSS device in a case series of total laryngectomy and radical neck dissection procedures. LVSS has proved a reliable device, providing safe and time‐saving haemostasis during these procedures.