These authors present their experience with the combined use of both old and new technology, ie, ultrasonic scalpel and LigaSure Vessel Sealing System (LVSS), respectively, as an improved method of closure when resecting giant bullae, multiple lung cysts, and metastatic lesions. This technique is supposed to preserve lung function and reduce costs associated with the use of disposable cartridges. LVSS is a new proprietary bipolar instrument with a higher current and lower voltage than other electrosurgical units, which is able to regulate output based upon the tissue involved. The device has been approved by the FDA so one has to assume that the usual questions of efficacy, safety, and “are you any worse off if it does not work” kind of questions have been asked and satisfactorily answered. This is a “Methods” or “How to do it” paper, and I think that the mix of patients included in this report is unfortunate. The problems most thoracic surgeons have in making technical decisions about the extent of resection in the three categories of patients listed here is different in each case. There are usually no problems with re-approximation and air leaks in peripheral metastatic lesions (N = 5/12 pts), and multiple pulmonary cysts are too rare to warrant much attention in support of a new technology. I am not sure why they utilized this technology for peripheral metastatic lesions since they can usually be done with the TA devices or as a wedge resection with the GIA instruments. That leaves the number of patients in this report, which are germane to the problem at three. So then the question as to why they chose the value of 15 cm of water to test for air leaks. They had one slightly prolonged (one week) air leak or 33% in this cohort. If this ratio is sustained over time in a much larger group, then the utility of this “new” technology will be denigrated. If you apply this to a cohort of 250 patients with emphysematous bullae, you are not going to get away with pressure testing to only 15 cm of water and the duration of the leak is going to be considerable. The authors note the “size of operated lung with an applied pressure of 15 cm of water was determined as the maximum diameter × minimum diameter,” but never instructed us as to the proper use of this information. One would infer that there is a ceiling of this ratio that precludes the use of this technology, but this is neither implied nor stated. The authors mention cost containment advantages of this device, but never once do they provide any comparative expenses for this device versus multifire staple cartridges. It would have been nice to know the purchase price of this bipolar unit, the cost of the pencil units, and any other costs specifically associated with the device. Also, can it be used by other services and for what kind of procedures? Most of us remember the love affair neurosurgeons always had with bipolar units that they would not share. This is a new application of “soon to be available technologies” and certainly warrants our attention as its proper place in our armamentarium is being elucidated. However, the problem that most of us face in dealing with severe emphysematous bullous disease and large tension cysts, which is finding two suitable edges that will be held together by this concept, still appears to be problematic to me. This is akin to sewing “wet tissue paper to dry tissue paper”, and I do not see this technique as a solution to that problem. Therefore, I intend to accept this as a “methods” paper with some success in a small group of three patients and will await the reports of much larger series with short-term follow-up. This may actually be of significance to those of us involved with LVRS, which is where it may have its greatest utility at the present time.