Traditional Suture Ligation Research Articles

Ligasure Vessel Sealing Versus Conventional Suture Ligation in Thyroidectomy

Objective: To evaluate the efficacy of ligature sealing versus standard suture sealing for multinodular goiter patients after thyroidectomy. Method: The aim of our study is to evaluate the efficacy of ligature sealing versus standard suture sealing for multinodular goiter patients after thyroidectomy. The research was done in the Mayo Hospital in Lahore, Pakistan, specifically in the General Surgery Division. Ligasure-sealed patients made up Group A, while those in Group B were treated with traditional suture-ligation. The average duration of surgery, the average amount of discomfort felt by the patient afterward, and the average amount of drain fluid collected aftersurgery were all recorded. Results: Eighty people in total participated in the study. Patients in Group-Ahad an average operation time of 67.3±6.9 minutes, while those in Group-B averaged 85.6±8.3 minutes; this difference was statistically significant (p0.000001). Patients in group Areported an average of 2.6±1.3 units of pain, while those in group B reported 1.7±0.7 units of pain; this difference was statistically significant (p 0.001). Patients in Group-A had a mean drain output of 53.5±4.9 ml following surgery, while those in Group-B had an output of 68.2±7.3 ml; this difference was statistically significant (p = 0.0001). Conclusion: Thyroid surgery using ligature sealing is an effective and safe alternative to the standard approach, resulting in significantly less downtime, less discomfort, and less drainage after the procedure.

Evaluation of LigaTie device for total lung lobectomy in small breed dogs - An ex vivo study

This study aimed to evaluate an effectiveness of airway-sealing techniques used in total lung lobectomies in small dog breeds. Total lung lobectomies were performed on five canine cadavers weighing 2.5–8 kg. Airway-sealing techniques were performed on two randomly selected lobes per cadaver. The airway-sealing techniques consisted of traditional suture ligation, Endoloop, and LigaTie. After applying all surgical methods, bronchial stump was collected from the tongue and prepared. The effectiveness of each airway-sealing technique was evaluated by submerging the bronchial stumps in saline, followed by intubation to gradually increase the airway pressure to 80 cmH2O to identify the presence of air leakage in each lobe. Seven of the ten lobes in the traditional suture ligation group had a leakage; the leakages were fatal in three lobes. A single fatal leak occurred in the Endoloop group, while no leakage was noted in the LigaTie group. Therefore, the LigaTie technique had a higher statistical efficacy than the traditional suture ligation (p = 0.007). In conclusion, the LigaTie application reduced the incidence of air leakage following total lung lobectomies in small dog breeds.

Comparative Characteristics of Hemostasis During Vaginal Hysterectomy

Aim. To compare the results of surgical treatment using bipolar hemostasis and traditional ligation of ligaments and blood vessels in vaginal hysterectomy.Material and methods. Fifty patients with benign uterine disease underwent vaginal hysterectomy using electrosurgery (n = 29) or conventional suture ligation (n = 21 controls).Results. Postoperative pain (especially on the fi rst day) was decreased in the electrosurgery group (5.50 ± 1.43 VAS points) as compared to the control group (7.64 ± 0.58 points), p < 0.001. Intraoperative blood loss was signifi cantly lower in electrosurgery group (82.86 ± 22.58 ml) than in the control group (226.36 ± 129.12 ml), p < 0.001. Operating time was signifi cantly shorter in the main group than in the controls (65.36 ± 20.9 min vs. 86.59 ± 40.19 min, p < 0.05). On average, 2.75 ± 1.11 suture packages were used with bipolar coagulation, 6.00 ± 1.93 in the controls (p < 0.001). Hospital stay was similar for both groups. Adverse event rates did not differ signifi cantly.Conclusions. Bipolar coagulation with the TissueSeal Plus proved to be more effi cient or identical to traditional suture ligation. Intraoperative blood loss, postoperative pain and the duration of the operation were less, while the complications were identical for both groups. In addition, bipolar coagulation was easier to use and cost effective. These fi ndings prove the feasibility and effectiveness of the use of electrosurgical techniques to perform hysterectomy and its further study

INTERNAL ILIAC ARTERY LIGATION: A STEPWISE APPROACH

Video abstract summary This video presents a stepwise approach to an internal iliac artery ligation (IIAL) at laparotomy. Internal iliac artery ligation is an important technique for the gynecologic surgeon as it can bea life-saving intervention for gynecologic or obstetric hemorrhage. Internal iliac artery ligation can also be performed prophylactically when severe hemorrhage is anticipated. This video reviews the history of this surgical technique, the mechanism of action and the anatomy of the pelvic vasculature. We outline five key surgical steps required to successfully perform an internal iliac artery ligation: 1. Access the retroperitoneum; 2. Dissect the pararectal space; 3. Identify the anatomy; 4. Isolate the internal iliac artery; and 5. Ligate the vessel through either using a traditional suture ligation technique or contemporary clipping technique.

Outcomes of sutureless total thyroidectomy in elderly

IntroductionThyroid disease is common in elderly population. The incidence of hypothyroidism and multinodular goiter increases with age. Surgery in elderly patients has been considered to be more hazardous than in a youthful population. Besides the traditional surgical hemostatic techniques, different hemostatic approaches, which further minimize the risk of bleeding and complications during thyroidectomy, have become available. Aim of this study was to review and compare the outcomes of total thyroidectomy (TT) in elderly performed with different energy system. MethodsA total of 255 patients were eligible for the study and enrolled. One hundred and five patients with age >70 years (median age 76, range 70–90) constituted the elderly group (EG), whereas the young group (YG) was composed by 150 patients (median age 36, range 18–69). Each group was further divided into three subgroups, on the basis of the device used (none, Ligasure Precise/Small Jaw or Harmonic Focus) for performing TT as follows: conventional thyroidectomy in EG (CTE) and YG (CTY), Ligasure thyroidectomy (LTE and LTY) and Harmonic thyroidectomy (THE and HTY). Intra-operative and post-operative data, as well as complications rate, were collected. ResultsThere was no significant difference between the elderly and the young patients treated with total thyroidectomy. Using of Harmonic Focus or Ligasure Precise/Small Jaw allowed a reduction of the duration of surgery (p < 0.05) than conventional approach; complication rate for hemorrhage, hypocalcemia and vocal cord paralysis was similar in all sub-groups. ConclusionsTotal thyroidectomy in elderly patients is as safe as in the younger population.Moreover, using the Harmonic Focus and the Ligasure Precise/Small Jaw is a safe, effective, and time-saving alternative to the traditional suture ligation technique for thyroid surgery.

5: Salpingo-oophorectomy by transvaginal natural orifice transluminal endoscopic surgery

The objective of this video is to demonstrate a Salpingo-oophorectomy performed entirely by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) following a vaginal hysterectomy. We believe that the majority of adnexa can be safely removed vaginally using the traditional suture ligation technique or a vessel-sealing device. If the ovaries are not readily accessible, a pre-tied surgical loop can be placed around the adnexa to improve traction and hemostasis. Alternatively, one could isolate the round ligament to improve descensus and proceed with suture ligation. In rare situations, the surgeon might need to convert to laparoscopy or laparotomy due to difficult visualization. In this video, we demonstrate an additional technique that can be used as an alternative to converting to an abdominal approach. Prior to performing this procedure on a live patient, the surgical team practiced the approach on six unembalmed cadavers. In this footage, we start by demonstrating the port placement. We then proceed with describing the technique on how to perform a salpingo-ooporectomy via vNOTES. Salpingo-oophorectomy was safely and effectively completed via vNOTES. The use of this technique could avoid the need to convert to an abdominal route. vNOTES to remove the adnexa is a novel approach that requires further validation.

Differences in Thyroidectomy Outcomes Based on Surgical Method: A Comparison of LigaSure Precise, Harmonic Focus, and Traditional Methods

New surgical devices have been developed to improve haemostatic control and vascular closure in thyroid surgery. Here, we compare the efficacy and clinical outcomes of 3 surgical methods, Harmonic Focus, LigaSure Precise, and the traditional suture-ligation method, in patients undergoing total thyroidectomies. This retrospective study compared total thyroidectomies performed between July 2008 and August 2012. Thyroidectomies were performed in 243 patients using Harmonic Focus (n = 81), LigaSure Precise (n = 81), and traditional suture-ligation (n = 81). No significant differences were observed among groups in terms of patient demographics, thyroid weight, pathological diagnoses, pre- and postoperative calcium levels, postoperative complications, length of hospitalization, and clinical outcomes. The Harmonic Focus approach showed an ∼15% shortening in operating time relative to the suture-ligation group; no statistically significant differences were detected between the LigaSure and traditional suture-ligation groups. All 3 methods were found to be both safe and effective. Operating time was significantly shorter in the Harmonic Focus group; no differences in terms of postoperative complications were observed among groups.

Electrosurgical bipolar vessel sealing during axillary lymphadenectomy: a systematic review and meta-analysis.

Various methods are currently used during axillary lymphadenectomy. Our systematic review aims to investigate the potential benefits of bipolar vessel sealing systems (EBVS) over conventional suture ligation during the axillary dissection of breast cancer patients. We searched Medline (1966-2014), Scopus (2004-2014), Popline (1973-2014) Cochrane CENTRAL (1999-2014) and ClinicalTrials.gov (2000-2014) together with reference lists from included studies Statistical meta-analysis was performed using the RevMan 5.1 software. Four studies were finally included, involving 352 patients. Usage of EBVS significantly increased the number of retrieved axillary lymph nodes (MD 1.67 nodes, 95% CI 0.21, 3.13). Intraoperative times were not affected by these new technique, when compared to traditional suture ligation (MD -10.82 minutes, 95% CI -23.27, 2.70). Neither the volume of postoperative axillary drainage (MD -38.47 ml, 95% CI -110.26, 32.59) nor the duration of drainage (MD -0.49 days, 95% CI -1.23, 0.25) were significantly affected by EBVS application. We observed, however, that bipolar systems may be associated with an increased risk of postoperative seroma formation (OR 2.04, 95% CI 1.13, 3.70). Electrosurgical bipolar vessel sealing systems seem to increase the accuracy of axillary dissection and are equally safe compared to conventional suture ligation regarding intraoperative and postoperative blood loss. They are associated, however, with and increased incidence of seroma formation. Further randomized trials are needed in the field in order to obtain firm conclusions.

The safety of the Harmonic® FOCUS in open thyroidectomy: A prospective, randomized study comparing the Harmonic® FOCUS and traditional suture ligation (knot and tie) technique

Since Kocher and Billroth refined an acceptable technique, the thyroidectomy has become one of the most frequent procedures in endocrine surgery and bilateral total thyroidectomy is performed in the majority of thyroid diseases.This work evaluated the use of the Harmonic® FOCUS and traditional suture ligation (knot and tie) technique in a prospective, randomized study of open thyroidectomy.Eighty two patients were randomized and divided into two similarly sized groups: the Harmonic® FOCUS group (F group) and traditional group (T group).The use of the harmonic FOCUS shows some statistically significant advantages limited to a few intraoperative parameters: surgical time and volume of blood loss.The surgical time was significantly shorter in F group than in the T group (105 ± 27 min vs 143 ± 32 respectively; p < 0.05).Intraoperative volume blood loss was significantly more in the T group than in the F group (36 ± 23 ml vs. 24 ± 18; p < 0.05).The postoperative parameters (volume of drainage fluid, serum calcium at 12 and 48 h, hypocalcemia, wound complication, RLN palsy, postoperative pain and length of hospital stay) showed no statistical difference.The Harmonic Focus may provide a cost-effective option only in high volume centers where reducing operative time may balance the number of daily procedures.

Sutureless thyroidectomy

ObjectiveThe ultrasonic scalpel is a surgical shear that uses high-frequency mechanical energy to enable simultaneous vessel sealing and tissue coagulation at the same time. We conducted a prospective study to compare the outcome of total thyroidectomy using the ultrasonic scalpel versus the device Ligasure in terms of safety, operative time, overall drainage volume, complications, hospital stay. MethodsBetween January 2008 and December 2013,400 patients (260 women, 140 men; mean age 46 years) undergoing thyroidectomy were randomized into two groups: group A, where Ultracision were used, and group B, where the Ligasure device was used. ResultsThere was no significant differences between the two groups in terms of age, gender, indication for thyroidectomy, thyroid gland weight and diameter, histopathologic diagnosis, preoperative and postoperative serum calcium levels, postoperative complications and reoperative thyroid surgery, time of operation and amount of drainage. ConclusionsThe ultrasonic scalpel and the Ligasure ares safe, effective, useful, and time-saving alternative to the traditional suture ligation technique for thyroid surgery. They simplified total thyroidectomy, eliminating the need for clamp-and-tie maneuvers while achieving efficient hemostasis.

Electrosurgical bipolar vessel sealing for vaginal hysterectomies.

Vascular clamping of the uterine vessels and the ovarian and broad ligaments during vaginal hysterectomies is more difficult than in traditional abdominal hysterectomies. We aimed to assess the efficacy of electrosurgical bipolar vessel sealing systems (EBVS) as an adequate alternative to traditional suturing that could facilitate the accomplishment of securing the vascular pedicles. We searched MEDLINE (1966-2013), Scopus (2004-2013), POPLINE (1973-2013), Cochrane Central (1999-2013) and Google Scholar (2004-2013) search engines, along with reference lists from all included studies. Eight randomized trials were selected, including 772 patients. We found that operative duration did not differ significantly among women treated with EBVS and those treated with traditional suture ligation (MD -16.86, 95 % CI -34.77, 1.05). Intraoperative blood loss on the other hand was significantly lower in the EBVS-treated group (MD -49.47, 95 % CI -67.60, -31.35). There were no significant differences in intraoperative complication rates (OR 0.96, 95 % CI 0.46, 2.01), major postoperative complication rates (OR 0.61, 95 % CI 0.29, 1.32) or minor complications (OR 1.63, 95 % CI 0.67, 3.92). Our meta-analysis showed that EBVS seem to produce less intraoperative blood loss during vascular clamping, without significantly lowering intraoperative time or complication rate. However, the heterogeneity of included studies preclude firm conclusions. Future studies examine consistently their safety, and cost-effectiveness, and whether the application of such units will enhance the rates of vaginal hysterectomies.

Comparison of Ultrasonic Shears and Traditional Suture Ligature for Vaginal Hysterectomy: Randomized Controlled Trial

Study ObjectiveTo compare operating time, intraoperative blood loss, postoperative analgesia, and length of hospital stay using ultrasonic shears vs traditional suture ligature in vaginal hysterectomy. DesignRandomized controlled trial (Canadian Task Force classification I). SettingGynecology units within a single health network, university hospital. PatientsForty women requiring vaginal hysterectomy because of benign disease. InterventionsVaginal hysterectomy performed using either ultrasonically activated shears (USS) or traditional suture ligatures. Measurements and Main ResultsTwenty-one patients were randomized to the USS arm, and 19 patients to the traditional suture ligature arm. Patient characteristics were comparable. Mean (SD) hysterectomy time and was similar in both the USS and traditional arms, 28.66 (4.0) minutes vs 32.37 (3.18) minutes (p = .47), as was total operating time, 97.38 (8.9) minutes vs 91.63 (7.69) minutes (p = .63). Operative blood loss was significantly decreased in the USS group: 62.63 (12.46) mL vs 136.05 (21.54) mL (p = .006). There was, however, no significant change in hemoglobin concentration between the 2 groups: 19.53 (1.79) g/L vs −16.72 (2.5) g/L. There was no significant difference in mean oxycodone use: 9.29 (2.66) mg vs 8.06 (3.19) mg (p = .77). Length of hospital stay was similar in both groups: 58.98 (3.27) hours vs 60.05 (6.48) hours (p = .88). There was no significant difference in overall complication rates between the groups. ConclusionAlthough the Harmonic scalpel system, compared with the traditional suture ligation method, seems to be a safe alternative for securing the pedicles in vaginal hysterectomy, it offers no benefit insofar as operative time, reduction in clinically significant blood loss, and analgesic requirements.

Decreasing operative time and incontinence rates in patients treated with radical cystectomy and urethral diversion: a prospective randomized trial using a new suturing device (CAPIO)

Radical cystectomy and orthotopic urinary diversion has been associated with significant long surgery time and postoperative urinary incontinence. We undertook a prospective randomized study to investigate the potential decrease in surgery time and improvement in the continence rate using a new suturing device compared with the traditional suture ligation, which is used for urethro-ileal anastomosis after radical cystectomy and orthotopic diversion for invasive bladder carcinoma. Between April 2005 and March 2010, 50 consecutive patients (37 men and 13 women) were recruited for the study. They were all subjected to radical cystectomy and W ileal neobladder orthotopic diversion by two senior surgeons. They were divided and randomized into two equal groups according to the methods of urethro-ileal anastomosis. The preoperative characteristics of both groups were equally distributed. One group underwent urethro-ileal anastomosis by the CAPIO suturing device, and the other group subjected to the usual stitches by needle older. Operative and early postoperative parameters were assessed. We followed the patients for 6 months postoperatively. The preoperative parameters of the two groups were equally distributed with no statistically significant difference in any parameter. There were no intraoperative deaths. The mean time spent for urethro-ileal anastomosis in CAPIO group was 10.2 ± 1.4 min versus 19.6 ± 2.4 min, which was statistically significant (P value = 0.0001). Also, the mean blood loss was less in the CAPIO group (P value 0.05). As regard the early postoperative follow-up, the postoperative continence rate was significantly better in the CAPIO group than in the classic suturing group. CAPIO as a new suturing device significantly shortened the time needed to achieve the urethro-ileal anastomosis with better early postoperative continence rate. It makes urethral stump accessible at any time during surgery. It also enables surgeons to do anastomosis at any time after cystectomy with any number of sutures.

Thyroid surgery: comparison between the electrothermal bipolar vessel sealing system, harmonic scalpel, and classic suture ligation

Background This study was conducted to compare the outcome of total thyroidectomy using the electrothermal bipolar vessel sealing system, the harmonic scalpel, and the classic suture ligation technique. Methods This was a retrospective study of prospectively collected data from 382 consecutive total thyroidectomies from September 2004 to August 2006. Patients were divided into 3 groups: group SL patients (n = 90) underwent total thyroidectomy with the classic suture ligation technique, group L (n = 148) with the electrothermal bipolar vessel sealer, and group U (n = 144) with the harmonic scalpel. The main outcomes measured were surgical and hospitalization time, intraoperative and postoperative bleeding, postoperative hypocalcemia, and superior and inferior laryngeal nerves injuries. Results The 3 groups were similar in terms of demographics, thyroid gland weight and pathology, perioperative complications, and hospital stay. Compared with the classic technique, surgical time was reduced significantly by about 20% when the bipolar vessel sealer or harmonic scalpel was used (93.3 ± 12.5 vs 74.3 ± 14.2 and 73.8 ± 13.8 min, P = .001, and P = .001, respectively). Conclusions Both the bipolar vessel sealer and harmonic scalpel are safe, useful, and time-saving alternatives to the traditional suture ligation technique for thyroid surgery. Because no differences were observed regarding these 2 devices, the choice should be made based on the surgeon’s preferences and experience.

Decreasing Blood Loss in Patients Treated With Radical Cystectomy: A Prospective Randomizes Trial Using A New Stapling Device

Radical cystectomy has been associated with significant blood loss and the need for heterologous transfusion. We investigated the potential decrease in blood loss and/or in transfusion requirement using a new stapling device compared with the traditional suture ligation technique. We prospectively examined 70 patients with urothelial carcinoma who were scheduled for radical cystectomy. Each patient was randomized to traditional suture ligation or the Compact Flex Articulating Linear Cutter (Ethicon Endo-Surgery, Cincinnati, Ohio) stapling device. The 2 groups were prospectively compared with respect to estimated blood loss, transfusion requirement, operative time and complications. The groups were equivalent in terms of demographic and clinical variables, indicating that randomization produced 2 comparable groups. The stapler group had significantly lower estimated blood loss during cystectomy (p = 0.007) and during the whole procedure (p = 0.02). This group also required fewer transfusions (p = 0.006) and fewer mean units transfused (p = 0.003). The overall transfusion rate was 20% (14 of 70 cases). All patients in the stapler group had lower estimated blood loss and transfusion requirements. There was no statistical difference in time needed for bladder removal (p = 0.91) or total operative time (p = 0.17). No complications were attributable to the stapler device. In this prospective randomized study the stapling device significantly decreased blood loss and the transfusion requirement during radical cystectomy. These significant advantages combined with its relative safety make it an attractive surgical option and argue in favor of continued strategic attempts to decrease blood loss during radical cystectomy.