Vessel Sealing System Research Articles

Evaluation of thermal effects of surgical energy devices: ex vivo study

This study evaluated the direct and indirect thermal effects of various surgical energy devices using an ex-vivo model. Two types of three devices were evaluated: ENSEAL™ X1 Curved Jaw Tissue Sealer (X1) and ENSEAL™ G2 Curved Tissue Sealer (G2) as vessel sealing systems (VSSs), and HARMONIC® HD1000i Shears (HA) as an ultrasonic activating device (USAD). Each device was activated once under DRY or WET conditions. The tissue’s maximum temperature (MT), steam MT surrounding the activation site, and steam spread area (SSA) were measured. Under WET conditions, the median MT of a porcine common carotid artery at 1 mm from the activation site by X1, G2, and HA were 84.4, 83.3, and 50.5 °C, respectively. The direct thermal effect of HA was the lowest among the three devices. VSSs showed higher tissue MT under WET conditions compared with DRY conditions. Conversely, USAD showed the opposite trend. G2 demonstrated a significantly higher MT than X1 and HA (P < 0.05). A significant decrease in SSA was observed with decreasing grasping range. In conclusion, VSSs generated higher temperatures than USAD, especially under WET conditions. Surgeons should consider minimizing thermal effects by creating DRY conditions or performing gradual incisions when using VSS devices.

Use of a vessel-sealing device compared with Jaboulay's technique for adult hydrocelectomy surgery: a retrospective cohort study.

Hydrocele is a common benign scrotal condition affecting adult men. The gold standard of treatment includes hydrocelectomy, with the use of Winkelman's/Jaboulay's technique or Lord's procedure. The vessel-sealing device (VSD) is a blood vessel-sealing system, known to enhance patient's postoperative outcomes in multiple different surgeries. The aim of this study was to compare the procedural and postoperative outcomes of a novel hydrocelectomy method using a VSD to the conventional hydrocelectomy using the Jaboulay's technique. We performed A retrospective review for all adult cases who underwent surgical hydrocelectomy at Hillel Yaffe Medical Center between 2011 and 2022. Study cases were grouped into one of two groups, patients undergoing conventional hydrocelectomy, or patients undergoing hydrocelectomy with the use of a VSD. Patients operated using other techniques were excluded. Data collected included demographic data and operative and postoperative parameters. Among 102 patients, 47 underwent Jaboulay's technique and 55 underwent hydrocelectomy using a VSD. We observed significantly shorter duration of hospitalization (1.18 vs 1.53, P = 0.038) and shorter surgery time (31.87 vs 37.4, P = 0.003) when using the VSD during a hydrocelectomy compared to conventional surgical hydrocelectomy. Both techniques indicated low complication rates and no recurrent hydrocele was observed in either group. We report our experience with a novel surgical technique that includes hydrocelectomy with the use of VSD. Our findings demonstrated shorter surgery time and length of hospitalizations, which may indicate improved patient's postoperative outcomes with the use of the VSD for hydrocelectomy.

A case of a thoracic duct cyst extending from the mediastinum to the cisterna chyli resected using bilateral thoracoscopic surgery in the prone position

BackgroundThoracic duct cysts are extremely rare mediastinal tumors. We report a case of a thoracic duct cyst extending from the caudal aspect of the left main bronchus to the left renal artery that was safely and completely resected via bilateral thoracoscopic surgery in the prone position.Case presentationA 77-year-old male was referred to our hospital for follow-up computed tomography (CT) of prostate cancer, which revealed a mediastinal tumor and fatty low-density along the posterior mediastinum of the para-aortic artery with a slightly high-density component. Magnetic resonance imaging revealed a T2-weighted image with high intensity. The preoperative radiological diagnosis was lipoma or well-differentiated liposarcoma. CT in the prone position suggested that the tumor could be resected from the thoracic cavity to the caudal side, and bilateral thoracoscopic surgery was performed in the prone position. Based on the surgical findings, the tumor was diagnosed as a thoracic duct cyst rather than a lipoma. Dissection around the thoracic duct cyst was performed using a vessel-sealing system to prevent leakage of the chyle, and reliable clipping was performed to resect the cisterna chyli. Histopathological examination revealed smooth muscle structures around the cyst, suggestive of a thoracic duct cyst. The diagnosis of a thoracic duct cyst was made based on a high triglyceride level of 1310 mg/dL on examination of the milky-white cyst fluid. The patient's postoperative course was uneventful, and he was discharged 4 days postoperatively. A CT scan performed 13 months after surgery showed no recurrence.ConclusionsA rare thoracic duct cyst extending from the mediastinum to the cisterna chyli was safely and completely resected using bilateral thoracoscopic surgery, with the patient in the prone position.

A vessel sealing system can help reduce the risk of postoperative complications after tumour resection in the medial thigh.

The risk of postoperative complications after resection of soft-tissue sarcoma in the medial thigh is higher than in other locations. This study investigated whether a vessel sealing system (VSS) could help reduce the risk of postoperative complications after wide resection of soft-tissue sarcoma in the medial thigh. Of 285 patients who underwent wide resection for soft-tissue sarcoma between 2014 and 2021 at our institution, 78 patients with tumours in the medial thigh were extracted from our database. Information on clinicopathological characteristics, preoperative treatment, surgical treatment (use of VSS, blood loss volume, operating time), and postoperative course (complications, postoperative haemoglobin changes, total drainage volume, and drainage and hospitalization durations) were obtained from medical records. We statistically compared clinical outcomes between patients whose surgery did or did not use VSS (VSS and non-VSS groups, respectively). There were 24 patients in the VSS group and 54 in the non-VSS group. There were no significant differences between the two groups in terms of clinicopathological background. The total drainage volume in the VSS group was significantly less than that in the non-VSS group (1,176 ml vs 3,114 ml; p = 0.018). Moreover, the drainage and hospitalization durations were significantly shorter in the VSS group compared to the non-VSS group (p = 0.017 and p = 0.024, respectively). Our results suggest that use of VSS can help reduce the risk of postoperative complications after wide resection of soft-tissue sarcoma in the medial thigh.

O079 Randomised controlled trial of LigaSure use versus monopolar diathermy in mastectomy

Abstract Introduction LigaSure is an electrothermal bipolar vessel-sealing system shown to decrease blood loss and drainage volume compared to electrocautery in axillary node dissection. This prospective randomised controlled trial aimed to assess whether using LigaSure improved perioperative outcomes when compared with monopolar diathermy alone in performing mastectomy without axillary dissection. Methods Mastectomy was performed with the LigaSure device and compared with mastectomy using conventional monopolar diathermy in a prospective randomised trial. Patients were recruited over 39 months and were aged from 33 to 86 years of age. Block randomisation (44 in the Ligasure group and 42 in the diathermy group) was performed. The primary outcome measures include total volume in drain output (ml), time to drain volume less than 30mls in 24 hours and operating time. Results Drain output volume was measured to the day the drain yielded less than 30mls in a 24 hour period in both groups (484 mls in the monopolar group v 494 mls in Ligasure group). This time point was also used to calculate time to drain removal in both groups (Monopolar 7.2 days and Ligasure 7.3 days). Drain output volume and number or days to drain removal did not show any significant difference in both groups (p=0.05). The operative time in both groups was similar (106mins in monopolar group and 112.5 mins in LigaSure group). Conclusion Use of the LigaSure device is feasible in performing mastectomy. It is not associated with reduced drain volume or shorter operative time compared with monopolar diathermy.

Feasibility and safety of renal artery closure with advanced bipolar energy device during nephrectomy.

Many devices are available to control the renal pedicle during nephrectomy but the gold standard is still a matter of debate. Nanotechnology has evolved to include vessel-sealing systems; companies guarantee an efficacy for vessels until 7 mm. The aim of our study is to evaluate feasibility and safety of closure of the renal artery with radiofrequency energy during nephrectomy. We retrospectively evaluated consecutive patients undergoing nephrectomy between November 2016 and July 2020. Inclusion criteria were: renal artery diameter <7 mm and no significant arterial wall calcification. The EnSeal device was used in all cases for dissection, hemostasis and to secure the renal artery when feasible. Overall 101 patients underwent nephrectomy, in 68 cases the radiofrequency alone was used to close the renal artery; in 45 patients during a laparoscopic procedure and in 23 during an open surgery. Conversion to open surgery was never necessary. No patients had major hemorrhagic complications. Mean operative time was 75 min, mean intraoperative blood loss was 85 ml. Overall 11 patients had postoperative complications, according to Clavien-Dindo: five grade I, three grade II, three grade III. In our experience the closure of the renal artery with a radiofrequency energy device is a feasible and safe procedure. It allows a safe manipulation of the renal hilum, free from clips, which could limit surgeons' maneuvers and be dislocated. We believe that a deep knowledge of the available technologies is fundamental for the surgeon and guarantees the best achievable results.

We perform intraluminal ligation of the proximal part of the pulmonary artery (PA) branches and seal and cut off the periphery using the daVinci Vessel Sealing System.

We perform intraluminal ligation of the proximal part of the pulmonary artery (PA) branches and seal and cut off the periphery using the daVinci Vessel Sealing System.

Efficacy and Safety of LigaSure in Laparoscopic Sutureless Appendectomy.

BackgroundThe closure of the appendiceal stump is a crucial step during an appendectomy. The purpose of this study is to evaluate the LigaSure Vessel Sealing System in laparoscopic appendectomy (LA) for sealing and dividing the base of the appendix.Material and methodsLaparoscopic appendectomy was performed using the 5-mm LigaSure Vessel Sealer in 53 patients, and the mesoappendix along with the base of the appendix was divided by LigaSure. Patient demographic details, operative time, return to oral feed, duration of hospital stay, and postoperative complications were recorded, and statistical analysis was done.ResultsOut of 53 patients (24 women and 29 men), no complications occur in 51 patients. The mean age and standard deviation (SD) were 26.50 ± 10.46 years. The mean operative time for 53 appendectomies by LigaSure was 27.8 ± 6.72 minutes. The mean duration of hospital stay after surgery was 3.3 ± 0.72 days. One patient developed mild subcutaneous emphysema over the abdomen (1.8%), and surgical site infection occurred in one patient (1.8%).ConclusionThis study demonstrated that sealing and dividing the base of the appendix by the LigaSure Vessel Sealing System is safe and feasible. It is associated with low complication rate and may help in simplifying the operative procedure.

Randomized Clinical Trial Comparing Mean Postoperative Pain Score in Hemorrhoidectomy using a Bipolar Vessel Sealing System Ligasure with Conventional open Diathermy Hemorrhoidectomy

Background: Hemorrhoids are one of the most frequent anorectal disorders and are responsible for considerable patient suffering and disability. Excisional hemorrhoidectomy is considered the gold standard1 for grade 3 and 4 haemorrhoids. Milligan Morgan haemorrhoidectomy by LigaSure is being investigated by a number of studies in the literature for its comparison with conventional diathermy method in terms of post-operative pain scores. Many studies favor the use of LigaSure in haemorrhoidectomy while other studies have found conventional methods to be either comparable or even superior to Ligasure. The purpose of this study was to know which method is superior, so that the better method would be preferred over the other one to minimize the post-operative pain, the major cause of post-operative morbidity and also to reduce the post-operative analgesia requirement, an important factor influencing the cost-effectiveness of the proposed method. Objective: To compare mean postoperative pain score in patients undergoing hemorrhoidectomy using Ligasure bipolar vessel sealing system with conventional open diathermy hemorrhoidectomy Methods: Patients aged between 20 to 60 years with symptomatic, third or fourth degree haemorrhoids were included in the study. Randomization to Group A (LigaSure group) or Group B (Diathermy group) was done using sealed envelopes with allocations to either procedure determined just prior to surgery. Perioperative medical treatment was standardized. Operative time was recorded. Patients were inquired about the pain score by using Visual analogue score at 24 hours post-operatively. Numbers of doses of analgesia required in 24 hours were also recorded. Results: Mean age of the patients was 42.05 ± 10.82 years. Study population consisted of 60 % males and 40% females. Mean operative time was significantly lower in Group A (17.10 ± 2.15 min) than Group B (24.63 ± 3.17 min) (P-value ˂ 0.001). Mean VAS score at 24 hours post-operatively was also significantly lower in Group A (2.07± 2.13) versus Group B (4.67± 1.62) (P-value ˂ 0.001). Mean number of doses of analgesia requirement in 24 hours post-operatively was also found to be significantly lower in Group A (0.97± 0.41) compared to Group B (2.17± 0.53) (P-value ˂ 0.001). Conclusion: LigaSure haemorrhoidectomy is significantly better than conventional method of open diathermy haemorrhoidectomy in terms of post-operative pain scores and post-operative analgesia requirement and it can be preferred over the conventional method due to its effect on reducing the morbidity and reducing the cost of analgesia requirement. Keywords: Hemorrhoids, LigaSure, Hemorrhoidectomy, Milligan-Morgan

Interlobar division using vessel-sealing system in robot-assisted pulmonary lobectomy.

ObjectiveWe investigated the safety of a novel interlobar fissure division technique using the da Vinci vessel sealing system in robot-assisted pulmonary lobectomy.MethodsThe medical records of patients who underwent robotic pulmonary lobectomy with node dissection for primary lung cancer between 2018 and 2020 were reviewed. The inclusion criteria were fulfilled by 111 patients, whose perioperative factors and postoperative results were compared with those previously reported. Furthermore, the new robotic lung interlobar division technique using the da Vinci vessel sealing system without a robotic stapler was evaluated in patients with low-grade incomplete fissure. We considered the Craig and Walker classification of lung fissures grades 1 and 2 as a good adaptation for the vessel sealing system interlobar fissure division.ResultsThe vessel sealing system group had shorter mean operative and console times (P = .03 and P = .01, respectively) and lesser median intraoperative blood loss (20 mL vs 50 mL; P = .01). The vessel sealing system group had lower surgical complication rates (2.2% vs 20.0%; P = .01). The incidence of persistent postoperative air leak was lower (0% vs 10.0%; P = .06), and fewer robotic stapler cartridges were used during surgery (3.4 vs 5.6; P < .001) in the vessel sealing system group than in the stapler group.ConclusionsWe report the safety of using the da Vinci vessel sealing system as an alternative to the use of robotic staples for interlobar fissure division in robot-assisted pulmonary lobectomy. This technique seems easy and feasible though limited to the low-grade incomplete fissure.

LigaSure Vessel Sealing System for Small Bowel Transection During Roux Limb Construction.

Roux limb construction is an essential part of several major reconstructive hepatobiliary and upper gastrointestinal surgeries. This can be achieved with a stapling device or suturing. For over two decades, the LigaSure vessel sealing systems (Medtronic, MN, USA) have been in use for omental division, mesenteric transection, and sealing of vessels. We used the LigaSure vessel sealing system with a ForceTriad energy platform (Medtronic) for transection of the bowel during the formation of the Roux limb for a Roux-en-Y reconstruction. Between July 2019 and December 2020, patients who had Roux limb construction as part of a pancreato-enteric anastomosis in surgery for chronic pancreatitis were analysed. The data was reviewed from a prospectively maintained database. Fifteen patients had undergone surgery for chronic pancreatitis. The mentioned technique takes approximately eight minutes to construct a Roux limb. There was no bleeding from the gut ends that had been transected. There was no breach in the bowel’s seal. The field was free of enteric contamination. In the post-operative course of these individuals, there was no Roux limb-related morbidity. This procedure is useful because it is cost-effective, time-saving, dependable, and prevents contamination and blood loss. It is also simple to learn and apply.

Impact of Electrothermal Bipolar Vessel Sealing System in Breast Surgery with Axillary Lymph Node Dissection and in Stage III Melanoma Patients: A Review of Current Evidence for its use in Surgical Practice

To consolidate the feasibility, safety and effectiveness in performing axillary lymph node dissection in breast surgery and in patients with stage III melanoma, using the electrothermal bipolar vessel sealing system, we revisit and analyze the main studies on the subject, in order to identify its use as the best in this surgical practice.

Surgical advances in the management of placenta accreta spectrum: establishing new expectations for operative blood loss

Objective To evaluate whether the implementation of our surgical approach, referred to in the text as Linear Cutter Vessel Sealing System (LCVSS) technique, will improve perioperative outcomes in patients with placenta accreta spectrum (PAS), specifically by reducing blood loss and blood transfusion rates at the time of cesarean hysterectomy (C-HYST). The LCVSS technique integrates the following: (1) hysterotomy performed using the Linear Cutter, (2) no placental manipulation, (3) cauterization of anatomically prominent vascular anastomosis using the handheld vessel sealing system, and (4) completion of bladder dissection until the cervico-vaginal junction before ligation and division of uterine arteries. Materials and methods This is a retrospective cohort study that analyzed perioperative outcomes in patients undergoing C-HYST for PAS at a tertiary care center from 1 July 2014 to 1 December 2019. Comparisons were performed between cases managed with the use of the LCVSS technique (designated as LCVSS cohort) and those managed without the use of the LCVSS technique (designated as no technique cohort). The primary outcomes were cumulative blood loss (CBL) and total perioperative blood transfusion of ≥4 and ≥6 units of PRBCs. The secondary outcomes were intra- and postoperative complications. Continuous and categorical variables were compared according to the sample size and distribution. Binary logistic regression analysis was performed to predict confounders for blood transfusion of ≥4 units of PRBCs. Results A total of 69 prenatally diagnosed PAS cases underwent C-HYST at the time of delivery. Forty-four cases that were performed using the LCVSS technique comprised the LCVSS cohort. The remaining 25 were marked as no technique cohort. CBL was significantly lower in the LCVSS cohort (1124 ml [300–4100] vs 3500 ml [650–10600]; p < .001). The rate of urinary tract injuries was similar (16%). The rate of postoperative complications and reoperation for intra-abdominal bleeding were lower but not significantly different in LCVSS cohort (9 vs 20% and 0 vs 8%, p = .26 and p = .12, respectively). There were no differences in neonatal outcomes. Conclusion Implementation of this advanced surgical approach for PAS management resulted in reduced blood loss and blood transfusion rates in comparison with no technique cohort.

A new method using a vessel-sealing system provides coagulation effects to various types of bleeding with less thermal damage

BackgroundHemostasis is very important for a safe surgery, particularly in endoscopic surgery. Accordingly, in the last decade, vessel-sealing systems became popular as hemostatic devices. However, their use is limited due to thermal damage to organs, such as intestines and nerves. We developed a new method for safe coagulation using a vessel-sealing system, termed flat coagulation (FC). This study aimed to evaluate the efficacy of this new FC method compared to conventional coagulation methods.MethodsWe evaluated the thermal damage caused by various energy devices, such as the vessel-sealing system (FC method using LigaSure™), ultrasonic scissors (Sonicision™), and monopolar electrosurgery (cut/coagulation/spray/soft coagulation (SC) mode), on porcine organs, including the small intestine and liver. Furthermore, we compared the hemostasis time between the FC method and conventional methods in the superficial bleeding model using porcine mesentery.ResultsFC caused less thermal damage than monopolar electrosurgery’s SC mode in the porcine liver and small intestine (liver: mean depth of thermal damage, 1.91 ± 0.35 vs 3.37 ± 0.28 mm; p = 0.0015). In the superficial bleeding model, the hemostasis time of FC was significantly shorter than that of electrosurgery’s SC mode (mean, 19.54 ± 22.51 s vs 44.99 ± 21.18 s; p = 0.0046).ConclusionThis study showed that the FC method caused less thermal damage to porcine small intestine and liver than conventional methods. This FC method could provide easier and faster coagulation of superficial bleeds compared to that achieved by electrosurgery’s SC mode. Therefore, this study motivates for the use of this new method to achieve hemostasis with various types of bleeds involving internal organs during endoscopic surgeries.

Comparison of Axillary Lymph Node Dissection by Using Ligasure Vessel Sealing System Vs Conventional Thread Ligation in Patients Undergoing Modified Radical Mastectomy for Carcinoma of Breast

Background: Breast Cancer is very common among women in Pakistan. Unfortunately, in our country patients present at late stage in teaching hospitals due to lack of awareness and traditional false beliefs. At this late stage modified radical mastectomy is the most common procedure carried out in our public sector hospitals. Traditional thread ligation is time consuming for axillary dissection. The modern vessel sealing devices are available. We aimed to compare the vessel sealing device Ligasure with the conventional method for axillary dissection during modified radical mastectomy. Objective: To compare conventional thread ligation method versus ligasure vessel sealing system use in axillary dissection for carcinoma breast in terms of mean post-operative drain output and mean number of days till drain removal. Study Design: Randomized Controlled Trial. Settings: The study was conducted in Department of Surgery, KEMU/ Mayo Hospital, Lahore-Pakistan. Duration: Seven months from 13-11-2018 to 13-05 2019. Methodology: After patients meeting inclusion criteria, they were prepared and underwent surgery. Patients were divided in two groups (group A and group B) Group-A patients underwent axillary dissection using Ligasure vessel sealing system while group-B patients underwent axillary dissection using traditional thread ligation. Drain outputs were recorded in Milliliters daily till drain output becomes less than 20 ml in preceding 24 hours. Drain removal day was noted. Data were analyzed using SPSS v20.0. t-test was used to compare the mean drain output and mean total number of days till drain removal in both groups. Data were stratified for age, BMI and tumor size to deal with effect modifiers. Post-stratification, t-test was applied. A p-value ≤0.05 was considered statistically significant. Results: A total of 112 patients were enrolled for this study. Patients were divided into two groups i.e. Group-A (Ligasure System) and Group-B (Conventional Method). In group-A, mean age was 45.8±18.2 years and 50.1±18.2 years in group-B. In group-A, mean drain volume was 500.1±60.8 ml and 665.3±84.9 ml in group-B with a p-value of 0.0001, which is statistically significant. In group-A, mean number of days till drain removal was 6.5±1.1 and 8.6±1.2 in group-B with a p-value of 0.0001, which is statistically significant. Conclusion: Axillary Lymph node dissection using Ligasure leads to decrease in mean post-operative drain output and mean number of days till drain removal as compared to conventional thread ligation method.

Longitudinal vaginal septum: a proposed classification and surgical management

To demonstrate various types of longitudinal vaginal septa (LVS), their classification, and the surgical management of typical and unique morphologic conditions of LVS. Video presentation of clinical appearance and surgical techniques for treatment of LVS. University hospital and two private. Representative cases from 121 consecutive women treated from 2013 to 2018 with LVS as a part of complex uterovaginal malformations or in isolated forms with [1] typical morphologic configuration of LVS, [2] rarer variants, or [3] specific anatomic restrictions. Resection of LVS performed as a main surgical procedure in cases with didelphys and bicornuate uterus in symptomatic women and as a part of corrective surgery of complete septate uterus. The three main nonsuturing techniques used were speculoscopy and septum excision using three different electrosurgical modalities; speculoscopy with laparoscopic devices; and vaginoscopy with hysteroscopic instruments. Clinical appearance and suggested classification, feasibility of surgery, and perioperative and anatomic results in a short follow-up period (3 months). We identified distinct types of longitudinal vaginal septa. Considering clinical appearance, we suggest classification of LVS based on four main features: [2] completeness of vaginal division: partial and complete type; [2] the symmetricity: symmetric and asymmetric position (with dominant left and right side); [3] association with the cervix: merged and isolated forms; and [4] concomitant vaginal openings: normal, and narrow openings: vaginal stenosis and hymen persistent (Fig.1). Vaginoscopic techniques by hysteroscope were successful in atraumatic treatment of women with substantial anatomic restrictions, and all of the presented techniques can be effectively used for typical LVS. However, vessel-sealing systems allow for bloodless surgery in contrast with other methods. This study was based on previously acquired data during large prospective study approved by the local ethics committee, and written informed consent to participate in the prospective study and permit publishing anonymous data regarding the medical images, videos of procedures, and results was obtained from all patients. A new classification of longitudinal vaginal septum allows better characterization compared with the currently available classification systems. Different surgical modalities are discussed with their respective advantages and disadvantages. Vaginoscopic incision using resectoscope is a reasonable alternative for women with an intact hymen and vaginal stenosis. The impact of vaginal septum resection on obstetric, reproductive, and sexual outcomes should be assessed in randomized controlled trials and large well-designed studies.

Ligasure Open Sealer / Divider – A useful tool in Resection of Tongue Lesions?

Introduction The Ligasure Vessel Sealing System has been around for a few years now and has been adapted into daily practice by many surgical specialties including the head & neck surgical specialties.

A novel approach to reduce blood loss in patients with placenta accreta spectrum disorder

Objective Cesarean hysterectomy for the treatment of placenta accreta spectrum (PAS) disorders has the potential to be associated with significant blood loss, massive transfusion, and operative morbidity. Two major contributors to blood loss are the hysterotomy and the bladder dissection. We introduce a new surgical technique and hypothesize that developing the hysterotomy with a linear cutter and mobilization of the bladder using a vessel sealing system (VSS) before clamping uterine arteries will lead to a total reduction in blood loss and transfusion rates. Materials and methods This was a case series, which presents clinical outcomes according to our described surgical technique. The following surgical outcomes were collected: operation time (minutes), estimated blood loss (EBL), intraoperative complications, need for reoperation before discharge, and transfusion rates. Our surgical technique utilizes a linear cutter to create a bloodless hysterotomy and a VSS to dissect the vesicouterine tissue. The VSS cauterizes and transects the small vesicouterine and placental-vesical vascular anastomoses that are prone to bleeding. Once the bladder is mobilized below the level of the cervix, the uterine arteries are ligated to complete the key components of the hysterectomy. Results Of the 23 cases, the median EBL was 1500 cubic centimeters and patients received a median of 1 unit of packed red blood cells. Eleven of the 23 cases did not require any blood transfusion and no patients required massive transfusion. The EBL did not differ between procedures that were performed emergently versus scheduled and it also did not differ between patients that had placenta increta versus placenta percreta, as diagnosed by histopathology. Conclusion Use of a linear cutter and closure of the lower anastomosis with VSS prior to clamping uterine artery during cesarean hysterectomy can significantly reduce blood loss and transfusion rates. This technique is applicable in emergent and nonemergent settings as well as for the most challenging procedures complicated by placenta percreta.

CLOSURE OF THE CYSTIC DUCT DURING LAPAROSCOPIC CHOLECYSTECTOMY BY THE LIGASURE VESSEL SEALING SYSTEM

Laparoscopic cholecystectomy is the “gold standard” in the treatment of symptomatic gallbladder lithiasis. Nevertheless, some pitfalls are associated with the use of the monopolar hook, such as the risk of thermal injuries and biliary complications. The present study assessed the efficacy of the Liga-Sure Vessel Sealing System (LVSS) when used for cystic duct closure during laparoscopic cholecystectomy. The laparoscopic cholecystectomy was done 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 and divided using the LVSS. The records were compared withthose of patients undergoing laparoscopic cholecystectomy with closure of the cystic duct with clips during the same period. The results showed that during the study period, 218 laparoscopic cholecystectomies were performed; 82 of these were performed with the Liga-Sure. The work was experienced a single case of bile leakage from the cystic duct due to missed stone in the common bile duct that was managed using ERCP.

Ligasure vessel-sealing system or harmonic scalpel versus conventional vessel ligation for thyroidectomy

Ligasure vessel-sealing system or harmonic scalpel versus conventional vessel ligation for thyroidectomy