Vessel Sealing System Research Articles

Safety and Effectiveness of Vessel Sealing for Dissection during Pancreaticoduodenectomy

Traditional pancreaticoduodenectomy dissection techniques are tedious and time-consuming. The LigaSure(®) Vessel Sealing System is an alternative to standard dissection methods. LigaSure(®) can be used in replace of ligatures, clips, and sutures in most of the pancreaticoduodenectomy procedure. The objective of this study was to examine our experience with LigaSure(®) in pancreaticoduodenectomies and to show the safety and time-effectiveness. Forty-three pancreaticoduodenectomies were performed by a single surgeon using the LigaSure(®) device in place of traditional dissection techniques. A retrospective chart review was conducted to evaluate patient management and outcome. Demographics, preoperative, intraoperative, and postoperative data were analyzed. The average patient age was 61 years. Primary pathologic diagnoses were: periampullary carcinoma (56%), chronic pancreatitis (5%), cystic lesion (26%), neuroendocrine tumor (7%), and other (5%). Our patient population demonstrated American Society of Anesthesiologists Class I (2%), Class II (14%), III (75%), and IV (9%). Average operative time was 4:11 hours. The study group required an average of 0.49 ± 1.35 units of blood. Eight patients (19%) received blood transfusion, receiving an average of 2.63 ± 2.13 units. Patients had a median hospital stay of 10 days (range, 5 to 41 days). An oral diet was ordered for most patients by Day 4. Fourteen patients (32.5%) had a complication, including two patients requiring additional surgery for drainage of abscess. There were no postoperative deaths. The use of LigaSure(®) is a practical and safe alternative to standard dissection techniques. Operative time, blood loss, and complication rate are favorable compared with published series.

Comparative Study between Harmonic Scalpel and LigaSure Vessel Sealing System: In Open and Laparoscopic Surgery

Background: Energy sources have been an important part of surgery in achieving hemostasis and bloodless field to operate. Nowadays the most recent and commonly used are the bipolar vessel sealing system (LigaSure) and the harmonic scalpel (HS). Purpose: To do a comparative review between the LigaSure vessel sealing system and harmonic scalpel to make surgery faster, safer and better. Materials and methods: The literature regarding this review article was searched online on various websites like Google, PubMed, World Journal of Gastrointestinal Surgeons, YouTube. Search words used were LigaSure vs harmonic scalpel, LigaSure vessel sealing system, role of vessel sealer and HS in laparoscopic surgery. Conclusion: LigaSure vessel sealing system (LVSS) proves to have a hand above the HS as it depends of the surgeon’s convenience to use which of the energy sources when it comes to handling and maneuverability during surgery resulting in an overall faster, safer and a bloodless experience.

Comparative Study between Harmonic Scalpel and LigaSure Vessel Sealing System: In Open and Laparoscopic Surgery

Comparative Study between Harmonic Scalpel and LigaSure Vessel Sealing System: In Open and Laparoscopic Surgery

Improved Efficiency of LigaSure Vessel Sealing System for Recipient Hepatectomy in Liver Transplantation

Vessel sealing devices expedite surgical procedures by the reliable sealing and dividing of vessels in one action that otherwise require multiple steps for ligation and division. Although the LigaSure device is widely used, its use in liver transplantation where compounding factors of portal hypertension, coagulopathy, and thrombocytopenia exist is poorly described. Methods: From October 1, 2011 to December 31, 2011, six patients underwent liver transplantation with recipient hepatectomy utilizing the LigaSure device for piggyback technique transplantation. Perioperative and intraoperative outcomes using the device were compared to six contemporaneous patients in whom the device was not used. Results: Patient demographics and pre-operative laboratory values and MELD scores were not significantly different. Recipient hepatectomy was performed, on average, 43 minutes faster using the LigaSure device (p = 0.02). Thermal spread was not observed to damage vascular structures. Although total operative time and intraoperative blood product usage were lower when the LigaSure was used, these differences did not reach statistical significance. Conclusions: LigaSure vessel sealing is an efficient method for recipient hepatectomy in liver transplantation. Vessel sealing of caval, portal, and other structures can be safely performed in the settings of end stage liver disease.

Thoracoscopic Mediastinal Lymph Node Dissection for Lung Cancer

In lung cancer, mediastinum lymphatic spread occurs. We review our technique and experience of thoracoscopic mediastinal lymphnode dissection (MLND). Between 1997 and 2011, 992 patients with primary lung cancer underwent thoracoscopic major pulmonary resection with MLND. Initially we used a combination of electrocautery and clips to divide blood vessels and lymphatic channels; our current technique relies on a vessel sealing system (VSS) which is expeditious and leads to less lymphorrhea. Furthermore, dissection of station 7 nodes is performed after each main bronchus or right intermediate bronchus is taped with a 0 silk suture, which is then brought out of the thorax through the access incision for antero-lateral retraction of the tracheal carina. We dissect between 3 and 4 N2 lymph node stations and a total of approximately 20 N2 lymph nodes. Postoperative complications related to MLND occurred in 35 of 992 patients (3.5%), 15 (1.5%) for recurrent laryngeal nerve injury, 3 (0.3%) for bilateral vagal injury, 14 (1.4%) for chylothorax and 3 (0.3%) for airway injury. However, none were lethal. Thoracoscopic mediastinal dissection is safe and feasible in treating lung cancer. We believe our technique and VSS are very useful for thoracoscopic MLND.

Two separate thoroscopic segmentectomies with vessel sealing system

Total thoracoscopic segmentectomy is an appealing concept in terms of providing a parenchyma-sparing treatment. We describe our technique of two seperate total thoracoscopic segmentectomies by using a vessel sealing system (VSS). A 76-year old female with four gradually enlarging ground glass lesions on the right segment 2 (10 and 3 mm) and segment 6 (8 and 3 mm) was admitted to our institute for surgical diagnosis and treatment. Preoperative three-dimensional computed tomography showed that the A2 is composed of descending A2 and ascending A2, branch of V6 coursed to V2 and B1a originated from B2 and B1b from B3. Two separate segmentectomies were subsequently scheduled. Pulmonary vessel division was performed with VSS after proximal ligation. Intersegmental division by VSS and electrocautery was performed with the use of inflation-deflation demarcation line and the pulmonary veins along the intersegmental plane (V2a and V2c for segment 2 and V6b and V6c for segment 6) as guides to confirm the intersegmental plane after pulmonary artery and bronchial divisions. The intraoperative frozen-section examinations revealed adenocarcinoma in situ. Two separate segmentectomies were successfully completed, with a total operative time of 240 min and blood loss of 30 ml. VSS is a very useful and safe device for intersegmental division and pulmonary vessel division.

The use of Ligasure Vessel Sealing System in Ivor Lewis esophagectomy

BackgroundThis study investigated the results of the LigaSure Vessel Sealing System (LVSS), which has been routinely used in esophageal resections in our clinic since 2006.MethodsFor this purpose, 60 patients who underwent Ivor Lewis esophagectomy were included in the study. The results were compared with the patients who underwent stomach mobilising procedure and esophagectomy with conventional methods (conventional group) before 2006 and the patients who underwent LVSS (group of LigaSure) in surgical cases after 2006. The cases were compared particularly in terms of intraoperative bleeding, operative time, duration of postoperative hospital stay, intraoperative complications, mortality, and morbidity.ResultsOf the patients, 34 (% 56.6) were female and 26 (43.3%) were male, and the range of the age was between 33 and 78, and the mean age of the patients was 52.73 ± 11,617. While the amount of intraoperative bleeding was 321.864 ± 575.00 ml in the conventional group, this was found to be 370.31 ± 238.456 ml in the LigaSure group (p = 0.007). In the statistical evaluation of the operative time, the mean duration was determined as 310.00 ± 24.795 minutes in the conventional group, whereas it was determined as 265.16 ± 31.353 minutes in the LigaSure group (p = 0.001).ConclusionsThe use of LVSS was associated with a significant reduction in the operative time and the rate of intra-operative complications.

Single-Port Thymectomy Through an Infrasternal Approach

We report a surgical procedure in which a port and devices designed for single-incision endoscopic surgery are employed for thymectomy through an infrasternal approach. As this single-port thymectomy procedure can be performed through a single 3.5-cm incision in the abdominal region usually concealed under clothes, it is esthetically excellent and is among the least invasive thymectomy procedures because no sternal incision is applied and no intercostal nerve is injured. Investigation of the safety of this procedure and long-term therapeutic outcomes for myasthenia gravis and anterior mediastinal tumors is necessary.

Unilateral and Bilateral Laparoscopic Ovariectomy in 157 Mares: A Retrospective Multicenter Study

To evaluate surgical techniques, perioperative complications and outcome of laparoscopic surgery for unilateral and bilateral ovariectomy in mares. Retrospective multicenter case series. Mares (n = 157). Indications for surgery were neutering, fertility problems, elimination of hormone-related abnormal behavior, ovarian tumors as well as nonregressive ovarian hematomas or cysts. Ovariectomy (n = 206) were performed by a standard laparoscopic procedure in 157 standing sedated mares. Dissection and hemostasis were achieved by using either (1) a linear stapling device, (2) bipolar electrosurgical instruments, with or without a modified Roeder knot, (3) a vessel-sealing system, or (4) a diode-laser with ligation. For some larger ovarian masses (>20 cm diameter), a 2-step surgical procedure was used with standing flank laparoscopic ovariectomy followed by ovarian retrieval through a median celiotomy. Surgical techniques, outcome, and perioperative complications of each method were recorded and analyzed. Laparoscopic dissection of the ovary was accomplished in all mares. Because of the size of the ovarian tumor (n = 7) or in 1 mare with behavioral problems (n = 1), the dissected ovary was removed through a median celiotomy under general anesthesia. Seventeen mares (10.8%) developed postoperative complications (eg, incisional drainage, incisional infection, seroma formation, dehiscence, transient fever and mild abdominal discomfort). All mares with flank incisional problems had ovarian size >12 cm and in 15 (88%) of these mares electrosurgical instruments were used for mesovarial dissection. Laparoscopic ovariectomy in standing sedated mares provides good surgical access and is associated with low morbidity.

Modern Technology–Assisted vs Conventional Tonsillectomy

To systematically review evidence regarding modern technology-assisted tonsillectomy pertaining to operative time, intraoperative and postoperative bleeding, postoperative pain, and other outcomes. A systematic search for randomized controlled trials comparing total tonsillectomies performed using vessel sealing systems (VSS), Harmonic Scalpel (HS), or radiofrequency ablation (ie, Coblation) with the conventional technique of cold steel and/or electrocautery dissection (CS/EC). Estimation of odds ratios and 95% confidence intervals (CIs), weighted mean differences (WMD), or standardized mean difference (SMD), as appropriate. Thirty-three randomized controlled trials studying a total of 3139 patients were included in this meta-analysis. Operative time, perioperative and postoperative bleeding, and postoperative pain. For the VSS group compared with the CS/EC group, operative time was significantly shorter (WMD), -4.09 minutes; 95% CI, -7.43 to -0.75 minutes; 760 patients), perioperative bleeding was significantly less (SMD, -1.67; -2.80 to -0.53; 355 patients), and postoperative bleeding was significantly less (odds ratio, 0.28; 0.13 to 0.61; 792 patients). Pain on the first and seventh postoperative days was significantly less in the VSS group (SMD, -1.73; 95% CI, -3.07 to -0.39; 740 patients; and SMD, -1.46; -2.35 to -0.57; 684 patients; respectively). For the HS group compared with the CS/EC group, the only studied outcome that differed significantly was perioperative bleeding, which was significantly less in the HS group (WMD -37.71 mL; 95% CI, -52.98 to -22.43 mL; 535 cases). No difference was noted between the Coblation and CS/EC groups for any of the studied outcomes. For tonsillectomies, the Coblation and HS techniques do not provide any significant advantage compared with CS/EC. Synthesis of the limited and heterogeneous data regarding VSSs showed a significant benefit in all studied outcomes.

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.

Laparoscopic appendectomy in the pediatric age group

Background Various techniques such as endoloops, endoscopic linear cutting staplers, electrothermal vesselsealing system (LigaSure), Harmonic scalpel, clips, and bipolar coagulation have been used for the division of the mesoappendix during laparoscopic appendectomy. This study was conducted to evaluate the potential benefits and limitation of LigaSure and electrocautery in laparoscopic appendectomy (LA). Patients and methods Forty patients with clinical diagnosis of acute appendicitis admitted to the Pediatric Surgery Unit at the Alexandria University Children’s Hospital between September 2008 and September 2010 were included in this study. The patients were assigned to two groups according to the mesoappendix dissection device: LigaSure and monopolar diathermy (MD) groups. The primary outcome measures (operating time, conversion rate, length of hospital stay, bleeding during dissection, port site infection, and readmissions) were compared. Results LA was performed in 40 patients with acute appendicitis. Twenty cases were in the LigaSure group and 20 cases were in the MD group. The mean operative times were 33.05 min and 43.80 min in the LigaSure and MD groups, respectively. Bleeding during appendicular dissection as roughly estimated by the mean number of needed irrigations were 1.60 and 1.95 for the LigaSure and MD groups, respectively. No statistically significant differences regarding hospital stay, rate of infection, readmissions, or conversion to open appendectomy were found, whereas significant differences were observed in operative time and bleeding. Conclusion The use of LigaSure for dissection of the mesoappendix shortens the operative time, and significantly decreases bleeding during LA. We believe that LigaSure is a safe and useful tool for mesoappendix dissection during LA Keywords : children, laparoscopic appendectomy, LigaSure, monopolar diathermy

Comparison of Lateral Thermal Spread Using Monopolar and Bipolar Diathermy, and the Bipolar Vessel Sealing System ThermoStapler™ During Thyroidectomy

Electric devices enabling the maintenance of haemostasis during surgery have found application in modern thyroidectomy procedures. The haemostatic effect is associated with generation of heat, which apart from the intended result may bring about thermal tissue injury. The aim of the study was to determine the thermal spread around the active tip of electric devices in the operating field during total thyroidectomy, and the safe temperature range during the operation of studied devices. Over 14 months from December 2009 until January 2011, 76 total thyroidectomy procedures were analysed. The surgeries employed mono- and bipolar diathermy as well as the ThermoStapler™ bipolar vessel sealing system. During the procedures, the thermal spread around the active tips of used electric devices was recorded with the use of high-definition camera. Comparable 5-second periods of electric device use at two power ranges (30 W and 50 W) were selected from the recorded material. The highest temperature of the active tip of electric devices was determined, and the 42°C isotherm was found with the use of computer image analysis, thus determining the safe distance of important anatomic structures from the active tip of the electric device. The temperature spread around the active tips of electric devices was recorded and the 42°C isotherm was determined. The diameter of this isotherm at the end of operation differed statistically significantly depending on the type of electric devices and power settings. The highest temperature, at both power ranges, was recorded for the bipolar vessel sealing system, while the lowest - for bipolar diathermy; at the same time a significantly lower 42°C isotherm diameter was found for ThermoStapler™ as compared with other devices. In all studied cases, the largest heat spread was found for monopolar diathermy. The mean safe distance of the active tip of an electric device from important anatomic structures is 5 mm and depends on the device type and its power settings. Monopolar diathermy causes the strongest heating of surrounding tissues, and the ThermoStapler™ bipolar vessel sealing system, despite producing the highest temperature during operation, causes relatively small thermal injury to the surrounding tissues.

Multicenter randomized comparison of LigaSure versus conventional surgery for gastrointestinal carcinoma

We conducted this randomized trial to compare the LigaSure Vessel Sealing System with conventional methods in gastrointestinal carcinoma surgery at five specialty cancer hospitals. Patients with resectable stomach or colorectal cancers were randomized to the LigaSure (n = 100) or conventional surgery (n = 74) groups according to sealed envelopes. The operative data were compared. There were no significant differences in operating times, blood loss, postoperative complications, or hospital stay. However, at the hospital where most of the procedures took place, the LigaSure was associated with a shorter operating time (173 ± 43 min for gastric carcinoma and 157 ± 43 min for colorectal carcinoma vs 211 ± 55 min and 202 ± 55 min for conventional surgery; P = 0.0046 and P = 0.0200, respectively) and less blood loss (300 ± 196 ml and 150 ± 133 ml, respectively, vs 453 ± 387 ml and 382 ± 444 ml; P = 0.0482 and P = 0.0465, respectively). The LigaSure is safe for both gastric and colorectal cancer surgery with extended lymph node dissection. Used effectively, the device appears to reduce operating times and blood loss, although this requires confirmation in a larger series.

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.

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

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.

Total Thyroidectomy Performed With the Starion Vessel Sealing System Versus the Conventional Technique: A Prospective Randomized Trial

Meticulous dissection and accurate hemostasis are required in thyroid surgery. The authors recently performed a number of thyroidectomies using a new device that combines heat and pressure for sealing and cutting tissue. A prospective randomized trial was conducted on 98 patients subjected to total thyroidectomy for benign disease: 49 patients (group A) with the Starion tissue welding system and 49 (group B) with the clamp-and-tie technique. The 2 groups were comparable in mean age, gender, thyroidal volume (20-60 mL), incision length (<35 mm), and pathology. The authors evaluated operative time, postoperative serum calcemia, dosage and length of postoperative calcium and vitamin D treatment, drainage volume, hospital stay, and complications. Student's t test was used for quantitative variables; for categorical variables, the chi(2) test or Fisher's exact test, as appropriate, was used. The mean operative time was 53.8 +/- 6.1 minutes in group A and 63.2 +/- 8 minutes in group B (P < .0001). The difference in terms of postoperative calcemia was significant (group A: 8.35 +/- 0.39 mg/dL; group B: 8.08 +/- 0.39 mg/dL; P < .001). The duration of postoperative treatment with calcium and vitamin D was significantly different (group A: 4 days; group B: 5 days; P < .039). No significant difference in terms of postoperative complications was found. The new system reduced operative time and the duration of postoperative hypocalcemia, and there was minimal tissue necrosis and thermal spread. The reduction in duration of postoperative calcium and vitamin D treatment is also an indication of improvement in quality of the treatment.

Comparative Study of an Electrothermal Bipolar Vessel Sealing System (LigaSure®), a Harmonic Curved Shears (Harmonic Focus™), and Traditional Technique in Total Thyroidectomy

Comparative Study of an Electrothermal Bipolar Vessel Sealing System (LigaSure®), a Harmonic Curved Shears (Harmonic Focus™), and Traditional Technique in Total Thyroidectomy