An evaluation of electrosurgical vessel-sealing devices in biliary tract surgery in a porcine model

Hope, William W.; Padma, Srikanth; Newcomb, William L.; Schmelzer, Thomas M.; Heath, Jessica J.; Lincourt, Amy E.; Heniford, B. Todd; Norton, H. James; Martinie, John B.; Iannitti, David A.

doi:10.1111/j.1477-2574.2010.00240.x

Cited by 17 publications

(12 citation statements)

References 19 publications

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“…The burst pressure setup, consisting of a pressure meter (Model 717 100 G, Fluke, Everett, Washington), infusion pump (Cole Parmer, Vernon Hills, Illinois), and an iris clamp is a standard method for measuring vessel seal burst strength 24,25 and is shown in Fig. 3.…”

Section: Burst Pressure Measurementsmentioning

confidence: 99%

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

et al. 2013

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Abstract. Suture ligation of blood vessels during surgery can be time-consuming and skill-intensive. Energy-based, electrosurgical, and ultrasonic devices have recently replaced the use of sutures and mechanical clips (which leave foreign objects in the body) for many surgical procedures, providing rapid hemostasis during surgery. However, these devices have the potential to create an undesirably large collateral zone of thermal damage and tissue necrosis. We explore an alternative energy-based technology, infrared lasers, for rapid and precise thermal coagulation and fusion of the blood vessel walls. Seven near-infrared lasers (808, 980, 1075, 1470, 1550, 1850 to 1880, and 1908 nm) were tested during preliminary tissue studies. Studies were performed using fresh porcine renal vessels, ex vivo, with native diameters of 1 to 6 mm, and vessel walls flattened to a total thickness of 0.4 mm. A linear beam profile was applied normal to the vessel for narrow, full-width thermal coagulation. The laser irradiation time was 5 s. Vessel burst pressure measurements were used to determine seal strength. The 1470 nm laser wavelength demonstrated the capability of sealing a wide range of blood vessels from 1 to 6 mm diameter with burst strengths of 578 AE 154, 530 AE 171, and 426 AE 174 mmHg for small, medium, and large vessel diameters, respectively. Lateral thermal coagulation zones (including the seal) measured 1.0 AE 0.4 mm on vessels sealed at this wavelength. Other laser wavelengths (1550, 1850 to 1880, and 1908 nm) were also capable of sealing vessels, but were limited by lower vessel seal pressures, excessive charring, and/or limited power output preventing treatment of large vessels (>4 mm outer diameter). © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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Section: Burst Pressure Measurementsmentioning

confidence: 99%

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

et al. 2013

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“…None of the cystic ducts sealed with the VSD leaked at the cut surface of the duct. Previous studies using different animal models for cystic duct and common bile duct closure with vessel sealant devices have conflicting results . The seal failure that occurred in the study from Matthews et al used the first generation of vessel sealant device whereas we used the newer generation with a different algorithm for the measurement of impedance.…”

Section: Discussionmentioning

confidence: 99%

“…It is difficult to draw conclusions from the study because of the variability in species and tissue type (cystic duct versus common bile duct). We also used a 10 mm VSD whereas other studies that reported leakage used a 5 mm sealant device . The seal dimensions for the 10 mm Atlas hand piece are 22 mm in length and ∼2.5 mm in width (after cut; personal communication, Heard D, Covidien, April 2013) whereas the seal dimensions for the 5 mm hand piece by Hope et al are 18 mm in length and 1–1.8 mm in width (after cut) leaving a substantially smaller seal width behind.…”

Section: Discussionmentioning

confidence: 99%

“…Vessel sealant devices (VSD) have been shown to seal vessels up to 7 mm in diameter and have been used in other organ systems including the reproductive tract, lung, liver, and other soft tissue structures . Although previous porcine studies using a vessel sealant device for cystic and common bile duct ligation revealed conflicting results, with some documenting bile leakage, recent human studies have not been associated with bile leakage after cystic duct closure and appear to be associated with minimal complications . Because the quality of a seal is based on the content of elastin and collagen in the tissue, it is difficult to extrapolate from one species to another .…”

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confidence: 99%

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Use of a Vessel Sealant Device for Cystic Duct Ligation in the Dog

Marvel

Monnet

2014

Veterinary Surgery

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“…Vessel burst pressure measurements are considered a standard method for measuring vessel seal strength 26,29,31 and was, therefore, used as the primary indicator of success for this study. The burst pressure setup consisted of a pressure meter (Model 717 100 G, Fluke, Everett, Washington), infusion pump (Cole Parmer, Vernon Hills, Illinois), and an iris clamp.…”

Section: Burst Pressure Measurementsmentioning

confidence: 99%

Rapid sealing and cutting of porcine blood vessels,ex vivo, using a high-power, 1470-nm diode laser

et al. 2014

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Abstract. Suture ligation with subsequent cutting of blood vessels to maintain hemostasis during surgery is time consuming and skill intensive. Energy-based electrosurgical and ultrasonic devices are often used to replace sutures and mechanical clips to provide rapid hemostasis and decrease surgery time. Some of these devices may create undesirably large collateral zones of thermal damage and tissue necrosis, or require separate mechanical blades for cutting. Infrared lasers are currently being explored as alternative energy sources for vessel sealing applications. In a previous study, a 1470-nm laser was used to seal vessels 1 to 6 mm in diameter in 5 s, yielding burst pressures of ∼500 mmHg. The purpose of this study was to provide vessel sealing times comparable with current energy-based devices, incorporate transection of sealed vessels, and demonstrate high vessel burst pressures to provide a safety margin for future clinical use. A 110-W, 1470-nm laser beam was transmitted through a fiber and beam shaping optics, producing a 90-W linear beam 3.0 by 9.5 mm for sealing (400 W∕cm 2 ), and 1.1 by 9.6 mm for cutting (1080 W∕cm 2 ). A two-step process sealed and then transected ex vivo porcine renal vessels (1.5 to 8.5 mm diameter) in a bench top setup. Seal and cut times were 1.0 s each. A burst pressure system measured seal strength, and histologic measurements of lateral thermal spread were also recorded. All blood vessels tested (n ¼ 55 seal samples) were sealed and cut, with total irradiation times of 2.0 s and mean burst pressures of 1305 AE 783 mmHg. Additional unburst vessels were processed for histological analysis, showing a lateral thermal spread of 0.94 AE 0.48 mm (n ¼ 14 seal samples). This study demonstrated that an optical-based system is capable of precisely sealing and cutting a wide range of porcine renal vessel sizes and, with further development, may provide an alternative to radiofrequency-and ultrasonic-based vessel sealing devices.

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An evaluation of electrosurgical vessel-sealing devices in biliary tract surgery in a porcine model

Abstract: Given the high rates of failure of the EBVS device and the shears in consistently sealing biliary ducts, we do not recommend their routine use in biliary surgery.

Cited by 17 publications

References 19 publications

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

Use of a Vessel Sealant Device for Cystic Duct Ligation in the Dog

Rapid sealing and cutting of porcine blood vessels,ex vivo, using a high-power, 1470-nm diode laser

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