The Aquamantys® system improves haemostasis and pneumostasis in open decortication for thoracic empyema

Abstract

Background: Decortication for thoracic empyema is associated with significant blood loss and prolonged postoperative air leak. We sought to assess the potential application of an irrigated-tip radiofrequency (RF) sealing device, in an attempt to reduce this morbidity.Methods: Data for all patients undergoing open decortication (OD) for stage II thoracic empyema, using either conventional approach or facilitated by use of the Aquamantys ® device, at a single thoracic surgical unit between April 2010 and July 2014, were retrospectively analysed. Unpaired t-test and Fisher's exact test were used for statistical analysis. Results: Thirty-three patients, aged 54±15 years (mean ± SD), and with a Charlson comorbidity index of 2.5±1.9 were included. Preoperative and intraoperative characteristics, including surgical time, were similar in the conventional and Aquamantys ® groups. Patients in the Aquamantys group were less likely to require red cell transfusion (9/22 vs. 10/11 patients, P=0.024) and received lower volume transfusions [0.0 (2.0) vs. 3.0 (1.6) units (median, IQR), P<0.0001]; chest drain duration was shorter [3.0 (1.0) vs. 6.5 (6.8) days, P=0.006], as was length of postoperative hospital stay [6.0 (8.7) vs. 10.0 (4.6) days, P=0.031]. There was no demonstrable difference in mortality. Conclusions:Our data indicates that the use of irrigated tip RF ablation is safe and effective in improving pneumostasis and haemostasis in decortication for thoracic empyema; and that this translates to morbidity and logistical benefit. (4,5).Major thoracic surgical procedures carry significant risk of morbidity; particularly significant haemorrhage, and high-volume or prolonged air leak, with associated prolonged length of hospital stay. Several strategies have been proposed in an attempt to minimize the extent and duration of parenchymal air leak and bleeding. Lung sealants have shown mixed success in reducing air leaks (6). Haemostatic agents may be considered in an attempt to control diffuse bleeding (7).The Aquamantys ® system (Medtronic, Minneapolis, MN, USA) is a single-use portable handheld device with a salineirrigated tip and an adjustable radiofrequency (RF) energy generator system with integrated pump. It was launched commercially in its current form in March 2006, and sells for GBP 290 per disposable unit. The combination of RF energy and saline provides haemostatic sealing of tissues, without charring or carbonisation. It has been widely adopted in a number of other surgical specialties, including orthopaedic, hepatobiliary and neurosurgery (8-10). Reports in the literature of the use of the Aquamantys ® system in a thoracic surgical setting are limited and deal with older, lower-energy models of the device that proved inefficient at sealing lung tissue (11,12). We sought to assess the potential application of this technology in adult patients undergoing OD for stage III post-pneumonic empyema. The primary outcome measures included red cell transfusion requirements as a marker of clinically-significant bleedin...

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