Evaluation of Surgical Energy Devices for Vessel Sealing and Peripheral Energy Spread in a Porcine Model

Hruby, Gregory W.; Marruffo, Franzo; Durak, Evren; Collins, Sean M.; Pierorazio, Phillip M.; Humphrey, Peter A.; Mansukhani, Mahesh; Landman, Jaime

doi:10.1016/j.juro.2007.07.121

Cited by 108 publications

(104 citation statements)

References 5 publications

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“…[16][17][18][19] However, both electrosurgical and ultrasonic devices have limitations, including the potential for undesirable charring and unnecessarily large collateral thermal damage zones. [20][21][22] For example, more thermal energy is required to seal large blood vessels with such devices, and stray thermal energy escaping the seal area can lead to unintended lateral tissue thermal damage.…”

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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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Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

et al. 2013

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“…[7] The LigaSure ® vessel sealing system has shown to have shorter dissection time, better seal quality time, lesser blood loss, fewer conversion rates. [8][9][10] Moreover, the device claims to measure temperature or impedance to provide consistent heating in order to prevent injuries. [11] A study has revealed the sealing procedure to be as reliable as clips or ligatures.…”

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confidence: 99%

Comparison of adrenal vein control methods in laparoscopic adrenalectomy

Arslan¹

2017

Laparosc Endosc Surg Sci

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“…14,24,25,26,27,28 However, for some of these devices, successful sealing of vessels >5 mm have not been reported. 21 Ultrasonic vessel sealing devices tend to produce less lateral thermal damage (1 to 1.9 mm), but require longer seal times (3.3 to 14 s), produce lower mean burst pressures (204 to 921 mmHg), and are limited to use on smaller vessels with <5 mm diameter.…”

Section: Discussionmentioning

confidence: 99%

“…13 Ultrasonic-based devices have been shown to produce less thermal spread than RF devices. 14,15 However, the active jaw of ultrasonic devices can reach temperatures in excess of 200°C (Refs. 15 and 16) and take >20 s to cool to usable temperatures.…”

Section: Energy-based Surgical Devicesmentioning

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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Evaluation of Surgical Energy Devices for Vessel Sealing and Peripheral Energy Spread in a Porcine Model

Abstract: The LigaSure 5 was superior to the other devices tested regarding the ability to seal vessels up to 7 mm. The ACE is an efficient vessel sealing system with the ability to seal vessels up to 5 mm.

Cited by 108 publications

References 5 publications

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

Comparison of adrenal vein control methods in laparoscopic adrenalectomy

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

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