Perpendicular Blood Vessel Seals Are Stronger Than Those Made at an Angle

Voegele, Aaron C.; Korvick, Donna L.; Gutierrez, M.; Clymer, Jeffrey W.; Amaral, Joseph F.

doi:10.1089/lap.2013.0028

Cited by 11 publications

(12 citation statements)

References 5 publications

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“…The principle of achieving hemostasis closer to the midline means that vessels are sealed perpendicularly rather than at an angle. Voegele et al . showed that in vessels of more than 5 mm in diameter, sealing at an angle resulted in significantly less burst pressure than did sealing perpendicular to the vessel.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of early discharge following vaginal hysterectomy with a bipolar electrocoagulation device

Cassis

Mukhopadhyay

Sule

et al. 2018

Intl J Gynecology & Obste

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Section: Discussionmentioning

confidence: 99%

Feasibility of early discharge following vaginal hysterectomy with a bipolar electrocoagulation device

Cassis

Mukhopadhyay

Sule

et al. 2018

Intl J Gynecology & Obste

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“…The AH mode may also be useful when vessels are sealed at an angle. Burst pressure studies show that a 5 mm vessel divided at a 45° angle has an equivalent burst pressure to that of a 7 mm vessel divided perpendicularly 28. In other words, even though the vessel is 5 mm in diameter, the area of seal is equivalent to a 7 mm vessel.…”

Section: Discussionmentioning

confidence: 99%

Sealing vessels up to 7 mm in diameter solely with ultrasonic technology

Timm¹,

Asher²,

Tellio³

et al. 2014

MDER

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IntroductionUltrasonic energy is a mainstay in the armamentarium of surgeons, providing multifunctionality, precision, and control when dissecting and sealing vessels up to 5 mm in diameter. Historically, the inability to seal vessels in the 5–7 mm range has been perceived as an inherent limitation of ultrasonic technology. The purpose of this study was to evaluate sealing of vessels up to 7 mm in diameter with an ultrasonic device that modulates energy delivery during the sealing period.MethodsIn ex vivo benchtop and in vivo acute and survival preclinical models, a new ultrasonic device, Harmonic ACE®+7 Shears (Harmonic 7), was compared with advanced bipolar devices in sealing vessels 1–7 mm in diameter with respect of burst pressure, seal reliability, and seal durability. Lateral thermal damage and transection time were also evaluated.ResultsEx vivo tests of Harmonic 7 demonstrated significantly greater median burst pressures than an advanced bipolar device both for vessels <5 mm in diameter (1,078 mmHg and 836 mmHg, respectively, P=0.046) and for those in the range of 5–7 mm (1,419 mmHg and 591 mmHg, P<0.001). In vivo tests in porcine and caprine models demonstrated similar rates of hemostasis between Harmonic 7 and advanced bipolar devices, with high success rates at initial transection and seal durability of 100% after a 30-day survival period.ConclusionSealing 5–7 mm vessels is not a limitation of the type of energy used but of how energy is delivered to tissue. These studies document the ability of ultrasonic energy alone to reliably seal large vessels 5–7 mm in diameter, with significantly greater burst pressure observed in in vitro studies than those observed with an advanced bipolar technology when energy delivery is modulated during the sealing cycle. Furthermore, the seals created in 5–7 mm vessels are shown to be reliable and durable in in vivo preclinical studies.

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“…The smaller end effector of Focus+ enables the surgeon to more readily approach, seal, and cut a vessel at a perpendicular angle, which has been shown to provide a stronger seal. 20 The larger jaw aperture not only allows larger tissue bundles to be coagulated and transected, but also provides better dissecting ability by providing greater mechanical advantage of the dual-action jaw provided by the higher ratio of the handle size to the jaw size.…”

Section: Discussionmentioning

confidence: 99%

Ex vivo and in vivo evaluation of an ultrasonic device for precise dissection, coagulation, and transection

Bertke¹,

Scoggins²,

Welling³

et al. 2014

OAS

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Background:A new ultrasonic device, Harmonic Focus ® +, has been developed that is smaller and delivers energy more efficiently than its predecessor via the inclusion of Adaptive Tissue Technology. This study was undertaken to compare its dissection capabilities to an advanced bipolar electrosurgery device in benchtop and preclinical evaluations. Methods: In ex vivo testing, Focus+ and LigaSure™ Small Jaw were evaluated for physical dimensions, device and tissue temperature after repeated applications to porcine jejunum, and burst pressure of vessel seals, transection time, and tissue sticking in 3-5 mm porcine carotid arteries. In in vivo testing, the devices were tested on intact porcine carotid arteries for thermal damage via collagen denaturation and in muscle incisions near rat sciatic nerve for acute inflammation via hematoxylin and eosin and for impaired axonal transport via β-APP. Results: Focus+ was smaller than the Small Jaw in width and height, yet it had a longer active blade and larger jaw aperture. Device temperatures were not different after application, but thermal spread (tissue temperature above 50°C) was 78% greater for Small Jaw (9.6 mm) than for Focus+ (5.4 mm). Burst pressures of sealed vessels were not significantly different between the devices: 900 (±466) mmHg for Focus+ versus 974 (±500) mmHg for Small Jaw. Small Jaw had a shorter individual transection time (5.0 seconds compared to 6.3 seconds for Focus+), whereas Focus+ had 70% less tissue sticking. Thermal damage, neural inflammation, and impaired axonal transport were all significantly lower for Focus+ compared to Small Jaw, by 19%, 57%, and 50%, respectively. Conclusion: With the addition of Adaptive Tissue Technology, Harmonic Focus+ builds upon the manifold advantages of ultrasonic devices in procedures requiring meticulous dissecting capability. Improvements in energy sensing and controlled delivery produce lower tissue temperatures and less thermal damage, especially critical when working near nerves. Focus+ produces vessel seal strengths equivalent to advanced bipolar devices and, although individual device activations are longer, the reduction in tissue sticking is expected to materially lessen operative time in clinical practice.

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Perpendicular Blood Vessel Seals Are Stronger Than Those Made at an Angle

Cited by 11 publications

References 5 publications

Feasibility of early discharge following vaginal hysterectomy with a bipolar electrocoagulation device

Feasibility of early discharge following vaginal hysterectomy with a bipolar electrocoagulation device

Sealing vessels up to 7 mm in diameter solely with ultrasonic technology

Ex vivo and in vivo evaluation of an ultrasonic device for precise dissection, coagulation, and transection

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