Preliminary results of anatomic lung resection using energy-based tissue and vessel coagulative fusion technology

Abstract

Objectives: Mechanical stapling devices have been established as the mainstay of therapy in the selective isolation and division of bronchial and vascular structures during anatomic lung resection. Few data are available regarding the application of energy-based tissue fusion technology during anatomic lung resection. In the present study, we evaluated the use of energy-based instruments for the division of the pulmonary arterial and venous branches during anatomic lung resection. Methods: Anatomic lung resection (segmentectomy or lobectomy) was performed using energy-based coagulative fusion technology. A low-profile jaw can be used to facilitate dissection in both open and video-assisted thoracic surgery cases, applying a seal 6 mm wide by 22 mm in length. Two energy applications were applied to the arterial and venous branches before vessel division. Results: The bipolar tissue fusion system was used in 211 patients between 2008 and 2010 (104 lobectomies and 107 anatomic segmentectomies). Initially, we used a device with a smaller, curved jaw (n ¼ 12), producing a 3.3to 4.7-cm seal. No arterial dehiscences and 2 partial venous dehiscences that were recognized and controlled intraoperatively occurred. For the remaining cases, we used a new device with a larger jaw that applied a seal 6 mm wide by 22 mm in length. No arterial or venous dehiscences (vessel size range, 0.4-1.2 cm) occurred. Conclusions: The bipolar tissue fusion system provided safe and reliable control of pulmonary arterial and venous branches during anatomic lung resection. The use of energy-based tissue fusion technology represents a reasonable alternative to mechanical stapling devices during anatomic lung resection.

Use of energy-based coagulative fusion technology and lung sealants during anatomic lung resection

“…We have previously reported our experience with the Ligasure device in 211 patients. 17 Using the Ligasure Impact hand piece (n ¼ 12), no arterial dehiscences were encountered. However, 2 partial venous dehiscences occurred that were recognized and controlled intraoperatively.…”

“…Vascular division was successfully performed on 476 arterial and 229 venous branches without the need for hemostatic adjuncts (eg, clips, staples). 17 We have now used energy-based tissue fusion in 316 cases. We encountered 1 additional case of iatrogenic dehiscence involving an arterial branch that had undergone previous fusion.…”

Thoracoscopic‐assisted lung lobectomy in cat cadavers using a resorbable self‐locking ligation device

“…The procedure can be performed with a thoracotomy or video‐assisted thoracoscopic surgery (VATS). Various stapling devices, ligation clips, vessel sealant devices, and suture loops are used for partial and complete lung lobectomies in animals and man . Airways are most commonly sealed with linear stapling devices in animals.…”

Energy-Based Ligation of Pulmonary Vessels: A Six-Year Experience With Ultrasonic Shears in Video-Assisted Thoracoscopic Lobectomy and Segmentectomy

“…Mechanical endostaplers have been the mainstay of vascular control in the era of VATS lobectomy and segmentectomy, but their limitations when working around small-diameter vessels present a challenge. Schuchert and colleagues [10,11] first demonstrated a thoracic application for energy-based vessel ligation in anatomic lung resection using the Ligasure device (Valleylab, Boulder, CO). Our experience with the narrow profile and curved blade of the ultrasonic shears led us to extrapolate its usefulness to the ligation of small-diameter vessels, as frequently encountered in lobectomy and segmentectomy.…”