Pulmonary Artery Sealing Using the HARMONIC ACE+ Shears for Video-Assisted Thoracoscopic Surgery Lobectomy

Abstract

PA branches sealed using the HARMONIC ACE+ in a simulated ex vivo model were able to sustain high intraluminal pressures. ACE-sealed vessels burst at mean bursting pressures equal to or greater than the VES-stapled vessels.

Prospective, multicenter, international phase 2 trial evaluating ultrasonic energy for pulmonary artery branch sealing in video-assisted thoracoscopic surgery lobectomy

“…Ex vivo studies evaluated burst pressures of PA branches sealed with different energy vessel-sealing devices and with standard endostaplers. 6,15 Results showed that PAs sealed with ultrasonic energy can sustain higher pressures than PAs sealed with advanced bipolar energy devices or endostaplers. In an animal survival study, 10 lobectomies using the device were completed in 10 dogs without any bleeding complications at 30 days.…”

Pulmonary artery sealing with ultrasonic energy in open lobectomy: A phase I clinical trial

“…Ninety PA branches with a mean diameter of 5.2 mm (range, 1.7-11.4 mm) had a mean burst pressure of 333 mm Hg (range, 84-1415 mm Hg) with no seal failure. 17 Other studies with smaller sample size have shown similar results with bursting pressures far beyond physiological PA pressures. 11,16 The ACE is approved for vessel sealing up to 7 mm diameter.…”

“…The safety and effectiveness of ultrasonic energy vesselsealing devices for PA branch sealing has been reported in several ex vivo human lung specimen studies and animal studies. 11,[16][17][18] Burst pressure was measured on human PA stumps sealed with the ACE on lung specimens in a study published by our group. Ninety PA branches with a mean diameter of 5.2 mm (range, 1.7-11.4 mm) had a mean burst pressure of 333 mm Hg (range, 84-1415 mm Hg) with no seal failure.…”

The differences in histological changes among pulmonary vessels divided with an energy device

“…However, we found that part of the media remained at the sealed zone, which was stained with a-SMA and EVG stain. Electron microscopic findings of PA branches sealed with Harmonic Ace+ Shears in a human ex vivo model demonstrated various microscopic sealing patterns [7]. One-third of the sealed PAs presented invagination of the media and absence of melting.…”

“…Open and endosurgical stapling devices have become the standard instruments for closing the large pulmonary vessels [6], whereas the small pulmonary vessels are manually ligated with a suture or divided using a vessel-sealing device (VSD). Advanced bipolar and ultrasound technologies are still being evaluated in various trials [7][8][9]. Safe division of the pulmonary vessels, especially the pulmonary artery (PA), during anatomical lung resection, is critically important.…”