Randomized clinical trial of vessel sealing system (LigaSure) in esophagogastric devascularization and splenectomy in patients with portal hypertension

Yao, Hou Shan; Wang, Wei Jun; Wang, Qiang; Gao, Wen Chao; Xiang, Hong Gang; Hu, Zhiyan; Gao, Jia Dong; Chen, Xue Yun

doi:10.1016/j.amjsurg.2010.10.016

Cited by 23 publications

(17 citation statements)

References 35 publications

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“…In support of our observation, there is a report in the medical literature describing the intraoperative consequences of a failed LigaSure vascular seal . However, the overwhelming burden of evidence suggests that use of the LigaSure handsets reduces intraoperative hemorrhage compared with traditional techniques . Ultimately, it is the responsibility of each surgeon choosing to employ a reused handset to balance the increasing risk of vascular seal failure with multiple reuse cycles against the reduced cost of a beneficial technology.…”

Section: Discussionsupporting

confidence: 61%

“…27 However, the overwhelming burden of evidence suggests that use of the LigaSure handsets reduces intraoperative hemorrhage compared with traditional techniques. [28][29][30] Ultimately, it is the responsibility of each surgeon choosing to employ a reused handset to balance the increasing risk of vascular seal failure with multiple reuse cycles against the reduced cost of a beneficial technology. Investigation of the safety profile of LigaSure handsets intended for minimally invasive surgery undergoing reuse/resterilization is warranted.…”

Section: Discussionmentioning

confidence: 99%

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Influence of multiple reuse and resterilization cycles on the performance of a bipolar vessel sealing device (LigaSure) intended for single use

et al. 2018

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Influence of multiple reuse and resterilization cycles on the performance of a bipolar vessel sealing device (LigaSure) intended for single use

et al. 2018

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“…LVSS was designed as an alternative to clips or ligatures for sealing vessels ≤ 7 mm in diameter. Comparative studies have proven that LVSS is as safe, feasible, and beneficial as other vessel closure tools and techniques, including the plasma trisector, the surgical clip, the harmonic scalpel, and conventional hemostasis 14‐16. An increasing number of recent reports have described the use of LVSS not only for the sealing of vessels but also for the dissection/transection of various soft and parenchymal tissues (eg, liver resection, pancreatectomy, pulmonary resection, and hysterectomy).…”

Section: Discussionmentioning

confidence: 99%

Chylous ascites after liver transplantation: Incidence and risk factors

et al. 2012

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In this study, we evaluated the diagnosis, epidemiology, risk factors, and treatment of chylous ascites developing after liver transplantation (LT). Between 2002 and 2011, LT was performed 693 times in 631 patients at our clinic. One-hundred fifteen of these patients were excluded for reasons such as retransplantation, early postoperative mortality, and insufficient data. Chylous ascites developed after LT (mean 6 SD ¼ 8.0 6 3.2 days, range ¼ 5-17 days) in 24 of the 516 patients included in this study. Using univariate and multivariate analyses, we examined whether the following were risk factors for developing chylous ascites: age, sex, body mass index, graft-to-recipient weight ratio, Model for End-Stage Liver Disease score, vena cava cross-clamping time, total operation time, Child-Pugh classification, sodium level, portal vein thrombosis or ascites before transplantation, donor type, albumin level, and perihepatic dissection technique [LigaSure vessel sealing system (LVSS) versus conventional suture ligation]. According to a univariate analysis, a low albumin level (P ¼ 0.04), the presence of ascites before transplantation (P ¼ 0.03), and the use of LVSS for perihepatic dissection (P < 0.01) were risk factors for developing chylous ascites. According to a multivariate Cox proportional hazards model, the presence of pretransplant ascites [P ¼ 0.04, hazard ratio (HR) ¼ 2.8, 95% confidence interval (CI) ¼ 1.1-13.5] and the use of LVSS for perihepatic dissection (P ¼ 0.01, HR ¼ 5.4, 95% CI ¼ 1.5-34.4) were independent risk factors. In conclusion, the presence of preoperative ascites and the use of LVSS for perihepatic dissection are independent risk factors for the formation of chylous ascites. To our knowledge, this study is the most extensive examination of the development of chylous ascites. Nevertheless, our results should be supported by new prospective trials.

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“…For its prominent advantages of safe and reliable hemostatic properties and low thermal conductivity, it is widely used on patients with cirrhosis. Yao et al [26] demonstrated the safety and effectiveness of its application in devascularization on patients with portal hypertension in their randomized clinical trials, but some scholars [27] hold conservative and cautious attitudes, we also had no experience of processing the splenic pedicle with LigaSure in this study. More large-scale clinical researches are needed to study its safety in the processing of splenic vessels.…”

Section: Discussionmentioning

confidence: 92%

Prevention and treatment of hemorrhage during laparoscopic splenectomy and devascularization for portal hypertension

Wang

Tang

Zhang

et al. 2015

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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This study was aimed to explore prevention and treatment of hemorrhage during laparoscopic splenectomy plus devascularization (LSD) for portal hypertension by modified and simplified operation. From June 2012 to June 2014, LSD was performed on 138 patients with portal hypertension. The patients were allocated into two groups: earlier stage (ES) group, in which 45 patients received traditional LSD from June 2012 to Sep. 2012; later stage (LS) group, in which 93 patients underwent modified LSD from Jan. 2013 to June 2014. Perioperative variables were compared between the two groups. Laparoscopic operations were successfully performed in all but two patients in ES group who were converted to laparotomy (total conversion rate: 1.4%). There was no perioperative death or reoperation, and all patients recovered and were discharged from hospital with no serious complications in the six months of postoperative follow-up. The average time in the ES group was longer than that in the LS group (335.1 min vs. 201.3 min, P<0.05). LS group outperformed ES group in terms of blood loss (705.4 mL vs. 910.4 mL, P<0.05). The average operation time to oral diet intake after surgery (40.5 h vs. 50.3 h, P<0.05) and postoperative hospital stay (7.4 d vs. 9.0 days, P<0.05) were much less in the LS group than in the ES group. The overall complication rate (4.3 % vs. 11.1 %, P<0.05) and conversion rate (0% vs. 4.4%, P<0.05) were lower in the LS group than in the ES group. It was concluded that prevention and treatment of hemorrhage are the key points of LSD for portal hypertension. By creating a tunnel above the splenic pedicle and a tunnel behind the lower esophagus, the simplified and modified LSD can reduce hemorrhage and improve success of surgery dramatically, and splenomegaly and severe varices are not contraindications.

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Randomized clinical trial of vessel sealing system (LigaSure) in esophagogastric devascularization and splenectomy in patients with portal hypertension

Cited by 23 publications

References 35 publications

Influence of multiple reuse and resterilization cycles on the performance of a bipolar vessel sealing device (LigaSure) intended for single use

Influence of multiple reuse and resterilization cycles on the performance of a bipolar vessel sealing device (LigaSure) intended for single use

Chylous ascites after liver transplantation: Incidence and risk factors

Prevention and treatment of hemorrhage during laparoscopic splenectomy and devascularization for portal hypertension

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