To Knot or Not to Knot? Sutureless Haemostasis Compared to the Surgeon's Knot

Abstract

INTRODUCTION The aim of this study was to carry out an independent evaluation of the efficacy and security of a number of vessel ligation devices and ligatures.MATERIALS AND METHODS A vascular ligation model was devised using fresh, ex vivo porcine internal carotid arteries of varying external diameters. Coloured normal saline was infused via a pressure/monitor device through the artery. The end lumen was occluded by five different techniques: (i) braided suture in a surgeon's knot; (ii) a monofilament suture in a granny knot; (iii) a metallic clip (Ligaclip, Johnson and Johnson); (iv) a bipolar diathermy system (Ligasure, ValleyLab); and (v) an ultrasonically activated scalpel (Harmonic Scalpel, Johnson and Johnson). The vessels were subjected to supraphysiological pressures. Loss of haemostasis was evident by leakage of coloured perfusion fluid.RESULTS Secure haemostasis was obtained with all the techniques in all vessels below 5m m in diameter. In vessels over 5m m, secure haemostasis was obtained with all modalities except harmonic scalpel. With the harmonic scalpel, leaks occurred in 3/27 (11%) vessels between 5-6 mm and 3/5 (60%) vessels over 6 mm, confirming the manufacturer's instructions.CONCLUSIONS In this first, independent, randomised study comparing vessel ligation devices and ligatures, the manufacturer's claims for each of the haemostatic methods were accurate. We find that all the modalities tested perform as well as the traditional surgeon's knot in vessels of 5 mm and below.

Multicenter randomized comparison of LigaSure versus conventional surgery for gastrointestinal carcinoma

“…It is usually faster than conventional suture ligation and is operator-independent. Experimental and clinical studies have confi rmed its effi cacy and safety in many general surgical, [8][9][10][11] urologic, and gynecologic [12][13][14][15] procedures. Prolonged operating time, greater blood loss, and poor preoperative status are thought to be associated with morbidity in gastrointestinal surgery.…”

Thyroidectomy with LigaSure

“…A higher level of electrical energy dissipation occurs in extensive tissue treatment, when metal clips are present, when the sealing is done within an environment with high moisture (due to blood, lymph, fi brin, adhesive, or sponges), and within tissues characterized by high resistance (fat tissue). 2,3 Although ligatures "en masse" have not been used in thyroid 9 while the maximum temperatures, energy dissipation, and collateral damage are markedly less in comparison with other nonligature hemostasis methods. 10,11 In addition, the blood pressure necessary to break the site of blood vessel sealing is four times higher than the maximum possible arterial pressure (850-900 mm Hg), and more than twofold higher than the maximum venous pressure (200-250 mm Hg).…”

“…3,4,12 Thus, the results of the LigaSure procedure are significantly better than other forms of electrothermal hemostasis and mechanical hemostasis using titanium and plastic clips. 4,9 Of importance is that the LigaSure procedure is simple, easy to perform, and can be done rapidly. In addition to the other favorable characteristics provided by LigaSure, there are various factors that support the use of the LigaSure procedure over other techniques; there is no residual foreign material that can accumulate, the blood loss during the operation is lower, there is no need for double or multiple ligatures, the method can be used effi ciently in a humid environment (blood, tissue, and other liquids), and it reduces needle punctures and other injuries in the surgical fi eld.…”

Surgical Vein Occlusion—Comparison of Four Different Methods in a Rat Model

“…7,8 All these methods compete with the simplicity of metal clips, which promise easy use and moderate tissue reaction. 9,10 Unfortunately, all these methods come along with disadvantages, which are not compared with each other yet. [11][12][13] Reliability of the occlusion, tissue reaction, and consequences concerning the blood flow do finally influence the surgical result.…”