Use of a novel vessel‐sealing device for peripheral lung biopsy and lung lobectomy in a cadaveric model

Abstract

Objective To evaluate the Caiman vessel‐sealing device for peripheral lung biopsy and total lung lobectomy in cadaveric canine lung lobes. Material and Methods Twelve lung lobes were randomly assigned to peripheral lung biopsy (n=6) or total lung lobectomy (n=6) with the 12‐mm Caiman vessel‐sealing device. Lungs were connected to a ventilator set at 10 breaths per minute with an initial pressure of 5 cm H2O during the procedure. The lungs were submerged in water for leak testing and the pressure increased until leakage occurred. Results Mean airway pressure at which leakage occurred was 39.17 ±13.20 cm H2O for peripheral lung biopsies and 38.33 ±13.67 cm H2O for total lung lobectomies. None of the samples leaked below 25 cm H2O, which is well above the physiologic airway pressure. Histologically, the largest bronchial diameter at the sealed area was 8.84 mm and the extent of collateral damage was approximately 2.7 mm in all specimens. Clinical Significance The Caiman vessel‐sealing device was successfully used for peripheral lung biopsy and total lung lobectomy in cadaveric canine lung lobes. All sealed lung lobes tolerated supra‐physiologic airway pressure, displayed minimal collateral damage, and were of good diagnostic quality. Further experimental studies are needed to evaluate the clinical safety of the device for peripheral lung biopsy or total lung lobectomy.

Partial lung lobectomy with the Caiman® Seal & Cut device in a dog with spontaneous pneumothorax: case report

“…The presented case strengthens the safety and efficacy of the Caiman ® 5 Seal & Cut sealing device for partial lung lobectomy in dogs, which has only been reported in an ex-vivo experiment, so far ( Brückner et al , 2019 ). Even though, partial lung lobectomy had been performed for the treatment of spontaneous pneumothorax caused by a bulla, the authors would not limit the use of the Caiman ® 5 Seal & Cut device to only that indication.…”

“…While it is known that the type of sealing device impacts sealing safety and air burst pressure measured by the existence and duration of post-operative pneumothorax ( Koga et al , 2014 ), studies comparing the different devices are lacking. For the Caiman Seal & Cut device only experimental ex vivo data on canine lung tissue is available ( Brückner et al , 2019 ). In that study, lung tissue was safely sealed and no air leakage was evident at supra-physiological pressures.…”

“…In that study, lung tissue was safely sealed and no air leakage was evident at supra-physiological pressures. Moreover, one tissue sample exceeded bronchial diameter of 7 mm, the threshold for vessel diameter that can safely be sealed according to the manufacture’s recommendations and could also safely be sealed without air leakage at supra-physiological pressures ( Brückner et al , 2019 ). However, these results were achieved using the 12 mm device, while in the present case the 5 mm device was used.…”

“…Both safely seal vessels up to a diameter of 7 mm ( Eick et al , 2013 ). For partial lung lobectomy in dogs, the Caiman ® 12 has been evaluated in a cadaveric model with excellent results regarding efficacy and safety ( Brückner et al , 2019 ). So far, no in vivo report exists for either the Caiman ® 5 or 12 Seal & Cut sealing device for partial lung lobectomy in small animals.…”

Comparison of Two Radiofrequency Vessel-Sealing Device for Laparoscopic Ovariectomy in African Lionesses (Panthera Leo)

“…Both the instruments employed in the study deliver compression not controlled by the surgeon. The actual amount of compression is not stated by the manufacturer, but we can assume that the Caiman has a unique branch design and mechanism capable of applying a higher and more uniform force along the jaws, gripping the branch’s tip first [ 25 ]. The uniform compression along the jaws and their longer branches allowed better sealing performance in the lioness uterus.…”