Use of an electrothermal bipolar sealing device in ligation of major mesenteric vessels during laparoscopic colorectal resection

Martin, Seán T.; Heeney, Anna; Pierce, Colin; O’Connell, P. R.; Hyland, John; Winter, Desmond C.

doi:10.1007/s10151-011-0707-3

Cited by 12 publications

(15 citation statements)

References 20 publications

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“…The potential for improvement in vessel sealing, a reduced rate of hemorrhage, and translation into sealing other tissues [3e12] exists through a better understanding of the basic mechanism of sealing tissues [13]. There are a substantial number of unexplained vessel seal failures resulting in hemorrhage, death, reoperation, conversions, and other significant clinical interventions documented in the surgical literature and the FDA Manufacturer and User Facility Device Experience database [14,15]; however, an accurate count is difficult to establish because the database is limited to 500 records/y. Given that both of these forums rely on self-reporting by industry and surgeons and the reports are biased to more severe outcomes, it is likely that the actual incidence of seal failure (particularly intraoperative seal failure) is understated.…”

Section: Introductionmentioning

confidence: 99%

“…Surgical observation and empirical experience of intraoperative seal failures suggest that one contributing factor may be the morphometric and compositional changes that occur in commonly sealed vasculature with the development of advanced atherosclerosis [15]. However, no quantitative evidence in the form of the standard metric of vessel burst pressure exists to date for any human vasculature or diseased vasculature (human or animal model) as all testing for FDA clearance is done on excised, healthy, porcine renal arteries [16].…”

Section: Introductionmentioning

confidence: 99%

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The impact of atherosclerosis and vascular collagen on energy-based vessel sealing

Martin

Krugman

Latimer³

et al. 2013

Journal of Surgical Research

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The impact of atherosclerosis and vascular collagen on energy-based vessel sealing

Martin

Krugman

Latimer³

et al. 2013

Journal of Surgical Research

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“…Aunque existen varios estudios que han demostrado la eficacia y la seguridad de estos sistemas hemostáticos en modelos animales y humanos, se han centrado sobre todo en la cirugía abdominal y torácica endoscópica (5)(6)(7)(8)(9). Existe poca experiencia en el ámbito de la cirugía vascular, y aún en menor medida en la cirugía de revascularización, dada la baja implantación de la endoscopia en nuestra especialidad.…”

Section: Introductionunclassified

Bypass ilio-hepático para revascularización de isquemia mesentérica crónica

Larizgoitia¹,

Céniga²,

Fernández³

et al. 2019

Angiologia

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“…Failure to seal is usually immediately evident and easily controllable. However, it is important to note that care needs to be taken in patients with calcified vessels [4] and in those with inflamed and thickened mesenteries. …”

mentioning

confidence: 99%

Safety and efficacy of an electrothermal bipolar vessel sealing device in sealing and division of the inferior mesenteric vessels in minimally invasive colorectal surgery

et al. 2016

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The increasing use of minimally invasive techniques in colon and rectal surgery has led to widespread use of energy devices for tissue dissection and vessel sealing. Traditional devices for major vascular control, such as clips and vascular staplers, have been slowly replaced by energy devices due to their convenience and cost-effectiveness [1]. The use of electrothermal bipolar vessel sealing devices and ultrasonic energy devices has already been shown to be safe and effective in minimally invasive colon and rectal surgery [2]. Animal studies comparing EnSeal Ò (ES) (Ethicon Inc., Cincinnati, OH) with other bipolar devices have shown favorable results with higher burst pressures, comparable sealing time, and less lateral thermal damage [3]. However, to date, there are no large studies reporting clinical effectiveness of ES on mesenteric vessels in humans.In our practice, ES is used for vascular control, tissue dissection, and splenic flexure mobilization when applicable. The inferior mesenteric artery (IMA) is isolated and transected close to its origin from the aorta in resections for cancer (Fig. 1). In benign cases, a small stump is preserved. In all cases, the hypogastric nerves are identified and preserved. Isolation of the inferior mesenteric vein (IMV) is undertaken below the lower border of the pancreas, and the main trunk is sealed and divided with the ES. We completely skeletonize the vessels before sealing and transection. During transection, care is taken to avoid tension and tenting of the vessel in order to avoid disruption and bleeding. In robotic-assisted resections, tissue dissection is carried out using a monopolar hook cautery and the bedside assistant transects the mesenteric vessels using the ES device through a 5-mm port.We reviewed a prospectively maintained database of patients in our practice to assess the safety and efficacy of the ES bipolar device in ligation of inferior mesenteric vessels. Four hundred consecutive laparoscopic and robotic left colon and rectal resections between August 2007 and October 2011 where the ES device was used for sealing of inferior mesenteric vessels were included. Institutional review board approval was obtained for this study.Intraoperatively, six patients (1.5 %) had bleeding following vascular control of the IMA by ES. None required conversion or a major change in operative approach. Endostitch (n = 1), endoloop (n = 3), and endoclips (n = 2) were successfully used to control the bleeding. Two of these patients were noted to have calcified vessels. One patient required 4 units of packed red blood cells postoperatively; however, this patient did not have ES failure intraoperatively and the blood loss was found to be unrelated to inadequate vessel sealing. Main branch IMV sealing and transection were uneventful in all cases.None of the patients had intraoperative thermal injuries to the bowel or ureteric injuries during colonic mobilization. No patient was returned to the operating room for hemorrhage, bowel perforation, ischemic bowel, or ureteral injur...

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Use of an electrothermal bipolar sealing device in ligation of major mesenteric vessels during laparoscopic colorectal resection

Abstract: Use of the LigaSure™ device to seal and divide the major mesenteric vessels during laparoscopic colorectal resection is very effective, with a high success rate of 99.8%. Caution should be exercised in elderly atherosclerotic patients, particularly when using the 5-mm LigaSure™ device.

Cited by 12 publications

References 20 publications

The impact of atherosclerosis and vascular collagen on energy-based vessel sealing

The impact of atherosclerosis and vascular collagen on energy-based vessel sealing

Bypass ilio-hepático para revascularización de isquemia mesentérica crónica

Safety and efficacy of an electrothermal bipolar vessel sealing device in sealing and division of the inferior mesenteric vessels in minimally invasive colorectal surgery

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