TITLE

Evaluation of the efficacy of the electrosurgical bipolar vessel sealer (LigaSure) devices in sealing lymphatic vessels

AUTHOR(S)
Novitsky, Yuri W.; Rosen, Michael J.; Harrell, Andrew G.; Sing, Ronald F.; Kercher, Kent W.; Heniford, B. Todd
PUB. DATE
June 2005
SOURCE
Surgical Innovation;Jun2005, Vol. 12 Issue 2, p155
SOURCE TYPE
Academic Journal
DOC. TYPE
journal article
ABSTRACT
Various sources of ultrasonic and thermal energy have been developed to facilitate blood vessel ligation. However, their efficacy in sealing lymphatics has not been clearly established to date. We hypothesized that the electrosurgical bipolar vessel sealer (EBVS) produces reliable and durable sealing of large lymphatic vessels in a porcine model. Thoracic ducts from 4 adult pigs were explanted and sealed at multiple levels by using 3 different EBVS devices: LigaSure Atlas, XTD, and V. Fifteen seals (5 per group) were analyzed for sealing time and visual quality. Seal burst strength was measured by using a graduated pressure saline injection system. Twelve intact seals also underwent a histologic analysis. The mean overall burst strength of the seals was 271+/-78 mm Hg (127 to 360 mm Hg). The burst pressures in the 3 groups were not statistically different. The overall mean time to achieve a seal was 5.1+/-2.2 seconds (3 to 10 seconds). Seals were achieved significantly faster in the V group (4.1+/-0.6 seconds) compared with the Atlas (6.3+/-2.3 seconds) and XTD (6.4+/-2.6 seconds) groups. Qualitative seal assessment revealed minimal sticking and charring, a favorable degree of seal tissue clarity, and desiccation in the 3 groups. Histologic analysis demonstrated a fusion of lymphovascular channels with a complete obliteration of the lumens. We demonstrated that the use of EBVS results in a fast and effective sealing of large porcine lymphatic vessels. The seals created by all 3 devices burst at markedly supraphysiologic intraluminal pressures. Ongoing randomized human trials may prove the clinical benefits of the routine use of EBVS devices for various tissue dissections.
ACCESSION #
17754028

 

Related Articles

  • Laparoscopic Ligation of the Thoracic Duct in Management of Chylothorax. Icaza Jr., Orlando J.; Andrews, Kris; Kuhnke, Mark // Journal of Laparoendoscopic & Advanced Surgical Techniques;Apr2002, Vol. 12 Issue 2, p129 

    Laparoscopic ligation of the cisterna chyli at the level of the aortic hiatus was performed in a 69-year-old woman with post-lobectomy chylothorax refractory to 3 weeks of conservative therapy and one repeat thoracotomy with attempted ligation of a leaking lymphatic channel. This laparoscopic...

  • Prophylactic Thoracic Duct Mass Ligation Prevents Chylothorax After Transthoracic Esophagectomy for Cancer. Cagol, Matteo; Ruol, Alberto; Castoro, Carlo; Alfieri, Rita; Michieletto, Silvia; Ancona, Ermanno // World Journal of Surgery;Aug2009, Vol. 33 Issue 8, p1684 

    Chylothorax after transthoracic esophagectomy for cancer is an uncommon but potentially life-threatening postoperative complication. It has been reported that preventive thoracic duct ligation can reduce the incidence of postoperative chylothorax after esophagectomy for cancer. In this...

  • Treatment Options in Patients With Chylothorax. Schild, Hans H.; Strassburg, Christian P.; Welz, Armin; Kalff, Jörg // Deutsches Aerzteblatt International;11/29/2013, Vol. 110 Issue 48, following p819 

    Background: Chylothorax arises when lymphatic fluid (chyle) accumulates in the pleural cavity because of leakage from lymphatic vessels. It is most commonly seen after thoracic surgery (in 0.5% to 1% of cases) and in association with tumors. No prospective or randomized trials have yet been...

  • Thoracic Duct Injury Following Esophagectomy in Carcinoma of the Esophagus: Ligation by the Abdominal Approach. Mishra, Pramod; Saluja, Sundeep; Ramaswamy, Dinesh; Bains, Satinderpal; Haque, Parvez // World Journal of Surgery;Jan2013, Vol. 37 Issue 1, p141 

    Background: Thoracic duct injury (TDI) is a potentially lethal complication of esophagectomy. There is no consensus regarding when and how to intervene in these injuries. Both thoracic and abdominal approaches have been used. Methods: Esophagectomies performed for cancer of the esophagus ( n =...

  • Spontaneous healing of retroperitoneal chylous leakage following anterior lumbar spinal surgery: a case report and literature review. Su, I-Chang; Chen, Chang-Mu // European Spine Journal;Dec2007 Supplement 3, Vol. 16, p332 

    Cisterna chyli is prone to injury in any retroperitoneal surgery. However, retroperitoneal chylous leakage is a rare complication after anterior spinal surgery. To the best of our knowledge, only ten cases have been reported in the English literature. We present a case of a 49-year-old man who...

  • Percutaneous treatment of thoracic duct injuries. Marcon, Francesca; Irani, Katayun; Aquino, Theresa; Saunders, John K.; Gouge, Thomas H.; Melis, Marcovalerio // Surgical Endoscopy;Sep2011, Vol. 25 Issue 9, p2844 

    Background: Major thoracic or neck surgery or penetrating trauma can cause injury to the thoracic duct and development of a chylothorax. Chylothorax results in metabolic and immunologic disorders that can be life threatening, with a mortality rate reaching 50%. The management of chyle leaks is...

  • Chyluria after ligation of the thoracic duct: a rare complication after thoracoscopic-assisted esophagectomy for esophageal cancer. Takeno, Atsushi; Tamura, Shigeyuki; Miki, Hirofumi; Tanigawa, Noboru; Taniguchi, Hirokazu; Nakahira, Shin; Suzuki, Rei; Nakata, Ken; Takeda, Yutaka; Kato, Takeshi // Surgery Today;Apr2014, Vol. 44 Issue 4, p757 

    Chyluria is leakage of lymphatic fluid into the urine, following trauma to or obstruction of the lymphatic system. We herein report a rare case of chyluria after esophagectomy for esophageal cancer. A 69-year-old male complaining of epigastric pain and reflux symptoms was diagnosed with advanced...

  • Thoracoscopic Thoracic Duct Ligation for Congenital and Acquired Disease. Slater, Bethany J.; Rothenberg, Steven S. // Journal of Laparoendoscopic & Advanced Surgical Techniques;Jul2015, Vol. 25 Issue 7, p605 

    Purpose: Congenital and acquired chylothorax presents a unique management challenge in neonates and infants. A failure of conservative therapy requires surgical ligation to prevent continued fluid and protein losses. This article examines a 15-year experience with thoracoscopic ligation of the...

  • Video-assisted right supradiaphragmatic thoracic duct ligation for non-traumatic recurrent chylothorax Christodoulou, Michel; Ris, Hans-Beat; Pezzetta, Edgardo // European Journal of Cardio-Thoracic Surgery;May2006, Vol. 29 Issue 5, p810 

    Abstract: Background: Chylothorax is an uncommon disorder with respiratory, nutritional and immunological manifestations. Surgical management is indicated in case of recurrence or failure after conservative treatment. We report our experience with video-assisted right-sided supradiaphragmatic...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics