Evaluation of Surgical Energy Devices for Vessel Sealing and Peripheral Energy Spread in a Porcine Model

Hruby, Gregory W.; Marruffo, Franzo C.; Durak, Evren; Collins, Sean M.; Pierorazio, Phillip; Humphrey, Peter A.; Mansukhani, Mahesh M.; Landman, Jaime

doi:10.1016/j.juro.2007.07.121

« Previous Next »The Journal of Urology
Volume 178, Issue 6 , Pages 2689-2693, December 2007

Evaluation of Surgical Energy Devices for Vessel Sealing and Peripheral Energy Spread in a Porcine Model

Gregory W. Hruby
- Department of Urology, Columbia University Medical Center, New York, New York
Franzo C. Marruffo
- Department of Urology, Columbia University Medical Center, New York, New York
Evren Durak
- Department of Urology, Columbia University Medical Center, New York, New York
Sean M. Collins
- Department of Urology, Columbia University Medical Center, New York, New York
Phillip Pierorazio
- Department of Urology, Columbia University Medical Center, New York, New York
Peter A. Humphrey
- Department of Pathology, Washington University, St. Louis, Missouri
Mahesh M. Mansukhani
- Department of Pathology, Columbia University Medical Center, New York, New York
Jaime Landman
- Department of Urology, Columbia University Medical Center, New York, New York
- Correspondence: 161 Fort Washington Ave., Room 1111, New York, New York 10032 (telephone: 212-305-5630; FAX: 212-305-6813).
- Financial interest and/or other relationship with Ethicon Endosurgery, Valleylab and Gyrus-ACMI.

Received 1 March 2007 published online 17 October 2007.

Purpose

Vessel sealing capabilities and the peripheral energy spread associated with currently available energy based surgical instruments were evaluated.

Materials and Methods

Four groups of energy based surgical instruments were established for evaluation, including the ACE^™, LCS-C5 (Ethicon, Cincinnati, Ohio), LigaSure^™ V and the prototype Trissector^™. In vivo vessel diameter under physiological conditions, bursting pressures and seal failure were recorded and analyzed for arteries and veins separately. After burst testing the vessels were fixed and evaluated histopathologically for peripheral energy damage. ANOVA was used to determine differences between groups.

Results

The LigaSure V sealed arteries and veins with an average burst pressure of 536 and 386 mm Hg, respectively. The Harmonic ACE sealed arteries and veins with an average burst pressure of 436 and 160 mm Hg, respectively. The Harmonic LCS-C5 sealed arteries and veins with an average burst pressure of 363 and 215 mm Hg, respectively. The Trissector sealed arteries and veins with an average burst pressure of 328 and 237 mm Hg, respectively. For arteries the ACE, LCS-C5, Trissector and LigaSure V measured a full-thickness peripheral energy spread of 0.6, 0.3, 8.0 and 4.5 mm, respectively (p <0.0001). For veins the ACE, LCS-C5, Trissector and LigaSure V measured a full-thickness peripheral energy spread of 1.5, 1.3, 8.5 and 6.3 mm, respectively (p = 0.003).

Conclusions

The LigaSure 5 was superior to the other devices tested regarding the ability to seal vessels up to 7 mm. The ACE is an efficient vessel sealing system with the ability to seal vessels up to 5 mm.

Key Words: laparoscopy, hemostasis, surgical instruments, ultrasonics, heat

Abbreviations and Acronyms: ESI, energy based surgical instrument, HA, Harmonic ACE, HL, Harmonic LCS-C5, LV, LigaSure V, NA, not applicable, PT, prototype Trissector