Bipolar Sealing Device Use in Pancreas Graft Preparation: A Novel Tieless Backtable Surgery Technique.
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ABSTRACT:
SUBMITTER: Martins PN
PROVIDER: S-EPMC6233664 | biostudies-literature | 2018 Oct
REPOSITORIES: biostudies-literature
Publications
Bipolar Sealing Device Use in Pancreas Graft Preparation: A Novel Tieless Backtable Surgery Technique.
Martins Paulo N PN Gillooly Andrew R AR Movahedi Babak B Bozorgzadeh Adel A
Transplantation direct 20180925 10
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Project description:BACKGROUND:Dissection during laparoscopic surgery produces smoke containing potentially toxic substances. The aim of the present study was to analyze smoke samples produced during laparoscopic colon surgery using a bipolar vessel sealing device (LigaSuretrade mark). METHODS:Four consecutive patients undergoing left-sided colectomy were enrolled in this pilot study. Smoke was produced by the use of LigaSuretrade mark. Samples (5,5l) were evacuated from the pneumoperitoneum in a closed system into a reservoir. Analysis was performed with CO2-laser-based photoacoustic spectroscopy and confirmed by a Fourier-transform infrared spectrum. The detected spectra were compared to the available spectra of known toxins. RESULTS:Samples from four laparoscopic sigmoid resections were analyzed. No relevant differences were noted regarding patient and operation characteristics. The gas samples were stable over time proven by congruent control measurements as late as 24 h after sampling. The absorption spectra differed considerably between the patients. One broad absorption line at 100 ppm indicating H2O and several unknown molecules were detected. With a sensitivity of alpha min ca 10-5 cm-1 no known toxic substances like phenol or indole were identified. CONCLUSION:The use of a vessel sealing device during laparoscopic surgery does not produce known toxic substances in relevant quantity. Further studies are needed to identify unknown molecules and to analyze gas emission under various conditions.
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Project description:BackgroundAdvanced bipolar vessel sealing devices are widely used in human and veterinary medicine to reduce the operation time and intraoperative blood loss. Because most devices are made for a single use, their application is cost intensive. The aim of this study was to investigate the influence of multiple uses and sterilization on the performance of bipolar vessel sealing devices.MethodsThe burst pressure of sealed porcine renal arteries was compared between the disposable devices "LigaSure"(Valleylab) and "Caiman"(Braun Vetcare) and the reuseable device "MarSeal"(KLS Martin). Additionally, the influence of the sterilization process was investigated, and the sealing time, number of cutting activations and tissue sticking were noted.ResultsThe disposable devices showed reliable performances over multiple activations and sterilization cycles, except for one Caiman device. Seals created with all devices achieved supra-physiologic burst pressures, with the highest pressure measured in a cycle using a MarSeal device.DiscussionDuring 25 activations with and without intermittent sterilization, no correlation was found between increasing seal numbers and decreasing burst pressure. However, the number of cycles in our study was limited to five.ConclusionFor limited numbers of cycles and sterilization procedures, seals created with the disposable vessel sealing devices LigaSure and Caiman achieved burst pressures comparaable to those produced with the reuseable MarSeal.
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Project description:BACKGROUND: Blood transfusion has been reported as an independent risk factor for poor outcome after liver resection in spite of its well known benefits. Refinements in parenchymal dissection have been pursued to reduce blood loss and transfusion. A collagen-sealing device (CSD) has recently been touted as an alternative technique that aids in blood conservation. We report the results of our initial series of patients undergoing a CSD-assisted resection and present a historical comparison. PATIENTS AND METHODS: Consecutive patients who were undergoing liver resection at a single tertiary cancer centre were enrolled in this study. The Ligasure Atlas device (Valleylab Inc., Division of Tyco Healthcare) was used for parenchymal division in the CSD group. Known blood conservation techniques (i.e. low central venous pressure, ultrasonic dissection, Pringle clamp) were standardized in both groups. Clinical and outcome variables including operative time, estimated blood loss and transfusion requirements were collected. All statistical analyses were performed with SAS version 8.2e. RESULTS: In all, 28 consecutive patients underwent CSD-assisted hepatic resection between October 2003 and September 2004. The control group included 188 patients treated between January 1991 and September 2003. In the CSD group, we observed a reduction in mean estimated blood loss (930 vs 1450 ml, p=0.002) and mean transfusion requirements (0.46 vs 1.19 units, p=0.002). There was no increase in operative time with the new instrument (326 vs 363 min, p=0.167). DISCUSSION: Use of a CSD has the potential to further reduce blood loss and transfusion requirements without increasing operative time.
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