title: Evaluation of a vessel sealing system, bipolar electrosurgery, harmonic scalpel, titanium clips, endoscopic gastrointestinal anastomosis vascular staples and sutures for arterial and venous ligation in a porcine model.
abstract: OBJECTIVE
  We assessed the usefulness of the LigaSure (Valleylab, Boulder, Colorado) vessel sealing system for vascular control during laparoscopic surgery and compared it with other available hemostatic modalities.
  
  
  METHODS
  A total of 31 domestic pigs were divided into 5 groups. In groups 1 and 2 the vessel sealing system was compared with titanium clips and Endo-GIA (United States Surgical, Stamford, Connecticut) staples. In group 3 the vessel sealing system was compared with standard Klepinger (Karl Storz, Culver City, California) bipolar forceps. In group 4 the harmonic scalpel and Trimax (United States Surgical) bipolar forceps were compared. In group 5 in vivo laparoscopic application of the vessel sealing system was evaluated.
  
  
  RESULTS
  The 5 mm. laparoscopic vessel sealing system sealed arteries up to 6 mm. and veins up to 12 mm. in diameter at supraphysiological bursting pressure. We evaluated 13 arteries with a diameter of 6 mm. or less at a mean bursting pressure of 662 mm. Hg (range 363 to 1,985) and 11 veins with a diameter of 12 mm. or less with a mean bursting pressure of 233 mm. Hg (range 63 to 440). Collateral tissue damage extended 1 to 3 mm. from the application site. Standard bipolar energy with Klepinger and Trimax forceps was less reliable and in some cases vessel sealing could not be accurately assessed before vessel division. Collateral tissue injury was 1 to 6 mm. The harmonic scalpel did not reliably seal vessels larger than 3 mm. but resulted in the least acute collateral tissue injury of 0 to 1 mm.
  
  
  CONCLUSIONS
  In the porcine model the LigaSure system is a viable option for laparoscopic management of arteries up to 6 mm. and veins up to 12 mm. in diameter.
authors.affiliation: Department of Surgery (Division of Urology), Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
authors.forename: Kurt
authors.initials: K
authors.lastname: Kerbl
authors.forename: Jamil
authors.initials: J
authors.lastname: Rehman
authors.forename: Cassio
authors.initials: C
authors.lastname: Andreoni
authors.forename: Peter A
authors.initials: PA
authors.lastname: Humphrey
authors.forename: William
authors.initials: W
authors.lastname: Collyer
authors.forename: Ephrem
authors.initials: E
authors.lastname: Olweny
authors.forename: Chandru
authors.initials: C
authors.lastname: Sundaram
authors.forename: Ralph V
authors.initials: RV
authors.lastname: Clayman
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D001158:Arteries; D013505:Digestive System Surgical Procedures; D004598:Electrosurgery; D004724:Endoscopy; D008026:Ligation; D013525:Surgical Instruments; D013537:Sutures; D013552:Swine; D014025:Titanium; D014656:Vascular Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D014680:Veins
chemical_list: D014025:Titanium