title: A comparison of laparoscopic bipolar vessel sealing devices in the hemostasis of small-, medium-, and large-sized arteries.
abstract: BACKGROUND
  The development of new energy sources for hemostasis has facilitated advanced laparoscopic procedures. Few studies, however, have documented the strength of the vessels sealed or the extent of surrounding lateral thermal injury, two important factors in maintaining hemostasis while preventing injury to surrounding structures. This study compared the burst pressure and extent of thermal injury of vessels sealed with the 5-mm laparoscopic PlasmaKinetics trade mark sealer (PK) (Gyrus Medical, Maple Grove, Minnesota) and the 5-mm laparoscopic LigaSure trade mark sealing device (LS) (Valleylab, Boulder, Colorado).
  
  
  METHODS
  Arteries in three sizes (2-3 mm, 4-5 mm, and 6-7 mm) were harvested from domestic pigs. Eight to 17 specimens from each size were randomly sealed with the PK, and the same number with the LS. Burst pressures were measured in mm Hg. The extent of thermal injury, determined by coagulation necrosis, was measured microscopically in millimeters after staining the transected vessels with hematoxylin and eosin. Descriptive statistics, including means and standard deviations, are reported. Student's t-test and ANOVA were performed to determine significance (P <.05).
  
  
  RESULTS
  The mean bursting pressures of the PK and the LS were equal in the 2-3 mm vessels (397 vs. 326 mm Hg, P =.49). The PK bursting pressures were significantly less than the LS in the 4-5 mm (389 vs. 573 mm Hg, P =.02) and the 6-7 mm groups (317 vs. 585 mm Hg, P =.0004). As vessel size increased, the PK was associated with significantly lower burst pressures, while the LS was associated with progressively higher burst pressures (P =.035). Thermal spread was not significantly different between the PK and the LS in the 2-3 mm (1.5 vs. 1.2 mm, P =.27), the 4-5 mm (2.4 vs. 2.4 mm, P =.79), or the 6-7 mm vessel size groups (3.2 vs. 2.5 mm, P =.32). Increasing vessel size, regardless of instrument used, was associated with increased thermal injury (P <.0001).
  
  
  CONCLUSIONS
  The LS produces supraphysiologic seals with significantly higher bursting pressures than the PK in vessels ranging from 4 to 7 mm. The PK seals become progressively weaker while the LS seals increase in strength as the vessel size increases. Although thermal spread increases with vessel size, the degree of lateral thermal injury is no different between the two instruments.
authors.affiliation: Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA. Todd.Heniford@carolinashealthcare.org
authors.forename: Alfredo M
authors.initials: AM
authors.lastname: Carbonell
authors.forename: Charles S
authors.initials: CS
authors.lastname: Joels
authors.forename: Kent W
authors.initials: KW
authors.lastname: Kercher
authors.forename: Brent D
authors.initials: BD
authors.lastname: Matthews
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Sing
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
mesh_terms: D000818:Animals; D001158:Arteries / Q000033:anatomy & histology; D004867:Equipment Design; D006489:Hemostatic Techniques / Q000295:instrumentation*; D020706:Laparoscopes; D010535:Laparoscopy; D013552:Swine; D014656:Vascular Surgical Procedures / Q000295:instrumentation*