Closure of the cystic duct during laparoscopic cholecystectomy with a new feedback-controlled bipolar sealing system in case of biliary obstruction--an experimental study in pigs.
OBJECTIVE
The excellent results of new devices like the new bipolar feedback-controlled sealing system (LigaSure) for closure of blood vessels encouraged surgeons to use these instruments for other structures like bile ducts. The aim of this study was to evaluate the feasibility of closure of cystic duct in case of biliary obstruction.


METHODS
Ten domestic pigs underwent laparoscopic cholecystectomy sealing the cystic duct with LigaSure. The common bile duct was closed with an endoclip to create a biliary hypertension. On the 12th postoperative day blood samples were taken for liver enzymes. At autopsy on day 15 the pigs were investigated for bile leaks or biliary peritonitis. The cystic duct was resected for histological examination.


RESULTS
Seven pigs survived, one pig died during introduction of anesthesia, one on the 1st and one on the 2nd postoperative day without any findings at the autopsy. One pig out of 7 had a bile leak; the other 6 were without any sign of leakage. Histologically 3 pigs had a regular coagulation zone at the cystic duct, 3 had a total necrosis, one a partial necrosis of the mucosa only.


CONCLUSIONS
Though there was only one insufficiency, the feedback-controlled bipolar vessel sealer cannot be recommended for biliary surgery with regard to the high rate of necrosis stated in our experiment.
Shamiyeh
A
A
Ludwig Boltzmann Institute for Operative Laparoscopy and 2nd Surgical Department, General hospital Linz, Linz, Austria. andreas.shamiyeh@aon.at
Vattay
P
P
Tulipan
L
L
Schrenk
P
P
Bogner
S
S
Danis
J
J
Wayand
W
W
D000818:Animals; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation*; D002779:Cholestasis / Q000473:pathology / Q000601:surgery*; D003549:Cystic Duct / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D025461:Feedback, Physiological; D005260:Female; D009336:Necrosis; D011184:Postoperative Period; D013552:Swine