Sealing the thoracic duct with ultrasonic coagulating shears.
OBJECTIVE
Ultrasonic coagulating shears were developed as an endosurgical device that allows cutting of vessels without ligation. In this study, we obtained basic data on the feasibility of dividing and sealing the thoracic duct by using ultrasonic coagulating shears.


METHODS
We obtained the thoracic duct and the left gastric artery from surgical specimens of 27 patients. After one end of each vessel was sealed using ultrasonic coagulating shears, we recorded the bursting pressure. The sealed ends of the vessels were also examined histopathologically.


RESULTS
The mean bursting pressure of the thoracic duct was high enough to support the clinical use of this device, and was significantly higher than that of the left gastric artery (p<0.001). Microscopic examination of the sealed vessels showed that degenerated collagen fibers were more homogeneous and covered a significantly larger area in the thoracic duct than in the left gastric artery (p<0.001).


CONCLUSIONS
The present study provides a basis for using ultrasonic coagulating shears to seal the thoracic duct and possibly lymph node dissection.
Kajiyama
Yoshiaki
Y
First Department of Surgery, Juntendo University School of Medicine, Tokyo, Japan. kaji@med.juntendo.ac.jp
Iwanuma
Yoshimi
Y
Tomita
Natsumi
N
Amano
Takayuki
T
Hattori
Kimiaki
K
Tsurumaru
Masahiko
M
D004564:Electrocoagulation / Q000295:instrumentation*; D005240:Feasibility Studies; D016558:Hemostasis, Endoscopic / Q000295:instrumentation*; D006801:Humans; D066298:In Vitro Techniques; D013270:Stomach / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery*; D013718:Tensile Strength; D013897:Thoracic Duct / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014464:Ultrasonic Therapy / Q000295:instrumentation*