Use of an electrothermal bipolar tissue sealing system in lung surgery.
OBJECTIVE
We evaluated the validity of an electrothermal bipolar tissue sealing system (LigaSure, Valleylab Inc., USA) in lung surgery.


METHODS
Our study was divided into two phases.


METHODS
We performed sutures of pulmonary vessels and bronchi and lung wedge resections by LigaSure in 28 lungs of adult pigs; subsequently, we quantitated the sealing capacity of the system detecting the burst pressure for each anatomical structure. Clinical: LigaSure was used in 36 patients undergoing lung surgery. We performed 23 thoracotomic procedures in 16 patients (19 wedge resections, 2 segmentectomies, and 2 fissure separations), and 20 thoracoscopic procedures (13 wedge resections, 5 bullectomies, and 2 adherence dissections).


RESULTS



METHODS
Bronchi and vessels were divided into seven groups (diameter: 1-7 mm); 10 burst pressure measurements for each group were performed. A total of 84 wedge resections were performed; lung specimens were divided into seven groups (weight: 0.2-1.4 g). The percentage of bronchial sutures resistant to the pneumatic critical pressure (60 mmHg) was 100% in the 1-mm and 2-mm groups. No bronchi with 6-mm or 7-mm diameter reached the critical pressure. All pulmonary vessel sutures were resistant to the critical hydrostatic pressure (150 mmHg). The average burst pressure of wedge resection margins was higher than the critical pressure, and the percentage of suture margins resistant to the critical pressure decreased from 95% (0.2-g group) to 68% (1.4-g group). Histology confirmed the sealing of vessels, with a mean depth of thermal injury limited to 1.1mm. Clinical: In all patients, hemostasis obtained by LigaSure was effective, with minimal perioperative bleeding. The mean operating time was 77.2 min (range: 60-97) for thoracotomies and 60.3 min (range: 46-80) for thoracoscopies. The mean drainage duration was 3.1 days (range: 1-8). Two patients had prolonged air leaks (>7 days). The mean postoperative stay was 7.3 days (range: 5-13) for thoracotomies and 4.6 days (range: 1-6) for thoracoscopies.


CONCLUSIONS
Use of LigaSure in lung surgery appears feasible and easy. It provides satisfactory hemostasis and air-leak prevention; results are comparable to those of stapling devices, but this system seems to have a better benefit/cost ratio. Larger series are needed to confirm these data.
Santini
Mario
M
Department of Thoracic Surgery, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy. mario.santini@unina2.it
Vicidomini
Giovanni
G
Baldi
Alfonso
A
Gallo
Giuseppe
G
Laperuta
Paolo
P
Busiello
Luigi
L
Di Marino
Maria Pia
MP
Pastore
Vincenzo
V
D000328:Adult; D000368:Aged; D000818:Animals; D001696:Biomechanical Phenomena; D004564:Electrocoagulation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008171:Lung Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D023421:Models, Animal; D013510:Pulmonary Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D013536:Suture Techniques; D013552:Swine; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing