Differential response of arteries and veins to bipolar vessel sealing: evaluation of a novel reusable device.
BACKGROUND
A variety of energy-based techniques for arterial and venous vessel ligation have recently been introduced. Using a porcine model we studied the efficacy of the novel reusable BiClamp versus the standard disposable LigaSure bipolar vessel sealing device. We also compared whether arteries respond differently than veins upon sealing.


METHODS
In five Swabian Hall pigs, splenectomy and nephrectomy were performed using two different bipolar vessel sealing devices. Measurements of the sealed arteries and veins (diameter 2-7 mm) included rate of seal failure, burst strength, and heat-associated vascular wall morphologic appearance. An additional three animals underwent splenectomy, salpingo-oophorectomy, and small bowel resection, and vessel seals were studied histologically after a seven-day survival period for vessel wall fusion, inflammation, and fibrous organization.


RESULTS
Sealing was highly successful, with only one seal failure overall and thus no difference between the two instruments analyzed. The burst pressures of BiClamp-sealed arteries (842 +/- 117 mm Hg) did not differ from that of arteries sealed with LigaSure (856 +/- 102 mm Hg), but were significantly higher than the burst pressures of veins (155 +/- 26 and 216 +/- 71 mm Hg, respectively) (P < 0.05). Independent of the sealing device used, thermal spread was found increased in veins compared to arteries. Histologic analysis after seven days revealed appropriate healing of the vessel wall, including thrombus fibrosis, fibroblast proliferation, and collagen deposition. With both devices, however, the venous but not the arterial walls still presented with massive inflammatory cell infiltrates.


CONCLUSIONS
Our study indicates that the BiClamp device is as appropriate as the LigaSure instrument to successfully ligate 2-7 mm arteries and veins, demonstrating supraphysiological bursting strengths and adequate lumenal fusion healing. However, veins are more prone to collateral tissue damage and inflammatory wall infiltration.
Richter
Sven
S
Department of General, Visceral, Vascular, and Pediatric Surgery, University of Saarland, Homburg, Germany.
Kollmar
Otto
O
Neunhoeffer
Eva
E
Schilling
Martin K
MK
Menger
Michael D
MD
Pistorius
Georg
G
D000818:Animals; D001158:Arteries / Q000601:surgery*; D017743:Equipment Reuse; D007668:Kidney / Q000098:blood supply*; D008026:Ligation / Q000295:instrumentation; D009392:Nephrectomy; D013154:Spleen / Q000098:blood supply*; D013156:Splenectomy; D018709:Statistics, Nonparametric; D013525:Surgical Instruments; D013552:Swine; D014656:Vascular Surgical Procedures / Q000295:instrumentation*; D014680:Veins / Q000601:surgery*