title: The effect of intraluminal content on the bursting strength of vessels ligated with the harmonic ACE and LigaSure V.
abstract: OBJECTIVE
  Energy-based surgical devices (ESDs) are critical for maintaining hemostasis during laparoscopy; however, there are no studies that have evaluated the function of ESDs under different physiologic conditions. We evaluated the effect of intraluminal vessel content on bursting pressure (BP) after ligation with two ESDs: the Harmonic ACE and the LigaSure V.
  
  
  METHODS
  Bursting trials were performed on the vasculature of 24 pigs. Blood vessels were distended with blood of different hematocrit concentrations or an albumin solution of varying protein content. The vessel size and BP of each vessel was recorded after ligation with each ESD.
  
  
  RESULTS
  In arteries 0 to 3 mm and veins 0 to 3 mm in size ligated with the Harmonic ACE or the LigaSure V, there were significantly elevated vessel BPs with supraphysiologic intraluminal hematocrits. In arteries and veins ligated with the Harmonic ACE, increasing albumin concentrations also led to increasing BPs, though these maximal BPs were lower than those obtained with supraphysiologic hematocrit levels. Increasing albumin concentrations did not increase the BP of the LigaSure V. Within the ranges tested, there was no decrease in vessel BP associated with anemia.
  
  
  CONCLUSIONS
  In small vessels, a supraphysiologic hematocrit increased the BP of both arteries and veins when using the Harmonic ACE or the LigaSure V. With the devices tested, anemia did not seem to affect BP. While factors such as intraluminal protein concentration may play a role with ultrasonic energy devices, the mechanism of the increased BP remains unclear. Better understanding of ESDs will help in the design of future devices.
authors.affiliation: Department of Urology, Columbia University School of Medicine, New York, New York, USA.
authors.forename: Courtney K
authors.initials: CK
authors.lastname: Phillips
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Hruby
authors.forename: Gabriella
authors.initials: G
authors.lastname: Mirabile
authors.forename: Piruz
authors.initials: P
authors.lastname: Motamedinia
authors.forename: Evren
authors.initials: E
authors.lastname: Durak
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Lehman
authors.forename: Pun Wei
authors.initials: PW
authors.lastname: Hong
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D001808:Blood Vessels / Q000502:physiology*; D006400:Hematocrit; D008026:Ligation; D011312:Pressure; D012709:Serum Albumin / Q000032:analysis; D013525:Surgical Instruments; D034421:Sus scrofa
chemical_list: D012709:Serum Albumin