title: Electrothermal bipolar vessel sealing device LigaSureV for pulmonary artery ligation--burst pressure and clinical experiences in complete video-assisted thoracoscopic major lung resection for lung cancer.
abstract: Intraoperative bleeding is one of the main severe complications in complete video-assisted thoracoscopic surgery (c-VATS). We investigated whether one sealing device, the LigaSureV (LSV) vessel sealing system (Valleylab, Tyco Healthcare, Boulder, CO, USA) was experimentally and clinically safe and effective for c-VATS. The burst pressures (BP) of each pulmonary artery (PA) in resected lungs were measured and were compared between a thin PA group (<5 mm) and a thick PA group (> or =5 mm). To investigate the influences of the sealing situations to the adequacy of sealing, BPs were measured after dry or wet conditioned PA (soaked with 0.9% saline) were sealed and cut by the LSV. Clinically, a total of 203 PA were divided with the LSV in c-VATS. The BP of the thin PA with small diameters (<5 mm) were higher than the thick PA (607 mmHg vs. 447 mmHg; P<0.05). The sealing effect was higher when the thick PA was sealed in a dry state than in a wet state (447 mmHg vs. 399 mmHg; P<0.05). However, average BP was physiologically high enough to inhibit a burst even for thick PA sealed in a wet state. There was single case of delayed bleeding sealed PA resulted from seal contact with a sucton device. These studies demonstrated the safety and efficacy of the LSV to sealed PA in c-VATS.
authors.affiliation: Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kuratsukihigashi 2-1, Kanazawa 920-8530, Japan. tsuney@nifty.com
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Tsunezuka
authors.forename: Ryu-ichi
authors.initials: R
authors.lastname: Waseda
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Yachi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001794:Blood Pressure; D004564:Electrocoagulation / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008026:Ligation; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D016896:Treatment Outcome