title: An evaluation of electrosurgical vessel-sealing devices in biliary tract surgery in a porcine model.
abstract: OBJECTIVE
  The purpose of this study was to evaluate two electrosurgical vessel-sealing devices in biliary surgery.
  
  
  METHODS
  Porcine common bile ducts (CBDs) were sealed with two electrosurgical devices, an electrothermal bipolar vessel-sealing device (EBVS) and ultrasonic coagulation shears. Acute study animals underwent surgical bile duct sealing followed by immediate burst pressure testing. Chronic study animals were maintained for 1 week postoperatively and then tested.
  
  
  RESULTS
  The seal failure rate in the acute study was 50% for both the EBVS device and shears, and 0% for the laparoscopic surgical clip device used as a control. The latter had significantly higher burst pressures (646.2 ± 281.8 mmHg; P = 0.006) than the EBVS device (97.6 ± 86.6 mmHg) and shears (71.7 ± 89.3 mmHg). No significant difference in burst pressures was noted between the EBVS device and shears (97.6 ± 86.6 mmHg vs. 71.7 ± 89.3 mmHg). In the chronic study, obvious bile leaks occurred in one of four pigs (25%) in the EBVS device subgroup and two of four pigs (50%) in the shears subgroup. The average proximal CBD pressure in seven pigs was 16.1 ± 4.1 mmHg. The average chronic burst pressure in the control subgroup was 1088.0 ± 922.6 mmHg.
  
  
  CONCLUSIONS
  Given the high rates of failure of the EBVS device and the shears in consistently sealing biliary ducts, we do not recommend their routine use in biliary surgery.
authors.affiliation: Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, USA. william.hope@seahec.net
authors.forename: William W
authors.initials: WW
authors.lastname: Hope
authors.forename: Srikanth
authors.initials: S
authors.lastname: Padma
authors.forename: William L
authors.initials: WL
authors.lastname: Newcomb
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Schmelzer
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Heath
authors.forename: Amy E
authors.initials: AE
authors.lastname: Lincourt
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
authors.forename: H James
authors.initials: HJ
authors.lastname: Norton
authors.forename: John B
authors.initials: JB
authors.lastname: Martinie
authors.forename: David A
authors.initials: DA
authors.lastname: Iannitti
mesh_terms: D000818:Animals; D001662:Biliary Tract Surgical Procedures / Q000295:instrumentation*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003135:Common Bile Duct / Q000601:surgery*; D004598:Electrosurgery / Q000295:instrumentation*; D004867:Equipment Design; D004868:Equipment Failure; D019544:Equipment Failure Analysis; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D010535:Laparoscopy / Q000295:instrumentation*; D008422:Materials Testing; D023421:Models, Animal; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011312:Pressure; D013314:Stress, Mechanical; D013523:Surgical Equipment; D013552:Swine; D013997:Time Factors