title: Use of an electrothermal bipolar sealing device in ligation of major mesenteric vessels during laparoscopic colorectal resection.
abstract: BACKGROUND
  A variety of approaches are available for division of major vascular structures during laparoscopic colorectal resection. Ultrasonic coagulating shears (UCS), vascular staplers, plastic or titanium clips and electrothermal bipolar vessel sealing (EBVS) are currently available. We report our experience with an EBVS device, LigaSure™ (Covidien AG), used in division of the ileocolic, middle colic and inferior mesenteric arteries during laparoscopic colorectal resection.
  
  
  METHODS
  We report the immediate outcome of 802 consecutive unselected patients who underwent elective laparoscopic colorectal cancer resection performed with use of the LigaSure™ (5 and 10 mm) at our institution over a 5-year period. Operative procedures included right hemicolectomy (n = 180), left hemicolectomy (n = 96), sigmoid colectomy (n = 347) and anterior resection (n = 179). Data were collected from a prospectively maintained cancer database and operative records. The procedures were performed primarily by three consultant surgeons with an interest in laparoscopic colorectal resection.
  
  
  RESULTS
  Of 802 cases in which the LigaSure™ device was employed to divide major vascular structures, immediate effective vessel sealing was achieved in 99.8% (n = 800). Two patients experienced related adverse events both following division of the inferior mesenteric artery with a 5 mm LigaSure™. Both patients had immediate uncontrolled haemorrhage that required laparotomy.
  
  
  CONCLUSIONS
  Use of the LigaSure™ device to seal and divide the major mesenteric vessels during laparoscopic colorectal resection is very effective, with a high success rate of 99.8%. Caution should be exercised in elderly atherosclerotic patients, particularly when using the 5-mm LigaSure™ device.
authors.affiliation: Department of Colorectal Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: S T
authors.initials: ST
authors.lastname: Martin
authors.forename: A
authors.initials: A
authors.lastname: Heeney
authors.forename: C
authors.initials: C
authors.lastname: Pierce
authors.forename: P R
authors.initials: PR
authors.lastname: O'Connell
authors.forename: J M
authors.initials: JM
authors.lastname: Hyland
authors.forename: Desmond C
authors.initials: DC
authors.lastname: Winter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000601:surgery*; D004564:Electrocoagulation / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008026:Ligation / Q000009:adverse effects / Q000295:instrumentation; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000601:surgery*; D008875:Middle Aged