title: Hemostasis with a bipolar sealer during surgical correction of adolescent idiopathic scoliosis.
abstract: METHODS
  Retrospective before-after comparison study.
  
  
  OBJECTIVE
  The primary aim of this study was to evaluate the effectiveness of a radiofrequency-based bipolar hemostatic sealer during surgical correction of adolescent idiopathic scoliosis (AIS).
  
  
  BACKGROUND
  Spinal reconstructive surgery is commonly associated with excessive blood loss. Perioperative bleeding is of particular concern during correction of AIS, which often requires allogeneic or autologous transfusion. However, there are specific risks and limitations that often preclude the utilization of transfusions. Alternatives include the use of antifibrinolytic drugs and topical fibrin-based and thrombin-based agents, although safety and effectiveness are yet to be fully established. There is a clear need for assessing alternative methods of hemostasis.
  
  
  METHODS
  One hundred seventy-six AIS patients undergoing corrective spinal surgery were included in this study. Seventy-six consecutive patients were treated intraoperatively with a standard method of hemostasis consisting of hypotensive anesthesia, thrombin-soaked sponges, and intraoperative blood salvage (Control). Subsequently, an additional 100 consecutive patients were treated after the introduction of a bipolar sealer (Aquamantys 2.3 Bipolar Sealer, Salient Surgical Technologies, Portsmouth, NH). The outcomes of this study were estimated blood loss (total and per level) and transfusion rate.
  
  
  RESULTS
  Blood loss was reduced by 57% after the introduction of the bipolar sealer compared with the Control (bipolar sealer: 435±192 mL, Control: 1009±392 mL; P<0.001). There was a statistically significant difference between groups for blood loss per fusion level (bipolar sealer: 39±17 mL, Control: 95±33 mL; P<0.001). Five (6.6%) Control patients required blood transfusions versus none treated with the bipolar sealer (P=0.014). Complication rates were similar between the groups.
  
  
  CONCLUSIONS
  These findings suggest that the Aquamantys 2.3 bipolar sealer effectively supports hemostasis and reduces the need for transfusions during surgical correction of AIS.
authors.affiliation: Raleigh Orthopaedic Clinic, Pediatric Orthopaedic Service, Raleigh, NC, USA.
authors.forename: Keith P
authors.initials: KP
authors.lastname: Mankin
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Moore
authors.forename: Larry E
authors.initials: LE
authors.lastname: Miller
authors.forename: Jon E
authors.initials: JE
authors.lastname: Block
mesh_terms: D000293:Adolescent; D016063:Blood Loss, Surgical / Q000503:physiopathology / Q000517:prevention & control*; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D002648:Child; D004564:Electrocoagulation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome