Use of energy-based coagulative fusion technology and lung sealants during anatomic lung resection.
OBJECTIVE
Energy-based tissue fusion technology is being increasingly used for vascular division in numerous intra-abdominal applications. Very few data, however, are available regarding the application of this technology in the chest during anatomic lung resection. In the present review, we evaluated the use of energy-based fusion and lung sealants during anatomic lung resection.


METHODS
We performed a review of case series and published studies to evaluate the use of energy-based coagulative fusion technology and lung sealants during anatomic lung resection. We then used energy-based coagulative fusion technology during anatomic lung resection (segmentectomy or lobectomy) in 316 cases from 2008 to 2011. Two energy applications were applied to the arterial and venous branches before vessel division.


RESULTS
In the first 12 cases, we used a device with a small curved jaw (range, 3.3-4.7 mm). Two partial venous dehiscences were noted and controlled intraoperatively. For the remaining cases, we used a larger jaw (6 mm × 22 mm) with no arterial or venous dehiscence occurring (vessels ranged from 0.4 to 1.2 cm). Autologous or synthetic tissue sealants applied to the parenchymal staple lines might reduce the severity and duration of perioperative air leaks. Suture line buttressing with pericardial or absorbable biosynthetic polyester strips might reduce the severity of air leaks in patients with severe emphysema undergoing anatomic lung resection or lung volume reduction surgery.


CONCLUSIONS
The bipolar tissue fusion system provides a safe and effective technique for the division of the pulmonary arterial and venous branches during anatomic lung resection. Surgical sealants and buttressing adjuncts might reduce perioperative air leak potential.
Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA. schuchertmj@upmc.edu
Matthew J
MJ
Schuchert
Ghulam
G
Abbas
Joshua P
JP
Landreneau
James D
JD
Luketich
Rodney J
RJ
Landreneau
D004564:Electrocoagulation / Q000009:adverse effects / Q000295:instrumentation; D004867:Equipment Design; D006801:Humans; D008168:Lung / Q000098:blood supply / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011651:Pulmonary Artery / Q000601:surgery*; D011667:Pulmonary Veins / Q000601:surgery*; D017792:Surgical Stapling; D013536:Suture Techniques; D014014:Tissue Adhesives / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D014014:Tissue Adhesives