title: Bipolar impedance-controlled sealing of the pulmonary artery with SealSafe G3 electric current: determination of bursting pressures in an ex vivo model.
abstract: BACKGROUND
  In every anatomic lung resection operation, the pulmonary artery itself or its branches must be sealed. This involves either stapling or ligating the vessels. Based on the positive results with the bipolar vessel sealing ≤7 mm in abdominal surgery the present study aimed to evaluate burst pressures of the pulmonary artery after sealing with the sealing instrument SealSafe G3 (Gebrüder Martin & CoKG, Tuttlingen, Germany).
  
  
  METHODS
  The whole pulmonary artery above the pulmonary valve was exposed up to the periphery of the left lung in freshly removed pig heart-lung blocks. A pressure-measuring cylinder was then implanted in the prepared vessel on the side at the main trunk of the pulmonary artery to determine the pressure in the vessel. After either ligation or bipolar sealing of the pulmonary artery, the pneumatic burst pressure (millimeters of mercury) was determined in a water bath. Three groups (n = 12 for each seal type) with different vessel diameters were examined: group 1: 0-6 mm, group 2: 7-12 mm, and group 3: >12 mm. In all cases, vessel sealing was performed with a MARSEAL 5 instrument (Gebrüder Martin & Co KG, Tuttlingen, Germany) and the SealSafe G3 current. The mean burst pressures of the individual groups (ligature and bipolar sealing) were compared using two-tailed, nonparametric Mann-Whitney U test. Significance was defined as P < 0.05.
  
  
  RESULTS
  The mean burst pressures in group 1 were measured by 340 ± 13.4 mm Hg with ligature and 205 ± 44.4 mm Hg with bipolar sealing (P < 0.001). In group 2, the mean values obtained were 270 ± 28.2 mm Hg for ligature and 162 ± 36.0 mm Hg for bipolar sealing (P < 0.001). In group 3, the mean burst pressures for bipolar sealing were only 52.1 ± 15.1 mm Hg, whereas those for ligated vessels were 253 ± 46.9 mm Hg (P < 0.001). For this size of vessel the burst pressure was also determined after stapling. The mean value in this case was 230 ± 21.8 mm Hg.
  
  
  CONCLUSIONS
  In all groups, the mean burst pressures after bipolar sealing were significantly lower than those achieved with ligation, but they were sufficient for a save closure of the pulmonary artery with diameters up to 12 mm.
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, Philipps-University Marburg, Marburg, Germany. Electronic address: akirschb@med.uni-marburg.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kirschbaum
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, Philipps-University Marburg, Marburg, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Kunz
authors.affiliation: Department of Anaesthesiology and Intensive Medicine, Philipps-University Marburg, Marburg, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Steinfeldt
authors.affiliation: Department of Pathology, Philipps-University Marburg, Marburg, Germany.
authors.forename: Anika
authors.initials: A
authors.lastname: Pehl
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, Philipps-University Marburg, Marburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Meyer
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, Philipps-University Marburg, Marburg, Germany.
authors.forename: Detlef K
authors.initials: DK
authors.lastname: Bartsch
mesh_terms: D000818:Animals; D017097:Electric Impedance / Q000627:therapeutic use; D004564:Electrocoagulation / Q000295:instrumentation* / Q000379:methods; D006321:Heart; D006488:Hemostasis, Surgical / Q000295:instrumentation* / Q000379:methods; D008168:Lung / Q000098:blood supply / Q000601:surgery; D008365:Manometry / Q000295:instrumentation / Q000379:methods; D023421:Models, Animal; D011312:Pressure; D011651:Pulmonary Artery / Q000601:surgery*; D013552:Swine
keywords: Bipolar vessel sealing; Bursting pressure; MARSEAL; Pulmonary artery; SealSafe G3