title: Pilot study of pulmonary arterial branch sealing using energy devices in an ex vivo model.
abstract: OBJECTIVE
  Vascular endostaplers are bulky and can be dangerous when dividing small pulmonary arterial (PA) branch vessels during video-assisted thoracoscopic lobectomy. We aimed to evaluate and compare the immediate efficacy of modern energy sealing devices in an ex vivo PA sealing model.
  
  
  METHODS
  Patients undergoing anatomical lung resection or lung transplantation were recruited for a prospective cohort pilot study. Four devices were evaluated: Harmonic Ace (Ethicon, Cincinnati, Ohio), Thunderbeat (Olympus, Tokyo, Japan), LigaSure (Covidien, Boulder, Colo), and Enseal (Ethicon; Cincinnati, Ohio). After anatomical lung resection, the PA branches were dissected in vitro. Sealing was then performed with 1 of the sealing devices, the vessel was slowly pressurized, and the bursting pressure was recorded.
  
  
  RESULTS
  Forty-nine PA branches were sealed in 14 patients. The mean PA branch diameter was 7.4 mm (1.8-14.5 mm). Ten patients had normal PA pressure and 3 had PA hypertension. The mean bursting pressure in each was as follows: Harmonic Ace group, 415.5 mm Hg (137.1-1388.4 mm Hg), Thunderbeat group, 875 mm Hg (237.1-2871.3 mm Hg); LigaSure group, 214.7 mm Hg (0-579.6 mm Hg); Enseal group, 133.7 mm Hg (0-315.38 mm Hg). There were 2 complete sealing failures: LigaSure (diameter 6.78 mm) and Enseal (diameter 8.3 mm).
  
  
  CONCLUSIONS
  In this pilot study to examine energy sealing of PA branches in a simulated ex vivo model, vascular sealing using energy was effective and was able to sustain high intraluminal bursting pressures. Further research is needed to determine the in vivo and long-term safety of PA branch energy sealing.
authors.affiliation: CETOC - CHUM Endoscopic Tracheobronchial and Oesophageal Center, Division of Thoracic Surgery, Department of Surgery, University of Montréal, Montréal, Québec, Canada. Electronic address: moishe.liberman@umontreal.ca.
authors.forename: Moishe
authors.initials: M
authors.lastname: Liberman
authors.affiliation: CETOC - CHUM Endoscopic Tracheobronchial and Oesophageal Center, Division of Thoracic Surgery, Department of Surgery, University of Montréal, Montréal, Québec, Canada.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Khereba
authors.affiliation: CETOC - CHUM Endoscopic Tracheobronchial and Oesophageal Center, Division of Thoracic Surgery, Department of Surgery, University of Montréal, Montréal, Québec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Goudie
authors.affiliation: CETOC - CHUM Endoscopic Tracheobronchial and Oesophageal Center, Division of Thoracic Surgery, Department of Surgery, University of Montréal, Montréal, Québec, Canada.
authors.forename: Jordan
authors.initials: J
authors.lastname: Kazakov
authors.affiliation: CETOC - CHUM Endoscopic Tracheobronchial and Oesophageal Center, Division of Thoracic Surgery, Department of Surgery, University of Montréal, Montréal, Québec, Canada.
authors.forename: Vicky
authors.initials: V
authors.lastname: Thiffault
authors.affiliation: CETOC - CHUM Endoscopic Tracheobronchial and Oesophageal Center, Division of Thoracic Surgery, Department of Surgery, University of Montréal, Montréal, Québec, Canada.
authors.forename: Edwin
authors.initials: E
authors.lastname: Lafontaine
authors.affiliation: CETOC - CHUM Endoscopic Tracheobronchial and Oesophageal Center, Division of Thoracic Surgery, Department of Surgery, University of Montréal, Montréal, Québec, Canada.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ferraro
mesh_terms: D000328:Adult; D000368:Aged; D062186:Arterial Pressure; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D008026:Ligation; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011013:Pneumonectomy / Q000379:methods*; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D013314:Stress, Mechanical; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D016896:Treatment Outcome