title: Pulmonary Artery Sealing Using the HARMONIC ACE+ Shears for Video-Assisted Thoracoscopic Surgery Lobectomy.
abstract: BACKGROUND
  The standard technique for pulmonary arterial (PA) branch sealing in video-assisted thoracoscopic surgery lobectomy consists of vascular endostaplers. We evaluated the immediate efficacy of an ultrasonic energy vessel-sealing device for sealing PA branches and compared it with the gold standard (endostapler) in an ex vivo model.
  
  
  METHODS
  This was a prospective cohort study. Immediately after anatomical lung resection, PA vessel sealing was achieved using the HARMONIC ACE+ Shears (ACE; Ethicon, Cincinnati, OH) sealing device or a vascular endostapler (VES) in a 3:1 ratio based on vessel diameter. The vessel was slowly pressurized, and the bursting pressure was recorded.
  
  
  RESULTS
  A total of 137 PA branches were sealed in specimens from 43 patients, of which 90 vessels were sealed with ACE and 47 were sealed with VES. The mean PA branch diameter was 6.0 mm (range, 1.7 mm to 24.0 mm; standard deviation, 3.1 mm Hg). The mean bursting pressure was 333.0 mm Hg (range, 84.0 mm Hg to 1415.1 mm Hg; standard deviation, 231.4 mm Hg) in the ACE group and 114.2 mm Hg (range, 0 mm Hg to 840.0 mm Hg; standard deviation, 124.7) in the VES group (p < 0.001). There were no complete sealing failures in the ACE group. Electron microscopy of ACE-sealed PA vessels demonstrated adventitial sealing with partial preservation of the collagen bundles and media with a sealed matrix of melted collagen.
  
  
  CONCLUSIONS
  PA branches sealed using the HARMONIC ACE+ in a simulated ex vivo model were able to sustain high intraluminal pressures. ACE-sealed vessels burst at mean bursting pressures equal to or greater than the VES-stapled vessels.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Centre hospitalier de l'Université de Montréal Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montréal, Montréal, Québec, Canada. Electronic address: moishe.liberman@umontreal.ca.
authors.forename: Moishe
authors.initials: M
authors.lastname: Liberman
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Centre hospitalier de l'Université de Montréal Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montréal, Montréal, Québec, Canada.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Khereba
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Centre hospitalier de l'Université de Montréal Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montréal, Montréal, Québec, Canada.
authors.forename: Basil
authors.initials: B
authors.lastname: Nasir
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Centre hospitalier de l'Université de Montréal Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montréal, Montréal, Québec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Goudie
authors.affiliation: Division of Reconstructive and Micro-Vascular Surgery, University of Montréal, Montréal, Québec, Canada.
authors.forename: Alain
authors.initials: A
authors.lastname: Danino
authors.affiliation: Division of Reconstructive and Micro-Vascular Surgery, University of Montréal, Montréal, Québec, Canada.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Giot
authors.affiliation: Division of Reconstructive and Micro-Vascular Surgery, University of Montréal, Montréal, Québec, Canada.
authors.forename: Nathanael
authors.initials: N
authors.lastname: Nizard
authors.affiliation: Department of Pathology, University of Montréal, Montréal, Québec, Canada.
authors.forename: Rachid
authors.initials: R
authors.lastname: Hadjeres
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Centre hospitalier de l'Université de Montréal Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montréal, Montréal, Québec, Canada.
authors.forename: Vicky
authors.initials: V
authors.lastname: Thiffault
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Centre hospitalier de l'Université de Montréal Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montréal, Montréal, Québec, Canada.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Farrenq
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Centre hospitalier de l'Université de Montréal Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montréal, Montréal, Québec, Canada.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ferraro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000601:surgery*; D013528:Surgical Staplers; D013537:Sutures; D020775:Thoracic Surgery, Video-Assisted; D014656:Vascular Surgical Procedures / Q000379:methods