title: Energy-Based Ligation of Pulmonary Vessels: A Six-Year Experience With Ultrasonic Shears in Video-Assisted Thoracoscopic Lobectomy and Segmentectomy.
abstract: BACKGROUND
  Mechanical staplers are widely employed in minimally invasive anatomic lung resections, but have limitations when managing smaller pulmonary arterial and venous branches. Published data is lacking regarding the safety and efficacy of pulmonary vessel ligation using ultrasonic shears. We describe a single-surgeon experience employing ultrasonic shears for the ligation of pulmonary vasculature during lobectomy and segmentectomy, primarily in the setting of video-assisted thoracic surgery (VATS) resection.
  
  
  METHODS
  A retrospective chart review was conducted for all patients, who underwent anatomic resection, between 2008 and 2014. Charts were divided into 2 groups based on method of ligation (energy based or conventional). Dictated operative reports were reviewed and patient demographics, tumor characteristics, and complications were recorded.
  
  
  RESULTS
  Ultrasonic shears were used for pulmonary vessel ligation (5 to 6 mm) in 82 of 283 anatomic resections. A total of 118 vessels were ligated with ultrasonic shears. The majority of patients (83%) in the energy-based ligation group underwent VATS resection. There were fewer complications in the energy-based ligation group (26% vs 38%; p = 0.05); however, rates of intraoperative transfusion, prolonged air leak, empyema, and return to the operating room were similar across the 2 groups, and no statistically significant difference was found. There were no postoperative complications directly attributable to ultrasonic vessel ligation.
  
  
  CONCLUSIONS
  Energy-based ligation of small-diameter pulmonary vessels is a safe and useful adjunct in anatomic VATS resection and a viable alternative to mechanical stapling. Its narrow profile and thin blades make it ideal for ligation of pulmonary vasculature, particularly where the size and necessary clearance of mechanical staplers prohibit safe dissection.
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: awhite12@partners.org.
authors.forename: Abby
authors.initials: A
authors.lastname: White
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Suden
authors.initials: S
authors.lastname: Kucukak
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Lee
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Swanson
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008026:Ligation; D008168:Lung / Q000098:blood supply*; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000295:instrumentation*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000295:instrumentation*; D016896:Treatment Outcome; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation*; D055815:Young Adult