title: Vessel sealing comparison: old school is still hip.
abstract: Ligation with either absorbable or non-absorbable sutures has been the traditional state of the art, but a proliferation of technology now offers a host of methods to close and divide vessels. Only limited data are available that objectively compare different vessel sealing methods. The objective of this study was to compare a broad variety of methods of surgical vessel closure in a reproducible, independent, standardized test-to-failure ex vivo pressure challenge.
  
  
  
  Ten of the most common surgical sealing devices were represented in this study, including both mechanical and energy devices. Unfixed porcine carotid arteries were selected for testing. They were connected to a pump, and automated controlled infusion was initiated. Upon identification of a leak at the source of sealing, the maximum pressure in mmHg was logged.
  
  
  
  There were a total of 184 trials conducted using the 10 vessel sealing methods. The average burst pressure across all trials was 1100 mmHg with a range of 51.3-5171 mmHg. Suture-based methods displayed the highest average pressure until failure. Stapling methods showed the lowest burst pressures. All methods showed mean burst pressures above the "physiologically relevant" level of 250 mmHg.
  
  
  
  This study presents an independent, reproducible, ex vivo comparison of multiple methods of surgical arterial closure. In these laboratory conditions, tests to failure demonstrated widely varying sealing strength, highly dependent on method. All hemostatic modalities tested are capable of securing vessels safely and well above physiologic blood pressures, while suture-based methods were significantly stronger than other mechanical methods or modern energy devices.
authors.affiliation: Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA. tharakans@email.chop.edu.
authors.forename: Sasha J
authors.initials: SJ
authors.lastname: Tharakan
authors.affiliation: Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Hiller
authors.affiliation: Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Shapiro
authors.affiliation: Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
authors.forename: Sourav K
authors.initials: SK
authors.lastname: Bose
authors.affiliation: Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
authors.forename: Thane A
authors.initials: TA
authors.lastname: Blinman
mesh_terms: D000818:Animals; D002339:Carotid Arteries / Q000601:surgery*; D010535:Laparoscopy; D008026:Ligation; D008953:Models, Anatomic; D011312:Pressure; D013536:Suture Techniques; D013537:Sutures; D013552:Swine; D065506:Vascular Closure Devices
keywords: Burst pressure; EBVS; Laparoscopy; Sealing device; Stapler