title: Pulmonary Artery Sealing With an Ultrasonic Energy Device in Video-Assisted Thoracoscopic Surgery Lobectomy: An Animal Survival Study.
abstract: BACKGROUND
  Pulmonary artery (PA) sealing in video-assisted thoracoscopic surgery (VATS) lobectomy is typically accomplished using vascular endostaplers. Endostaplers may be associated with iatrogenic PA branch injury, especially in short, small PA branches. We evaluated PA branch sealing with the HARMONIC ACE +7 (ACE) shears (Ethicon, Cincinnati, OH) in VATS lobectomy in a canine survival model.
  
  
  METHODS
  Ten adult dogs underwent VATS lobectomy. Standard VATS lobectomy operative technique was used for the entire operation, except for PA branch sealing. The ACE was used for all PA branch sealing. Dogs were kept alive for 30 days.
  
  
  RESULTS
  The 10 dogs underwent VATS right upper (n = 5) and right lower (n = 5) lobectomy. The ACE was used to seal 21 PA branches. No PA branch was divided with an endostapler. There were no intraoperative complications or conversions to thoracotomy. Mean in vivo PA diameter was 5.6 mm (range, 2 to 12 mm). One 10-mm PA branch had a partial seal failure immediately at the time of sealing. The device was reapplied on the stump, and the PA branch was successfully sealed. All dogs survived 30 days without hemothorax. Necropsy at 30 days did not reveal any signs of postoperative bleeding. Pathology of the sealed PA branches at 30 days revealed fibrosis, giant cell reaction, neovascularization, and thermal changes of the vessel wall.
  
  
  CONCLUSIONS
  The use of the ACE for PA branch sealing in VATS lobectomy is safe and effective in an animal survival model. Human studies are needed to determine the clinical safety of ultrasonic PA branch sealing before widespread clinical use.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal Endoscopic Tracheo-bronchial and Oesophageal Center, University of Montréal, Montreal, Quebec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Goudie
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal Endoscopic Tracheo-bronchial and Oesophageal Center, University of Montréal, Montreal, Quebec, 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 Tracheo-bronchial and Oesophageal Center, University of Montréal, Montreal, Quebec, Canada.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Tahiri
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal Endoscopic Tracheo-bronchial and Oesophageal Center, University of Montréal, Montreal, Quebec, Canada.
authors.forename: Pravachan
authors.initials: P
authors.lastname: Hegde
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal Endoscopic Tracheo-bronchial and Oesophageal Center, University of Montréal, Montreal, Quebec, Canada.
authors.forename: Vicky
authors.initials: V
authors.lastname: Thiffault
authors.affiliation: Department of Pathology, Centre Hospitalier de l'Université de Montréal, University of Montréal, Montreal, Quebec, Canada.
authors.forename: Rachid
authors.initials: R
authors.lastname: Hadjeres
authors.affiliation: Department of Pathology, Centre Hospitalier de l'Université de Montréal, University of Montréal, Montreal, Quebec, Canada.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Berdugo
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal Endoscopic Tracheo-bronchial and Oesophageal Center, University of Montréal, Montreal, Quebec, Canada.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ferraro
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal Endoscopic Tracheo-bronchial and Oesophageal Center, University of Montréal, Montreal, Quebec, Canada. Electronic address: moishe.liberman@umontreal.ca.
authors.forename: Moishe
authors.initials: M
authors.lastname: Liberman
mesh_terms: D000818:Animals; D001707:Biopsy, Needle; D004285:Dogs; D004867:Equipment Design; D005260:Female; D006489:Hemostatic Techniques / Q000295:instrumentation*; D007150:Immunohistochemistry; D008297:Male; D023421:Models, Animal; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality; D011651:Pulmonary Artery / Q000601:surgery*; D011897:Random Allocation; D013528:Surgical Staplers; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods / Q000401:mortality*; D014465:Ultrasonics