Comparison of blood vessel sealing among new electrosurgical and ultrasonic devices

Abstract

Background: Bipolar electrosurgical devices and ultrasonic devices are routinely used in open and advanced laparoscopic surgery for hemostasis. New electrosurgical and ultrasonic instruments demonstrate improved quality and efficiency in blood vessel sealing.

Methods: The 5-mm laparoscopic Gyrus PKS Cutting Forceps (PK), Gyrus Plasma Trissector (GP), Harmonic Scalpel (HS), EnSeal Tissue Sealing and Hemostasis System (RX), LigaSure V with LigaSure Vessel Sealing Generator (LS), LigaSure V with Force Triad Generator (FT), and Ligamax 5 Endoscopic Multiple Clip Applier (LM) were tested to compare burst pressure, sealing time, and failure rate. Each device was used to seal 13 small (2-3 mm diameter), 13 medium (4-5 mm diameter), and 13 large (6-7 mm diameter) arteries from euthanized pigs. A p value <0.05 was considered statistically significant.

Results: Mean burst pressures were not statistically different for 2-3 mm or 6-7 mm vessels. For 4-5 mm vessels, LS had the highest mean burst pressure recorded. Mean seal times were shorter for every vessel size when FT was compared with LS (p < 0.05). The shortest sealing times for 2-3 mm vessels were recorded for GP. The shortest sealing times for medium and large vessels were observed with FT. The highest percentage failure rate for each vessel size occurred with GP. For 4-5 mm diameter vessels, the failure rate was 48% for GP, 41% for PK, and 22% for HS. For 6-7 mm diameter vessels, the failure rate was 92% for GP, 41% for PK, and 8% for HS. LM and FT had no recorded failures.

Conclusion: Among the new 5-mm laparoscopic electrosurgical and ultrasonic instruments available for testing, RX, LS, and FT produced the highest mean burst pressures. FT had the shortest mean seal times for medium and large vessels. Minimal or no seal failures occurred with HS, RX, LS, LM, and FT.