Login to Access Video or Poster Abstract: MP52-17
Sources of Funding: none

Introduction

We evaluated the performance of 5 currently available energy-based vessel-sealing devices (VSD).

Methods

We tested the Caiman 5(C5), Harmonic Scalpel Ace Plus (HA), Harmonic Ace +7 (HA7), LigaSure (LS) and Enseal G2 (ES) on small (2-5mm), medium (5.1-7mm) and large (7.1-9mm) vessels in 16 Yorkshire pigs. Vessels were randomized to one of the five devices and then were sealed and transected. Sealing and transection time, thermal spread and burst pressures (BP) were recorded for each trial. The surgeon subjectively rated charring/carbonization, tissue sticking, seal quality and transection quality on a 1-5 scale (1 best and 5 worst). Specimens were sent for histopathologic evaluation of seal quality and thermal spread. BP was measured by inserting an 18-gauge angiocatheter into the lumen of each vessel and pressurizing the irrigant until the vessel ruptured or the seal failed. The angiocatheter was then attached to a digital pressure manometer. BP failure was defined as rupture at pressures less than 300mHg for arteries and 30mmHg for veins.

Results

A total of 246 vessels were evaluated; 125 were arteries and 121 were veins. _x000D_ _x000D_ Arteries: There was no difference in BP for small size arteries. However the ES had a 10% BP failure rate. For medium arteries the C5 provided the highest BP (proximal and distal jaw), followed by HA7, ES, LS and HA. All mean pressures were more than two times super physiologic for all devices. However, for HA there was a 20% failure rate and for ES the failure rate was 40% at mean pressures of 320 and 480 respectively. For large arteries C5 and LS provided highest BP followed by HA7, ES and HA: 1,676, 530, 467, 467 and 254 mmHg, respectively. HA had BP failure of 40% while ES had a failure rate of 80%, respectively._x000D_ _x000D_ Veins: The C5 provided the highest BP (proximal and distal jaw) across all vein sizes followed by LS, HA7 and HA. Among the small, medium and large veins (up to 9mm), there were no BP failures for all the devices. _x000D_ _x000D_ With regard to thermal spread, all of the devices had similar outcomes with an average of 1 to 2 mm on either side of the jaws. _x000D_

Conclusions

In this study, the C5 outperformed all other devices. Thermal spread is minimal with all devices. With all devices, the seal remained intact up to pressures of 250 mm Hg or twice physiologic; of note, the seals with the C5, HA7, and LS were stronger than the vessel wall itself.

Funding

none