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OBJECTIVE: During complete VATS lobectomy(c-VATS), suture ligation of pulmonary artery(PA) and treatment of intraoperative bleeding can be more stressful and challenging than during standard thoracotomy. We consider that energy-based instruments (EBIs) are useful clinical tools for dividing PA in c-VATS. We investigated whether several EBIs, the LigaSure (LS), Enseal (ES) as vessel sealing systems(VSS),and ultrasonic energy device (HS) were experimentally and clinically safe and effective for ligation of PA.
METHODS: Experimental study: The burst pressures(BP) of resected porcine common carotic arteries(diameter:about 5mm) with each EBIs were measured and histopathologically analyzed. The angiocatheter was attached to a digital pressure monitor to record maximal intraluminal pressure (mmHg). Samples were histologically analyzed. Using ES, sealing time was changed from 2sec to 8. Clinical study: A total of 180 cases were analyzed. We performed c-VATS with 2-ports and one 3cm utility window , thick segmental PA(diameter >10mm) were divided with staplers, PA with 5mm and larger in diameter were ligated with a suture and the peripheral site was ligated with the EBIs.
RESULTS: Experimental study: There was no significant differences in the BP among two VSS(458/452mmHg) but higher with VSS compared to HS(199mmHg). Sorter sealing time with ES was insufficient for sealing arteries, their BP is lower (211-265mmHg) than LS and ES with standard sealing time(8s). Histopathologically, the cut ends of arteries were completely sealed and degenerated by the VSS, the lengths of the weldings were longer than HS.
However the welding shape was destroyed at some points in ES, the cause was suspected to be the cutter systems. Clinically, there were some intraoperative bleeding cases from the peripheral sites, their PA were sealed with ES or HS resulted from moving of lung specimens.
CONCLUSIONS: These studies demonstrated the safety and the efficacy of the LS to seal and ligate pulmonary arteries in c-VATS. While ES and HS are not suit for dealing several PA because of clinical bleeding and histological imperfect welding constructions.