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Use of a Saline-Coupled Bipolar Tissue Sealer in Thoracic Surgery
Ara S. Klijian.
Sharp/Scripps Hospitals, San Diego, CA, USA.
OBJECTIVE: Standard practice in thoracic surgery is to use electrocautery to provide sealing of soft tissues. A saline-coupled bipolar tissue sealer that uses radiofrequency (RF) energy is frequently used in orthopedic and spinal surgery with resulting reductions in transfusion rates by minimizing blood loss.1,2 There is a paucity of data for use of the bipolar sealer in thoracic surgery, so this study was conducted to assess surgical outcomes comparing the two types of energy-based sealers in patients who underwent a variety of thoracic surgeries.
METHODS: Consecutive patients over a 6-month period were included in this study. Medical records were reviewed for surgical outcomes, including time to chest tube removal, ambulation, and discharge, estimated blood loss (EBL), and postoperative pain on a 10-point visual analog scale.
RESULTS: Twenty-eight patients were included in the results; 14 subjects (9 females; mean age 75.6 [range, 58-84]) in the RF bipolar sealer group and 14 subjects (7 females; mean age 67.5 [range, 55-80]) in the electrocautery (control) group. There was a significant (p<0.0024) difference in age between the two groups.Significant reductions in mean EBL (310ccs vs 54.3ccs, p<0.0001), postoperative pain (6.8 vs 2.6, p<0.0001), time to chest tube removal (3.1 days vs 1.1 day, p<0.0001), time to ambulation (2.6 days vs 1.1 day, p<0.0001), and time to discharge (4.7 days vs 2.1 days, p<0.0001) were found when the control was used compared to the RF bipolar sealer, respectively.
CONCLUSIONS: The results of this single-center, single surgeon, retrospective, small case series demonstrate a significant improvement in recovery outcomes, including reduced blood loss and less pain, when a saline-coupled RF bipolar sealer is used in thoracic surgery. Faster recovery also could represent cost-savings due to a shorter hospital stay. A larger, prospective study is advocated to confirm these findings.
1 Marulanda G, Ultrich S, Seyler T, et al. Reductions in blood loss with a bipolar sealer in total hip arthroplasty. Expert Rev Med Devices 2008; 5(2):125-131
2 Weeden S, Schmidt R, Isabell G. Haemostatic efficacy of a bipolar sealing device in minimally invasive total knee arthroplasty. J Bone Joint Surg Br Proceedings 2009; 91-B:45
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