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OBJECTIVE: We had reported that the LigaSure™-V (LSV), an electrothermal vessel sealing system, was safe and useful in sealing of pulmonary artery and systematic lymph nodes dissection (Interact Cardiovasc Thorac Surg. 2010:229-33). A novel instruments, Ligasure™-Blunt Tip (LSBT) and LigaSure™ Maryland (LSM) have been introduced for thoracoscopic surgery, we compared LSBT with LSM in points of the dissection of the superior mediastinal lymph nodes and the pulmonary arterial ligations.
METHODS: Forty-one patients with lung cancer were assessed and studied. All patients were performed totally thoracoscopic major lung resection and right superior mediastinal lymph nodes dissection using vessel sealing devices, LSBT(n=24) or LSM (n=17). We performed complete-VATS with 3-ports , pulmonary arteries with 5mm and larger in diameter (<10mm) were ligated with a suture at the central site and the peripheral site was ligated /incised with the LigaSure™. Retrospectively, we examined all recorded operation DVD and the operation time of right superior mediastinal lymph nodes dissection and other parameters likes of postoperative complications.
RESULTS: No patient needed conversion to open surgery. The lymph nodes dissection time was shorter in the LSM group than in the LSBT group, but not significant (unpaired t-test: P = 0.07, 925 +/- 186 vs 855 +/- 131 sec.). Postoperative complications and median number of lymph nodes removed (17.5 vs 17) were similar in the 2 groups. There was no intraoperative bleeding case from the peripheral sites in both groups. No other parameters showed any significant differences between the two groups. Histologically, the intima and media of almost all pulmonary arteries were dissected and invaginated into the lumen in LSBT groups but three layers were fused in 10 patients of LSM group.
The pulmonary arteries fused whole walls were with a diameter of 4mm and below.
CONCLUSIONS: LSBT and LSM were clinically safe and useful for mediastinal lymph nodes dissection and pulmonary ligation in thoracoscopic surgery. LSM was histologically superior to LSBT.