Carbonell Alfredo M, Joels Charles S, Kercher Kent W, Matthews Brent D, Sing Ronald F, Heniford B Todd
Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA.
J Laparoendosc Adv Surg Tech A. 2003 Dec;13(6):377-80. doi: 10.1089/109264203322656441.
The development of new energy sources for hemostasis has facilitated advanced laparoscopic procedures. Few studies, however, have documented the strength of the vessels sealed or the extent of surrounding lateral thermal injury, two important factors in maintaining hemostasis while preventing injury to surrounding structures. This study compared the burst pressure and extent of thermal injury of vessels sealed with the 5-mm laparoscopic PlasmaKinetics trade mark sealer (PK) (Gyrus Medical, Maple Grove, Minnesota) and the 5-mm laparoscopic LigaSure trade mark sealing device (LS) (Valleylab, Boulder, Colorado).
Arteries in three sizes (2-3 mm, 4-5 mm, and 6-7 mm) were harvested from domestic pigs. Eight to 17 specimens from each size were randomly sealed with the PK, and the same number with the LS. Burst pressures were measured in mm Hg. The extent of thermal injury, determined by coagulation necrosis, was measured microscopically in millimeters after staining the transected vessels with hematoxylin and eosin. Descriptive statistics, including means and standard deviations, are reported. Student's t-test and ANOVA were performed to determine significance (P <.05).
The mean bursting pressures of the PK and the LS were equal in the 2-3 mm vessels (397 vs. 326 mm Hg, P =.49). The PK bursting pressures were significantly less than the LS in the 4-5 mm (389 vs. 573 mm Hg, P =.02) and the 6-7 mm groups (317 vs. 585 mm Hg, P =.0004). As vessel size increased, the PK was associated with significantly lower burst pressures, while the LS was associated with progressively higher burst pressures (P =.035). Thermal spread was not significantly different between the PK and the LS in the 2-3 mm (1.5 vs. 1.2 mm, P =.27), the 4-5 mm (2.4 vs. 2.4 mm, P =.79), or the 6-7 mm vessel size groups (3.2 vs. 2.5 mm, P =.32). Increasing vessel size, regardless of instrument used, was associated with increased thermal injury (P <.0001).
The LS produces supraphysiologic seals with significantly higher bursting pressures than the PK in vessels ranging from 4 to 7 mm. The PK seals become progressively weaker while the LS seals increase in strength as the vessel size increases. Although thermal spread increases with vessel size, the degree of lateral thermal injury is no different between the two instruments.
新型止血能源的发展推动了先进腹腔镜手术的开展。然而，很少有研究记录血管封闭的强度或周围侧向热损伤的范围，这是维持止血同时防止周围结构损伤的两个重要因素。本研究比较了使用5毫米腹腔镜等离子动力学商标密封器（PK）（Gyrus Medical，明尼苏达州枫树谷）和5毫米腹腔镜血管结扎速融商标密封装置（LS）（Valleylab，科罗拉多州博尔德）封闭血管后的破裂压力和热损伤范围。
从家猪身上获取三种尺寸（2 - 3毫米、4 - 5毫米和6 - 7毫米）的动脉。每种尺寸的8至17个标本随机用PK密封，相同数量的标本用LS密封。破裂压力以毫米汞柱为单位测量。热损伤范围通过凝固性坏死确定，在对横断血管用苏木精和伊红染色后，在显微镜下以毫米为单位测量。报告了包括均值和标准差在内的描述性统计数据。进行了学生t检验和方差分析以确定显著性（P <.05）。
在2 - 3毫米的血管中，PK和LS的平均破裂压力相等（397对326毫米汞柱，P =.49）。在4 - 5毫米（389对573毫米汞柱，P =.02）和6 - 7毫米组（317对585毫米汞柱，P =.0004）中，PK的破裂压力显著低于LS。随着血管尺寸增加，PK的破裂压力显著降低，而LS的破裂压力逐渐升高（P =.035）。在2 - 3毫米（1.5对1.2毫米，P =.27）、4 - 5毫米（2.4对2.4毫米，P =.79）或6 - 7毫米血管尺寸组中，PK和LS之间的热扩散没有显著差异（3.2对2.5毫米，P =.32）。无论使用何种器械，血管尺寸增加都与热损伤增加相关（P <.0001）。
在4至7毫米的血管中，LS产生的超生理密封的破裂压力显著高于PK。随着血管尺寸增加，PK密封逐渐变弱，而LS密封强度增加。尽管热扩散随血管尺寸增加，但两种器械的侧向热损伤程度没有差异。
