Lacin Tunc, Batirel Hasan Fevzi, Ozer Kursat, Demirutku Alper, Ahiskali Rengin, Yuksel Mustafa
Marmara University Hospital, Department of Thoracic Surgery, Istanbul, Turkey.
Eur J Cardiothorac Surg. 2007 Mar;31(3):482-5; discussion 485. doi: 10.1016/j.ejcts.2006.11.038. Epub 2007 Jan 17.
LigaSure (Valleylab, Tyco Healthcare, Boulder, CO) is a novel instrument with widespread use in various surgical disciplines for vessel sealing. It uses heat energy to denature collagen and elastin and achieve vessel sealing. We investigated the safety of LigaSure in pulmonary arteries (PA) and veins (PV).
Twelve sheep were anesthetized and endotracheally intubated. Six underwent right lower lobectomy (Group 1) and six right upper lobectomy (Group 2). All of the vessels in both groups were divided with LigaSure. Diameters of vessels were measured. Intraoperatively, pulmonary artery pressures (PAP) were monitored in Group 1. Following vascular division, ephedrine was injected to increase PAP in Group 1. In Group 2, animals were followed and euthanized at 7 days. Both immediate and 7 day samples were obtained from divided vessel stumps. Conventional histology was done. Statistical analysis was performed using t-test and Fisher's exact test.
Mean diameter of PAs (n=9) divided in Group 1 was 8.3mm (3-11) and of PVs (n=8) was 10.4mm (4-15). Mean PAP increased from 18 (27/9) to 27 (45/18)mmHg after ephedrine injection. Dehiscence rate was 2/6 in PAs and 3/6 in PVs larger than 9 mm in diameter. Mean diameter of PAs (n=8) divided in Group 2 was 5.7 mm (3-7) and of PVs (n=9) was 4.6mm (4-6). No early or late (7 days) vascular disruption was seen in Group 2. Bleeding incidence was significantly different between groups (Fisher's exact test p=0.015). Overall no dehiscence was observed in vessels less than 7 mm in diameter. Histology of intraoperative samples showed thermal injury and necrosis. Seven day samples showed short segment necrosis limited to the vessel wall, fibrosis, thrombus formation without inflammation, and minimal granulation tissue.
LigaSure achieves perfect sealing in pulmonary vessels less than 7 mm in diameter in sheep intra- and postoperatively even following a pressure challenge. It can safely be used in segmental branches of PAs and PVs during open or thoracoscopic surgery.
LigaSure（美国科罗拉多州博尔德市泰科医疗集团旗下的威力实验室生产）是一种新型器械，在各种外科手术学科中广泛用于血管封闭。它利用热能使胶原蛋白和弹性蛋白变性，从而实现血管封闭。我们研究了LigaSure在肺动脉（PA）和肺静脉（PV）中的安全性。
对12只绵羊进行麻醉并气管插管。6只接受右下肺叶切除术（第1组），6只接受右上肺叶切除术（第2组）。两组所有血管均用LigaSure进行分割。测量血管直径。术中，第1组监测肺动脉压（PAP）。血管分割后，第1组注射麻黄碱以升高PAP。在第2组中，对动物进行随访并在7天时实施安乐死。从分割后的血管残端获取即时样本和7天样本。进行常规组织学检查。使用t检验和Fisher精确检验进行统计分析。
第1组中分割的肺动脉（n = 9）平均直径为8.3mm（3 - 11），肺静脉（n = 8）平均直径为10.4mm（4 - 15）。注射麻黄碱后，平均PAP从18（27/9）mmHg升至27（45/18）mmHg。直径大于9mm的肺动脉裂开率为2/6，肺静脉为3/6。第2组中分割的肺动脉（n = 8）平均直径为5.7mm（3 - 7），肺静脉（n = 9）平均直径为4.6mm（4 - 6）。第2组未观察到早期或晚期（7天）血管破裂。两组间出血发生率有显著差异（Fisher精确检验p = 0.015）。总体而言，直径小于7mm的血管未观察到裂开。术中样本的组织学检查显示有热损伤和坏死。7天样本显示短节段坏死局限于血管壁、纤维化、血栓形成且无炎症，以及极少的肉芽组织。
LigaSure在绵羊体内及术后对直径小于7mm的肺血管即使在压力挑战后也能实现完美封闭。在开放手术或胸腔镜手术中，它可安全用于肺动脉和肺静脉的节段性分支。
