Person Benjamin, Vivas David A, Ruiz Dan, Talcott Michael, Coad James E, Wexner Steven D
Department of Colorectal Surgery, Cleveland Clinic, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA.
Surg Endosc. 2008 Feb;22(2):534-8. doi: 10.1007/s00464-007-9619-8. Epub 2007 Dec 20.
To compare the safety and efficacy of four energy-based vascular sealing and cutting instruments.
Blood vessels of various types and diameters were harvested from four pigs using four instruments: Harmonic ACE (Ethicon Endo-Surgery, Cincinnati, OH), LigaSure V and LigaSure Atlas (Valleylab, Inc., Boulder, CO; a division of Tyco Healthcare), and EnSeal vessel fusion system (SurgRx, Inc. Redwood City, CA). The diameters of the vessels, speed and adequacy of the cutting and sealing process, and bursting pressures were compared. An additional set of specimens was sealed and left in situ for up to 4 h after which the vessels were harvested and histopathologically analyzed for the degree of thermal injury.
The bursting pressures were significantly higher with EnSeal compared to all other instruments (p < 0.0001). The sealing process was significantly shorter with Harmonic ACE and significantly longer with LigaSure Atlas (p <0.0001). The mean seal width was larger with the LigaSure Atlas compared to the other instruments, and it was smaller with EnSeal and Harmonic ACE. Less radial adventitial collagen denaturation was present with EnSeal and LigaSure V than with the other two instruments; there were no significant differences in collagen denaturation although proximal thermal injury to the smooth muscle in the media of the vessel wall was less common with LigaSure Atlas than with the other instruments; however, the numbers were too small for statistical analysis.
The bursting pressures with EnSeal were significantly higher than with all the other instruments. Harmonic ACE was the fastest sealing instrument and LigaSure Atlas was slowest. EnSeal created less radial thermal damage to the adventitial collagen of the vessels and LigaSure Atlas created less thermal damage to the media of the vessels. The clinical significance of these findings is unknown.
比较四种基于能量的血管封闭和切割器械的安全性和有效性。
使用四种器械从四头猪身上获取不同类型和直径的血管：超声刀ACE（爱惜康内镜外科公司，俄亥俄州辛辛那提）、LigaSure V和LigaSure Atlas（柯惠医疗公司，科罗拉多州博尔德；泰科医疗集团旗下部门）以及EnSeal血管融合系统（外科解决方案公司，加利福尼亚州红木城）。比较血管直径、切割和封闭过程的速度及充分程度，以及破裂压力。另外取一组标本进行封闭并原位留置长达4小时，之后获取血管并进行组织病理学分析以评估热损伤程度。
与所有其他器械相比，EnSeal的破裂压力显著更高（p < 0.0001）。超声刀ACE的封闭过程显著更短，而LigaSure Atlas的封闭过程显著更长（p <0.0001）。与其他器械相比，LigaSure Atlas的平均封闭宽度更大，而EnSeal和超声刀ACE的平均封闭宽度更小。与其他两种器械相比，EnSeal和LigaSure V导致的血管外膜胶原径向变性更少；尽管LigaSure Atlas导致血管壁中层平滑肌近端热损伤比其他器械少见，但胶原变性方面无显著差异；然而，样本数量过少无法进行统计学分析。
EnSeal的破裂压力显著高于所有其他器械。超声刀ACE是封闭速度最快的器械，而LigaSure Atlas是最慢的。EnSeal对血管外膜胶原造成的径向热损伤更小，而LigaSure Atlas对血管中层造成的热损伤更小。这些发现的临床意义尚不清楚。
