Clinical application of an ultrasonic scalpel to divide pulmonary vessels based on laboratory evidence.

The Harmonic Ace ultrasonic scalpel (Ethicon Endo-Surgery, Inc, Cincinnati, Ohio), has been widely used in endoscopic surgery to divide systemic vessels, but not pulmonary vessels. We describe our initial clinical experience of using it for pulmonary vessel division. The Harmonic Ace was used to divide pulmonary vessels 5 mm or less in diameter, secured with a proximal single ligation, in 20 patients who underwent video-assisted major lung resection between September 2007 and April 2008. We also evaluated the sealing potential of this device in a pig model. We divided 43 pulmonary arteries and 13 pulmonary veins (PV) by the device. The diameter of the divided vessels ranged from 2 to 5 mm. Vascular sealing was successful in all except two early procedures: several subsegmental arteries were held at once, and vessels positioned near the distal end of the blade jaw bled intraoperatively. There was no postoperative bleeding. In the pig model, the bursting pressure of sealed pulmonary arteries (PA) was >75 mmHg. Pulmonary vessels can be safely divided using the Harmonic Ace with proximal single ligation unless multiple or large pulmonary vessels are held within the blade jaw.