Division of Thoracic and Foregut Surgery, Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center Health System, Pittsburgh, PA 15232, USA.
J Thorac Cardiovasc Surg. 2010 Nov;140(5):1168-73. doi: 10.1016/j.jtcvs.2010.06.064. Epub 2010 Sep 17.
Mechanical stapling devices have been established as the mainstay of therapy in the selective isolation and division of bronchial and vascular structures during anatomic lung resection. Few data are available regarding the application of energy-based tissue fusion technology during anatomic lung resection. In the present study, we evaluated the use of energy-based instruments for the division of the pulmonary arterial and venous branches during anatomic lung resection.
Anatomic lung resection (segmentectomy or lobectomy) was performed using energy-based coagulative fusion technology. A low-profile jaw can be used to facilitate dissection in both open and video-assisted thoracic surgery cases, applying a seal 6 mm wide by 22 mm in length. Two energy applications were applied to the arterial and venous branches before vessel division.
The bipolar tissue fusion system was used in 211 patients between 2008 and 2010 (104 lobectomies and 107 anatomic segmentectomies). Initially, we used a device with a smaller, curved jaw (n = 12), producing a 3.3- to 4.7-cm seal. No arterial dehiscences and 2 partial venous dehiscences that were recognized and controlled intraoperatively occurred. For the remaining cases, we used a new device with a larger jaw that applied a seal 6 mm wide by 22 mm in length. No arterial or venous dehiscences (vessel size range, 0.4-1.2 cm) occurred.
The bipolar tissue fusion system provided safe and reliable control of pulmonary arterial and venous branches during anatomic lung resection. The use of energy-based tissue fusion technology represents a reasonable alternative to mechanical stapling devices during anatomic lung resection.
在解剖性肺切除术中，机械吻合器已被确立为选择性分离和支气管及血管结构的主要方法。关于在解剖性肺切除术中应用基于能量的组织融合技术的数据很少。本研究评估了在解剖性肺切除术中应用基于能量的器械分离肺动静脉分支。
采用基于能量的凝血融合技术进行解剖性肺切除术（肺段切除术或肺叶切除术）。在开胸和电视辅助胸腔镜手术中，都可以使用小尺寸的钳口来方便解剖，其密封长度为 6mm，宽度为 22mm。在血管分离前，对动脉和静脉分支进行两次能量应用。
2008 年至 2010 年期间，我们使用双极组织融合系统对 211 例患者进行了治疗（104 例肺叶切除术和 107 例解剖性肺段切除术）。最初，我们使用一种带有较小弯曲钳口的设备（n=12），产生 3.3-4.7cm 的密封。术中发现并控制了 2 例部分静脉裂开，但未出现动脉裂开。对于其余病例，我们使用一种带有较大钳口的新型设备，其密封长度为 6mm，宽度为 22mm。未发生动脉或静脉裂开（血管尺寸范围为 0.4-1.2cm）。
双极组织融合系统在解剖性肺切除术中为肺动静脉分支提供了安全可靠的控制。在解剖性肺切除术中，使用基于能量的组织融合技术是机械吻合器的合理替代方法。
