Martucci Nicola, Tracey Maura, La Rocca Antonello, La Manna Carmine, De Luca Giuseppe, Rocco Gaetano
Division of Thoracic Surgery, Department of Thoracic Surgery and Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS, Naples, Italy.
Division of Thoracic Surgery, Department of Thoracic Surgery and Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS, Naples, Italy
Eur J Cardiothorac Surg. 2015 Jan;47(1):e13-8. doi: 10.1093/ejcts/ezu391. Epub 2014 Oct 13.
The use of bipolar sealing devices during pulmonary resection is particularly useful in thoracoscopic surgery. Theoretically, a bipolar device, which contains the current in a smaller area and completes the current cycle only through the tissue between the electrodes, may reduce the proportion of patients experiencing atrial fibrillation compared with monopolar devices such as the electrosurgical pencil using which the current completes the cycle through the patient. We investigated the impact of the LigaSure™ (LS) tissue fusion technology with the ForceTriad™ energy platform device on the incidence of postoperative atrial fibrillation and on the reduction of postoperative chest tube output and hospital length of stay after open pulmonary lobectomy.
A pilot prospective randomized, controlled trial comparing LS tissue fusion technology with the ForceTriad™ energy platform to the conventional electrosurgical pencil. Overall, 146 patients with resectable lung cancer were recruited at the Division of Thoracic Surgery of the Istituto Nazionale Tumori, Fondazione Pascale, IRCCS, between January 2011 and July 2013. Of these, 119 candidates to open lobectomy for non-small-cell lung cancer were randomized to either LS tissue fusion technology with the ForceTriad™ energy platform (LS: 57 patients) or standard haemostatic procedure (standard treatment, ST: 62 patients) for hilar and mediastinal nodal dissection. The primary end-point was to compare the incidence of postoperative atrial fibrillation of LS compared with ST. The secondary end-point was to compare the efficacy of LS compared with ST in terms of total chest tube drainage, daily chest tube drainage and chest tube duration.
There was no statistically significant difference between LS and ST in terms of postoperative atrial fibrillation (P=0.31). However, LS was associated to significant reduction of duration of both mediastinal nodal dissection (P=0.017) and the cumulative chest tube drainage (P=0.025).
The incidence of atrial fibrillation with LS tissue fusion technology with the ForceTriad™ energy platform is not reduced as compared with conventional electrosurgical pencil. However, the use of LS during mediastinal nodal dissection is associated to shorter duration of lymphadenectomy and duration of chest tube drainage.
在肺切除术中使用双极密封装置在胸腔镜手术中特别有用。从理论上讲，双极装置将电流限制在较小区域内，并且仅通过电极之间的组织完成电流回路，与单极装置（如电刀笔，电流通过患者身体完成回路）相比，可能会降低发生心房颤动的患者比例。我们研究了采用ForceTriad™能量平台装置的LigaSure™（LS）组织融合技术对开放性肺叶切除术后心房颤动发生率、术后胸管引流量减少以及住院时间的影响。
一项前瞻性随机对照试验的初步研究，将LS组织融合技术与ForceTriad™能量平台与传统电刀笔进行比较。2011年1月至2013年7月期间，在IRCCS帕斯卡基金会国家肿瘤研究所胸外科招募了146例可切除肺癌患者。其中，119例非小细胞肺癌开放性肺叶切除候选患者被随机分为采用ForceTriad™能量平台的LS组织融合技术组（LS组：57例患者）或用于肺门和纵隔淋巴结清扫的标准止血程序组（标准治疗组，ST组：62例患者）。主要终点是比较LS组与ST组术后心房颤动的发生率。次要终点是比较LS组与ST组在总胸管引流量及每日胸管引流量和胸管留置时间方面的疗效。
LS组和ST组在术后心房颤动方面无统计学显著差异（P = 0.31）。然而，LS组与纵隔淋巴结清扫时间（P = 0.017）和累计胸管引流量（P = 0.025）的显著减少相关。
与传统电刀笔相比，采用ForceTriad™能量平台的LS组织融合技术并未降低心房颤动的发生率。然而，在纵隔淋巴结清扫过程中使用LS与较短的淋巴结清扫时间和胸管引流时间相关。
