Liberman Moishe, Khereba Mohamed, Nasir Basil, Goudie Eric, Danino Alain, Giot Jean-Philippe, Nizard Nathanael, Hadjeres Rachid, Thiffault Vicky, Farrenq Nicolas, Ferraro Pasquale
Division of Thoracic Surgery, Department of Surgery, Centre hospitalier de l'Université de Montréal Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montréal, Montréal, Québec, Canada.
Division of Thoracic Surgery, Department of Surgery, Centre hospitalier de l'Université de Montréal Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montréal, Montréal, Québec, Canada.
Ann Thorac Surg. 2015 Sep;100(3):898-903; discussion 903-4. doi: 10.1016/j.athoracsur.2015.04.063. Epub 2015 Jul 21.
The standard technique for pulmonary arterial (PA) branch sealing in video-assisted thoracoscopic surgery lobectomy consists of vascular endostaplers. We evaluated the immediate efficacy of an ultrasonic energy vessel-sealing device for sealing PA branches and compared it with the gold standard (endostapler) in an ex vivo model.
This was a prospective cohort study. Immediately after anatomical lung resection, PA vessel sealing was achieved using the HARMONIC ACE+ Shears (ACE; Ethicon, Cincinnati, OH) sealing device or a vascular endostapler (VES) in a 3:1 ratio based on vessel diameter. The vessel was slowly pressurized, and the bursting pressure was recorded.
A total of 137 PA branches were sealed in specimens from 43 patients, of which 90 vessels were sealed with ACE and 47 were sealed with VES. The mean PA branch diameter was 6.0 mm (range, 1.7 mm to 24.0 mm; standard deviation, 3.1 mm Hg). The mean bursting pressure was 333.0 mm Hg (range, 84.0 mm Hg to 1415.1 mm Hg; standard deviation, 231.4 mm Hg) in the ACE group and 114.2 mm Hg (range, 0 mm Hg to 840.0 mm Hg; standard deviation, 124.7) in the VES group (p < 0.001). There were no complete sealing failures in the ACE group. Electron microscopy of ACE-sealed PA vessels demonstrated adventitial sealing with partial preservation of the collagen bundles and media with a sealed matrix of melted collagen.
PA branches sealed using the HARMONIC ACE+ in a simulated ex vivo model were able to sustain high intraluminal pressures. ACE-sealed vessels burst at mean bursting pressures equal to or greater than the VES-stapled vessels.
在电视辅助胸腔镜手术肺叶切除术中，肺动脉（PA）分支封闭的标准技术是使用血管吻合器。我们在体外模型中评估了一种超声能量血管封闭装置封闭PA分支的即时效果，并将其与金标准（吻合器）进行比较。
这是一项前瞻性队列研究。在解剖性肺切除术后，根据血管直径以3:1的比例使用HARMONIC ACE+剪（ACE；爱惜康公司，俄亥俄州辛辛那提）封闭装置或血管吻合器（VES）实现PA血管封闭。对血管缓慢加压，并记录破裂压力。
来自43例患者的标本中共有137个PA分支被封闭，其中90个血管用ACE封闭，47个用VES封闭。PA分支的平均直径为6.0毫米（范围为1.7毫米至24.0毫米；标准差为3.1毫米汞柱）。ACE组的平均破裂压力为333.0毫米汞柱（范围为84.0毫米汞柱至1415.1毫米汞柱；标准差为231.4毫米汞柱），VES组为114.2毫米汞柱（范围为0毫米汞柱至840.0毫米汞柱；标准差为124.7）（p<0.001）。ACE组没有完全封闭失败的情况。对ACE封闭的PA血管进行电子显微镜检查显示，外膜封闭，胶原束部分保留，中膜有熔化胶原的密封基质。
在模拟体外模型中，使用HARMONIC ACE+封闭的PA分支能够承受较高的管腔内压力。ACE封闭的血管破裂时的平均破裂压力等于或大于VES吻合的血管。
