Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler Strasse 3, 72076, Tuebingen, Germany.
Research and Basic Technologies Department, Erbe Elektromedizin GmbH, Tuebingen, Germany.
Surg Endosc. 2018 Mar;32(3):1456-1463. doi: 10.1007/s00464-017-5832-2. Epub 2017 Sep 18.
Bipolar vessel sealing has been successfully introduced in a variety of procedures like prostatectomy, hysterectomy, and nephrectomy. In this study, we evaluated a new sealing mode-the thermoSEAL mode (TSM)-operated with the VIO3 generator in an ex vivo and in vivo animal study and compared the results with the commercially available BiClamp mode (BCM), operated with the VIO300D generator. Two different instruments were used in combination with both modes, BiCision and BiClamp 201T (Erbe Elektromedizin GmbH).
In the ex vivo experiment, the sealing of renal arteries was evaluated using both instruments and modes. For the in vivo study, different types of arteries and veins were sealed using both modes and instruments in a side-by-side comparison for acute complications in a total of four animals.
Mean burst pressure was in all cases significantly above 360 mmHg (p < 0.001). Sealing time during the ex vivo setting was significantly shorter for TSM compared to BCM: BiCision (3.7 ± 0.4 vs. 7.1 ± 0.3 s; p < 0.0001); BiClamp 201T (3.9 ± 0.3 vs. 5.1 ± 1.1 s; p < 0.0015). Lateral thermal damage was more pronounced for BCM: BiCision (TSM 1.4 ± 0.3 mm vs. BCM 1.9 ± 0.2 mm; p < 0.0001); BiClamp 201T (TSM 1.9 ± 0.6 mm vs. BCM 3.1 ± 0.6 mm; p < 0.0001). The sealing time during the in vivo study was significantly shorter for TSM in combination with BiCision for arteries [TSM 3.0 ± 0.7 s vs. BCM 6.5 ± 1.3 s, (p < 0.0001) and veins 3.2 ± 1.1 vs. 5.8 ± 1.8 s, (p < 0.0001)]. No significant differences were seen for the two modes used with BiClamp 201T [artery: TSM 3.3 ± 0.7 s vs. BCM 3.4 ± 0.9 s, (p = 0.891)]. High sealing rates for arteries (100%) and veins (>90%) were noted for both instruments and modes.
While both modes used with two different instruments reveal high safety characterized by a high burst pressure, low thermal damage (ex vivo) zones, and high sealing rates (in vivo), the thermoSEAL mode convinces by its fast sealing speed probably helping to reduce operation time.
bipolar 血管密封已成功应用于前列腺切除术、子宫切除术和肾切除术等多种手术。 在这项研究中，我们评估了一种新的密封模式-thermoSEAL 模式（TSM）-在离体和体内动物研究中使用 VIO3 发生器进行操作，并将结果与市售的 BiClamp 模式（BCM）进行比较，该模式使用 VIO300D 发生器进行操作。 两种不同的仪器结合两种模式，即 BiCision 和 BiClamp 201T（Erbe Elektromedizin GmbH）使用。
在离体实验中，使用两种仪器和两种模式评估肾动脉的密封情况。 在体内研究中，使用两种模式和仪器在总共四只动物中进行并排比较，以评估急性并发症时不同类型的动脉和静脉的密封情况。
在所有情况下，平均爆裂压力均明显高于 360mmHg（p<0.001）。 在离体设置中，TSM 的密封时间明显短于 BCM：BiCision（3.7±0.4 秒与 7.1±0.3 秒；p<0.0001）；BiClamp 201T（3.9±0.3 秒与 5.1±1.1 秒；p<0.0015）。 BCM 的横向热损伤更为明显：BiCision（TSM 1.4±0.3mm 与 BCM 1.9±0.2mm；p<0.0001）；BiClamp 201T（TSM 1.9±0.6mm 与 BCM 3.1±0.6mm；p<0.0001）。 在体内研究中，TSM 与 BiCision 联合使用时，动脉的密封时间明显缩短[TSM 3.0±0.7 秒与 BCM 6.5±1.3 秒，（p<0.0001）和静脉 3.2±1.1 秒与 5.8±1.8 秒，（p<0.0001）]。 与 BiClamp 201T 联合使用两种模式时，未见明显差异[动脉：TSM 3.3±0.7 秒与 BCM 3.4±0.9 秒，（p=0.891）]。 两种仪器和两种模式的动脉（100%）和静脉（>90%）的高密封率均得到证实。
虽然两种模式结合两种不同的仪器均显示出较高的安全性，具有较高的爆裂压力、较低的热损伤（离体）区和较高的密封率（体内），但 thermoSEAL 模式以其快速密封速度令人信服，这可能有助于缩短手术时间。
