• Interact Cardiovasc Thorac Surg · Dec 2020

    Heat production during pulmonary artery sealing with energy vessel-sealing devices in a swine model.

    • Eric Goudie, Ricardo Oliveira, Vicky Thiffault, Adeline Jouquan, Rachid Hadjeres, Jérémie Berdugo, Pasquale Ferraro, and Moishe Liberman.
    • CETOC-CHUM Endoscopic Tracheobronchial and Oesophageal Center, Division of Thoracic Surgery, Department of Surgery, University of Montréal, Montréal, QC, Canada.
    • Interact Cardiovasc Thorac Surg. 2020 Dec 7; 31 (6): 847-852.

    ObjectivesEnergy vessel-sealing devices are being increasingly utilized to seal pulmonary artery (PA) branches during lobectomy. Heat from these devices can potentially injure surrounding tissues. We evaluated heat production from devices in a live animal model.MethodsPA branches were sealed in pigs with 4 energy vessel-sealing devices: 2 ultrasonic (US), 1 advanced bipolar or 1 mixed US and bipolar (mixed) device. Thermocouples were implanted in tissue surrounding the PA branch being sealed to measure tissue temperature. A thermal camera measured the sealing site and the temperatures of the instruments. Pathological analysis was performed on PA stumps to identify thermal damage.ResultsA total of 37 PA branches were sealed in 4 pigs. Maximum tissue heat measured by the thermocouples for the 2 US, advanced bipolar and mixed devices was 42, 39, 42 and 46°C, respectively. The mean tissue temperatures at the site of the sealing measured with the thermal camera were 78, 75, 70 and 82°C (P = 0.834) and the mean instrument blade temperatures were 224, 195, 83 and 170°C (P = 0.000005) for the 2 US, advanced bipolar and mixed devices, respectively. The mean diameter of the region with tissue reaching 60°C or more measured with the thermal camera was between 4 and 6 mm for the 4 devices (P = 0.941). On pathological analysis, PA stumps had either thermal damage on the adventitia and external media (26/37) or transmural damage (11/37) at 1 mm from sealed site.ConclusionsA 3-mm safety margin between the instrument blades and vital structures is recommended. Instrument blades can reach high temperatures that may cause tissue damage.© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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