• Moishe Liberman, Mohamed Khereba, Basil Nasir, Eric Goudie, Alain Danino, Jean-Philippe Giot, Nathanael Nizard, Rachid Hadjeres, Vicky Thiffault, Nicolas Farrenq, and Pasquale Ferraro.
• 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. Electronic address: moishe.liberman@umontreal.ca.
• Ann. Thorac. Surg. 2015 Sep 1; 100 (3): 898-903; discussion 903-4.

BackgroundThe 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.MethodsThis 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.ResultsA 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.ConclusionsPA 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.Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

23 keywords...

hide…