Kazuo Koyanagi, MD, PhD1, Soji Ozawa, MD, PhD, FACS2, Fumihiko Kato, MD1, Jun Kanamori, MD1, Hiroyuki Daiko, MD, PhD1, Yuji Tachimori, MD, PhD3. 1Department of Esophageal Surgery, National Cancer Center Hospital, 2Department of Gastroenterological Surgery, Tokai University School of Medicine, 3Cancer Care Center, Kawasaki Saiwai Hospital
INTRODUCTION: Temporal and spatial tissue temperature profile in electrosurgical devises, such as ultrasonic scissors and bipolar vessel sealing system, was experimentally measured, and the incidence of postoperative complications after thoracoscopic esophagectomy was assessed according to the electrosurgical devises used.
METHODS AND PROCEDURES: Experiment of thermal spread: Sonicision (Sonic) was used for ultrasonic scissors and LigaSure (LS) was used for bipolar vessel sealing system. Each device was activated in order to cut porcine muscle at room temperature. Temperatures of both the device blade and porcine tissues beside the device were measured using a temperature probe. Each experiment was performed at least three times. Room temperature was 25 degrees. Clinical analysis: The 46 patients who underwent thoracoscopic esophagectomy with 3-field lymph node dissection in the prone position were selected in the study. Incidence of postoperative complications after thoracoscopic esophagectomy was compared according to electrosurgical devises. Bronchoscopy was used for diagnosis of recurrent laryngeal nerve paralysis (RLNP). Sonic and LS was employed in 6 and 40 patients, respectively.
RESULTS: Temperature of active blade and tissue pad of Sonic after 3 seconds of activation time was 100 and 68.8 degrees, respectively. That of blade of LS after single activation (approximately 3 seconds) was 44.7 degrees (Sonic vs. LS; P < 0.001). Temperature of active blade of Sonic after 10 seconds of activation time increased to 270 degrees. On the other hand, that of blade of LS after three times of activation (approximately 10 seconds) was 52.1 degrees (Sonic vs. LS; P < 0.001). Tissue temperature spreads of 1mm and 2mm lateral to Sonic were 50.8 and 44.6 degrees, respectively. Those to LS were 39.1 and 31.4 degrees, respectively (Sonic vs. LS; P = 0.001). Tissue temperature spread of 1mm ahead to Sonic and LS was 39.2 and 29.2 degrees (P = 0.004). Overall postoperative complications occurred in 3 (50%) and 11 (27.5%) in the Sonic and LS group, respectively (P = 0.056). Incidence of RLNP and anastomotic leakage was significantly higher in the Sonic group than in the LS group (RLNP, 3 (50%) vs. 6 (15%), P = 0.043; anastomotic leakage, 3 (50%) vs. 4 (10%), P = 0.010).
CONCLUSIONS: LS might be beneficial to thoracoscopic esophagectomy in prone position in terms of thermal spread from energy device. Appropriate temporal and spatial distance from electrosurgical devises to important mediastinal structure, such as recurrent laryngeal nerve and tracheobronchial membrane, was required for avoiding postoperative complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87546
Program Number: P510
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster