Introduction: To observe and compare the vessel-sealing ability of LOTUS and Ethicon ultrasonic shears with LigaSure bipolar device using a porcine model.
Methods and Procedures:
1. Porcine renal vessels of varying diameter were harvested from recently slaughtered animals and sealed/divided by one of the 3 devices.
2. A midline laparotomy was performed on 2 anaesthetised pigs. Mesenteric, renal, splenic and inguinal vessels were dissected from surrounding tissue and sealed using one of the 3 devices.
3. Bursting pressures of the sealed vessels was assessed with a closed system….histo thermal damage data if available.
Results: All instruments reliably sealed blood vessels. Ex-vivo; LOTUS sealed 28/28 renal vessels, Ethicon shears 24/28 (p=0.03), Ethicon ACE 24/24 and LigaSure 27/28 vessels. In-vivo; LOTUS sealed 18/20 vessels, ACE 13/14, LigaSure 10/10. Ex-vivo; Mean+/-sd vessel diameters were 3.4+/-1.7mm (LOTUS), 3.1+/-1.2mm (Ethicon Harmonic Scalpel, EHS), 3.6+/-1.1 (Ethicon ACE) and 4.5+/-1.9mm (LigaSure). Adjusted mean (SE) bursting pressures were 963.0 (89.5) mmHg, 549.3 (97.4) mmHg, 1398.9 (96.7) mmHg and 1231.5 (94.9) mmHg respectively. ANCOVA revealed evidence of differences between the mean bursting pressures; ACE and LigaSure had significantly higher mean bursting pressures than EHS.
In-vivo; Mean+/-sd vessel diameters were 2.7+/-1.0mm (LOTUS 3), 2.2+/-0.6mm (Ethicon ACE) and 2.2+/-0.4mm (LigaSure). Adjusted mean (SE) bursting pressures were 2244.0 (187.8)mmHg, 2626.4 (225.9) mmHg and 2416.2 (247.7) mmHg respectively. There was no significant difference between these mean bursting pressures.
Conclusions: There were no significant differences between the 3 types of instruments in terms of reliability of vessel sealing in or ex-vivo. There was some evidence of higher mean bursting–pressures for LigaSure and Ethicon ACE ex-vivo, but not in-vivo. Recorded bursting pressures in-vivo were significantly higher than ex-vivo. This is partly explained by the smaller vessel size in-vivo (younger animals) but may be related to the contribution from clotting factors. Data supports a current clinical trial on mesenteric vessel sealing.
Program Number: P233