Ajit Pai, MDMChMRCS, George Melich, MD, Slawomir J Marecik, MD, FACS, FASCRS, John J Park, MD, FACS, FASCRS, Leela M Prasad, MD, FACSFASCRSFRCS. Advocate Lutheran General Hospital
Background: Energy devices are being increasingly used for dissection and vessel sealing in minimally invasive surgery. The latest generations of these devices’ are designated as electrothermal bipolar vessel sealing devices (EBVS). Our objective was to assess the safety and effectiveness of the EnSealTM bipolar energy device in sealing and division of the inferior mesenteric vessels in minimal invasive colorectal surgery.
Methods: Patients undergoing minimally invasive left colonic and rectal resections where EnSealTM was used for dissection and division of inferior mesenteric vessels were identified in a prospectively maintained database. Minimal invasive techniques included laparoscopic and robotic operations between August 2007 and October 2011. Patient demographics, type of operation, peroperative complications such as inadequate sealing of vessels and post-operative complications and blood transfusion requirements were recorded.
Results: 400 consecutive patients were included in the study. Mean age was 57 years (range 10-97). Male to female ratio was 1.3:1. Procedures included low anterior resection (69 %), ultralow anterior resection with colo-anal anastomosis (12%), abdominoperineal resection (4%), ileal pouch anal anastomosis (6%), proctocolectomy (5%) and subtotal colectomy (4%). Indications for surgery were colorectal malignancy (47%), complicated diverticular disease (33%), inflammatory bowel disease (9%) and the remainder were performed for adenomas, rectal prolapse, endometriosis, familial adenomatosis polyposis, and Clostridium difficile colitis. The EBVS was used on 386 inferior mesenteric arteries and 305 inferior mesenteric veins. In 14 of 400 patients, the device was not used to divide the Inferior mesenteric artery (IMA) because of inflamed and thickened mesentery. The EnSealTM was also not used to divide the Inferior mesenteric vein (IMV) at its origin in 95 patients without malignancy and with a lax left colon. Six patients (1.5%) had controllable immediate intra operative bleeding from the IMA stump (Table 1). None required conversion to an open procedure.
Conclusions: The EnsealTM energy device is extremely safe for sealing inferior mesenteric vessels in minimally invasive colorectal surgery. It has additional utility as a blunt dissector to develop tissue planes and as a retractor. Failure to seal vessels with bleeding complications is rare, immediate and easily controlled. Thermal injuries to the bowel or ureter did not occur in this study.