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Efficacy and safety of 5-mm-diameter bipolar and ultrasonic shears for cutting carotid arteries of the hybrid pig

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Abstract

Background

Experimental data about the efficacy and safety of sealing devices are rare. Therefore, this study investigated these parameters for three commercially available energy-based vascular sealing and cutting systems.

Methods

In male hybrid pigs, 487 carotid artery segments were sealed and cut using the harmonic scalpel or several bipolar sealing devices. The sealing failure rate, burst pressure, process time, and extent of lateral thermal damage were analyzed.

Results

A regular sealing and cutting process in more than 90% of the carotid arteries was found using the following instruments: LS1520, ACE (level 1), ACE (level 3), CS14C (level 1), WAVE (level 1), and WAVE (level 5). The largest failure rate was found for the CS14C device (level 5: initial sealing failure, 21.5%). The maximal mean burst pressure (1727 ± 453 mmHg) was reached using the ACE device (level 1). Significant differences were found in the size of the lateral thermal damage, which a ranged from 2.5 mm (LS1520) to 1.51 mm (CS14C, level 1). The process time ranged widely from 6.8 s (ACE, level 5) to 31.83 s (WAVE, level 1).

Conclusion

The current study demonstrated that all the tested devices are efficacious and safe in sealing and cutting arteries up to 5 mm in diameter. All the devices showed supraphysiologic mean burst pressures. Differences in failure rate, thermal damage, and process time lead to an advised application of the different systems.

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Acknowledgments

The authors acknowledge the Valleylab Healthcare Group, Boulder, CO, USA, and Ethicon Endosurgery, Johnson & Johnson, Cincinnati, OH, USA, for support of this scientific paper. These companies partly provided the sealing devices, generators, and carotid vessels. The experiments were performed in the Department of Surgical Research at the Otto von Guericke University Magdeburg. None of the authors has a direct financial interest in the companies that supplied the tested devices (Ethicon Endosurgery, Johnson & Johnson, Cincinnati, OH, USA; Erbe Elektromedizin GmbH, Tübingen, Germany; Valleylab Helthcare Group, Boulder, CO, USA). None of the companies that provided tested devices had a role in the study design, analysis, or writing of the manuscript at any stage. The authors thank Mrs. C. Jechorek for her support and excellent technical assistance.

Disclosures

R. Mantke received a travel grant and a lecture fee from Ethicon Endosurgery and Johnson & Johnson in 2008. W. Halangk, A. Habermann, B. Peters, S. Konrad, M. Guenther, and H. Lippert have no conflicts of interest or financial ties in the last 36 months to disclose.

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Correspondence to René Mantke.

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Mantke, R., Halangk, W., Habermann, A. et al. Efficacy and safety of 5-mm-diameter bipolar and ultrasonic shears for cutting carotid arteries of the hybrid pig. Surg Endosc 25, 577–585 (2011). https://doi.org/10.1007/s00464-010-1224-6

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Keywords

  • Sealing and cutting systems
  • Sealing devices
  • Sealing failure
  • Thermal damage