 |
|
| Preliminary Results of Anatomic Lung Resection Utilizing Energy Based Tissue and Vessel Coagulative Fusion Technology |
|
Matthew J. Schuchert, Ghulam Abbas, Brian L. Pettiford, James D. Luketich, Rodney J. Landreneau; Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, PA Objective: Mechanical stapling devices are established as the mainstay of therapy in the selective isolation and division of vascular structures during anatomic lung resection. Little data currently exists regarding the application of energy-based tissue and vessel fusion technology during anatomic lung resection. We evaluated the use of the LigaSureTM (Valley Lab, Boulder, Co) device for vascular division during anatomic lung resection. Methods: Anatomic lung resection was performed initially utilizing the LigaSure ImpactTM (n=12) device, and subsequently with the AtlasTM (n=187) hand-controlled instruments. The ImpactTM device working jaw achieves a seal 36 mm in length and a variable width from tip to base of 3.3-4.7 mm. The jaw also has a 14-degree curvature, facilitating passage around vascular structures. In contrast, the LigaSure AtlasTM instrument has a uniform coagulating surface of 22mm in length and 6 mm in width. Two energy applications are applied prior to vessel division. We initially chose the ImpactTM device because of the increased working length, allowing for apposition across main pulmonary veins and large basilar arterial trunks. The LigaSure device is currently the only FDA-approved device for vascular fusion and division during pulmonary surgery. Results: The LigaSure system was utilized in 199 patients from 2008-2009 (104 lobectomies and 95 anatomic segmentectomies). Initially, the LigaSure ImpactTM device was employed (n=12 patients, 15 vascular fusions). There were two of five basilar partial arterial dehiscences, and seven partial pulmonary venous dehiscences that were recognized and controlled intra-operatively with local suture ligation. Due to the noted vascular dehiscences, we converted to the shorter but wider AtlasTM device. For the remaining cases, the LigaSure AtlasTM system was utilized without arterial or venous dehiscences (vessels ranging from 0.4-1.2 cm in diameter, 378 vessel fusions). The wider seal width (6mm) appears to enhance the vascular fusion integrity. In addition, we have found that two serial applications of the energy to the first order pulmonary venous branches prior to peripheral division appears safer than dividing the main pulmonary venous trunks. Conclusion: The LigaSure AtlasTM system provides safe and reliable control of pulmonary arterial and venous branches during anatomic lung resection. The use of energy-based tissue fusion technology represents a reasonable alternative to mechanical stapling devices during anatomic lung resection. Back to 2010 Annual Meeting Back to Program Outline Back to Main Program |
We Model Excellence |
|
Copyright © 2012 American Association for Thoracic Surgery
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.