Initial results with an electrothermal bipolar vessel sealer

Background: An electrothermal bipolar vessel sealer (EBVS; Ligasure, Valley lab, Boulder, CO, USA) was developed as an alternative to suture ligatures, hemoclips, staplers, and ultrasonic coagulators for ligating vessels and t issue bundles. The EBVS seals vessels up to 7 mm in diameter by denaturing collagen and elastin within the vessel wall and surrounding connective tiss ue. This study is the first to determine the clinical efficacy and safety o f this instrument and delineate its potential timesavings in both experimen tal (animal) and clinical scenarios. Methods: A prospective review of the author's clinical experience with the EBVS in laparoscopic and open operations from October 1998 to March 2000 wa s performed. In addition, five Yorkshire domestic pigs underwent 150-cm sma ll intestine resections (n = 10) using the EBVS (n = 5) and suture ligature s (n = 5). Measurements included time to complete intestinal resection, the number of applications per minute for each method, and the presence of pos tapplication bleeding. Statistical analysis was performed using Student's t -test. Results: The EBVS was used in 98 cases (46 laparoscopic and 52 open) with a mean of 43 applications (range, 10-150 applications) per case. The operati ons included 53 colon and/or small bowel resections (54.1%), 24 fundoplicat ions (24.5%), 12 gastric resections (12.2%), 3 splenectomies, 2 pancreatect omies, 1 adrenalectomy, 1 bilateral salpingo-oopherectomy, 1 pancreatic cys t-jejunostomy, and 1 vagotomy with gastrojejunostomy. In all these cases, t he EBVS was intended to be the only means of vessel ligation. An alternativ e ligation technique was required for bleeding in only 13 (0.3%) of more th an 4,200 applications of the EBVS. No postoperative hemorrhagic complicatio ns occurred. There was an estimated mean reduction in operative time of 39 min per open procedure, and a mean prolongation in operative time of 8 min per laparoscopic procedure when the EBVS was used in lieu of suture ligatur es, hemoclips, staplers, or ultrasonic coagulators. In the animal model, th e mean time for completion of the intestinal resection was 251.9 s for the EB VS and 702.0 s for ligatures (p < 0.001). The mean number of application s per minute was 7.6 for the EBVS and 1.8 for ligatures (p < 0.001). No pos tapplication bleeding was seen. Conclusions: Initial clinical results from the use of EBVS in laparoscopic and open procedures demonstrate it to be safe and effective, reducing opera tive time in open procedures. Suture ligatures, ties, hemoclips, and other ligating techniques were used rarely (0.3%) after an application of the EBV S. In an experimental animal model, the EBVS was significantly faster and m ore efficient (more applications per minute) than ligatures for intestinal resection.