"In Vitro" Evaluation of Energy-Based Sealing of Graft Side Branches in Bypass Surgery.


Journal

World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052

Informations de publication

Date de publication:
Nov 2023
Historique:
accepted: 19 06 2023
pubmed: 11 7 2023
medline: 11 7 2023
entrez: 11 7 2023
Statut: ppublish

Résumé

Our objective was to compare the in vitro efficacy of electrothermal bipolar [EB] vessel sealing and ultrasonic harmonic scalpel [HS] versus mechanical interruption, with conventional ties or surgical clips (SC), in sealing saphenous vein (SV) collaterals, during its eventual preparation for bypass surgery. Experimental in vitro study on 30 segments of SV. Each fragment included two collaterals at least 2 mm in diameter. One of them was sealed by ligation with 3/0 silk ties (control) and the other one with EB (n = 10), HS (n = 10) or medium-6 mm SC (n = 10). After incorporation in a closed circuit with pulsatile flow, the pressure was progressively increased until causing rupture. Collateral diameter, burst pressure, leak point, and histological study were recorded. Burst pressure was higher for SC (1320.20 ± 373.847 mmHg) as compared with EB (942.2 ± 344.9 mmHg, p = 0.065), and especially with HS (637.00 ± 320.61 mmHg, p = 0.0001). No statistically significant difference between EB and HS was found, and bursting always happened at supraphysiological pressures. The leak point for HS was always detected in the sealing zone (10/10), while for EB and SC, it occurred in the sealing zone only in 6/10(60%) and 4/10(40%), respectively (p = 0.015). Energy delivery devices showed similar efficacy and safety in sealing of SV side branches. Although bursting pressure was lower than with tie ligature or SC, non-inferiority efficacy was shown at the range of physiological pressures in both, EB and HS. Due to their speed and easy handling, they may be useful in the preparation of the venous graft during revascularization surgery. However, remaining questions about healing process, potential spread of tissue damage and sealing durability, will require further analysis.

Identifiants

pubmed: 37432421
doi: 10.1007/s00268-023-07107-0
pii: 10.1007/s00268-023-07107-0
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

2888-2896

Subventions

Organisme : Instituto de Salud Carlos III
ID : PI20/01171

Informations de copyright

© 2023. The Author(s) under exclusive licence to Société Internationale de Chirurgie.

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Auteurs

Manuel Miralles (M)

Department of Vascular Surgery, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
Department of Surgery, Facultad de Medicina, Universidad de Valencia (UV), Valencia, Spain.
Hemostasia, Thrombosis, Arteriosclerosis and Vascular Biology, Instituto de Investigación Sanitaria IIS La Fe, Valencia, Spain.

Moisés Falcón (M)

Department of Vascular Surgery, Hospital de Manises, Valencia, Spain. mfalcon6@gmail.com.

Lucía Requejo (L)

Department of Vascular Surgery, Hospital Universitario de La Ribera, Alzira, Valencia, Spain.

Emma Plana (E)

Hemostasia, Thrombosis, Arteriosclerosis and Vascular Biology, Instituto de Investigación Sanitaria IIS La Fe, Valencia, Spain.

Pilar Medina (P)

Hemostasia, Thrombosis, Arteriosclerosis and Vascular Biology, Instituto de Investigación Sanitaria IIS La Fe, Valencia, Spain.

Ignacio Sánchez-Nevárez (I)

Department of Vascular Surgery, Hospital Universitari i Politècnic La Fe, Valencia, Spain.

Albert Clará (A)

Department of Vascular Surgery, Hospital Universitari del Mar, Barcelona, Spain.

Classifications MeSH