| ObjectiveWith the development of laparoscopics surgery, various of laparoscopic hemostatic equipments are constantly emerging with the unceasing progress of hemostatic effect and reliability. The traditional method of hemostasis is mono and bipolar electrosurgery. Harmonic scalpel and laser are gradually applied to clinical in the last ten years. Ligasure vessel sealing system is a new hemostatic modality, developed successfully in abroad at the moment. In this experiment, we evaluate the reliability of vascular occlusion and extent of tissue damage from harmonic scalpel and ligasure, in order to provide scientific basis for laparoscopic surgeries to select the safer and more effective hemostatic modality.Methods(1) Evaluation of harmonic scalpel and ligasure vessel sealing system in reliability of vascular occlusionTwo common female dogs were used in this experiment. They were administered proper anesthesia. Harmonic scalpel and ligasure were used to seal and excise respectively the bilateral femoral , humeral arteries and veins, internal iliac % external iliac and common iliac arteries and veins, renal arteries and veins of the dogs. The diameter of the vessels tested was measured and recorded using a caliper before sealing and excising. And then, the bursting pressure tests were made, the bursting pressure was recorded.(2) Evaluation of harmonic scalpel and ligasure vessel sealing system in extent of tissue damageAfter the bursting trials were completed, the vessels were excised 1.0cmfrom the ends of occlusion, fixed in 10% neutral buffered formalin, embedded in paraffin and sectioned longitudinally. Hematoxylin and eosin staining of sections were performed. The extent of tissue damage was reviewed under microscope , including the distance of tissue damage from the edge of the seal, the description of tissue change extended into the adventitial , muscular layers or full - thickness of the vessels, the condition of apposition of the lumen wall and the histopathologic change of the tissue damaged.( 3) The result of this experiment was showed by x s, and t - test was a-dopted in data processing.Results(1) Harmonic scalpel successfully sealed 10 of the 12 arteries (83. 3% ) and 7 of the 12 veins (58. 3% ) ; Mean artery and vein diameter was 3. 26mm (range 1.16 to 5.25) and 5.43mm(range 2.43 to 9.10) , respectively; Meam artery and vein bursting pressure of those arteries successfully sealed was 389mmHg( range 220 to 530) and 336mmHg( range 200 to 480) , respectively. Ligasure successfully sealed all the arteries and veins, they were 12 pieces of arteries and veins, respectively; Mean artery and vein diameter was 3. 26mm (range 1.75 to 5.22) and 5.42mm(range 2.40 to 9.08), respectively; Meam artery and vein bursting pressure was 472mmHg ( range 380 to 560) and 378 mmHg( range 250 to 490) , respectively. We compared the bursting pressure of harmonic scalpel and ligasure in 4 conditions, they were arteries ,. veins , the vessels of < and = 3mm and > 3mm. Tne bursting pressure sealed by ligasure was larger than harmonic scalpel. Harmonic scalpel could effectively sealed 3mm and less in diameter, however, 7 of the 16 vessels(43.8% ) failed when it sealed those larger than 3mm in diameter. ligasure could successfully seal all the vessels tested.( 2) Histopathology of harmonic scalpel and ligasure seal segments revealed acute thermal and pressure injury to tissues. Harmonic scalpel mean extending distance of tissue damage from the edge of the seal in arterial and venous specimens was 1.03mm(range 0.40 to 1.56) and 1.16mm(range 0.65 to 1.60) ,respectively; Tissue change was predominantly localized to the adventitial layer; In all except 2 cases, the sealed area demonstrated apposition of the lumen walls. Ligasure mean extending distance of tissue damage from the margin in arterial and venous specimens was 2. 74mm(range 2.00 to 3.40) and 2. 85mm (range 2.10 to 3.50) , respectively; Tissue change extended into the adventitial and muscular layers; In all, the sealed area clearly con...
|
PDF Full Text Request