Comparison of various methods of vessel ligation: what is the safest method?
Background Recently, various hemostatic devices, such as metal or plastic clips, ultrasonic coagulating shears, and electrothermal bipolar vessel sealer, have been widely applied during an operation. The purpose of this study was to analyze the mechanical, histological, and biochemical differences o...
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Published in | Surgical endoscopy Vol. 27; no. 9; pp. 3129 - 3138 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Boston
Springer US
01.09.2013
Springer Nature B.V |
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Abstract | Background
Recently, various hemostatic devices, such as metal or plastic clips, ultrasonic coagulating shears, and electrothermal bipolar vessel sealer, have been widely applied during an operation. The purpose of this study was to analyze the mechanical, histological, and biochemical differences of vessels sealed with various hemostatic devices.
Methods
Thirty New Zealand White rabbits were randomly allocated into five groups, and short gastric vessels were ligated with metal clip, plastic clip, Harmonic Ace, LigaSure, or tie ligation. These vessels were harvested 3 days after operation and histologically analyzed at the site of ligation (proximal) and 5 mm from it (distal). Perivascular fibrosis was assessed on a score of mild to severe according to the severity. Inducible and endothelial nitric oxide synthase (iNOS and eNOS) mRNA expressions were measured quantitatively by real-time PCR at the sites of ligation. Abdominal aorta and inferior vena cava also were harvested and divided with each tool, and bursting pressures were measured.
Results
Bursting pressures were measured in 164 arteries and 141 veins. LigaSure showed significantly lower bursting pressures in arteries (
p
< 0.001), and plastic clip showed significantly lower bursting pressures in veins (
p
< 0.001). There was a negative relationship between outer diameters and bursting pressures in both the arteries (rho = −0.505,
p
< 0.001) and the veins (rho = −0.106,
p
= 0.24). The degree of perivascular fibrosis was not statistically different in either the proximal (
p
= 0.447) or distal (
p
= 0.381) sites. The expressions of iNOS and eNOS were significantly lower in the LS group (
p
< 0.001, and
p
< 0.001, respectively).
Conclusions
There might be no clinical limitations when applying various hemostatic devices to small vessels under physiologic blood pressures. There were no acute histological differences between the hemostatic devices. However, LS showed the lowest iNOS and eNOS expressions, which might be due to thermal injuries of the whole vessel wall. |
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AbstractList | BACKGROUNDRecently, various hemostatic devices, such as metal or plastic clips, ultrasonic coagulating shears, and electrothermal bipolar vessel sealer, have been widely applied during an operation. The purpose of this study was to analyze the mechanical, histological, and biochemical differences of vessels sealed with various hemostatic devices. METHODSThirty New Zealand White rabbits were randomly allocated into five groups, and short gastric vessels were ligated with metal clip, plastic clip, Harmonic Ace, LigaSure, or tie ligation. These vessels were harvested 3 days after operation and histologically analyzed at the site of ligation (proximal) and 5 mm from it (distal). Perivascular fibrosis was assessed on a score of mild to severe according to the severity. Inducible and endothelial nitric oxide synthase (iNOS and eNOS) mRNA expressions were measured quantitatively by real-time PCR at the sites of ligation. Abdominal aorta and inferior vena cava also were harvested and divided with each tool, and bursting pressures were measured. RESULTSBursting pressures were measured in 164 arteries and 141 veins. LigaSure showed significantly lower bursting pressures in arteries (p < 0.001), and plastic clip showed significantly lower bursting pressures in veins (p < 0.001). There was a negative relationship between outer diameters and bursting pressures in both the arteries (rho = -0.505, p < 0.001) and the veins (rho = -0.106, p = 0.24). The degree of perivascular fibrosis was not statistically different in either the proximal (p = 0.447) or distal (p = 0.381) sites. The expressions of iNOS and eNOS were significantly lower in the LS group (p < 0.001, and p < 0.001, respectively). CONCLUSIONSThere might be no clinical limitations when applying various hemostatic devices to small vessels under physiologic blood pressures. There were no acute histological differences between the hemostatic devices. However, LS showed the lowest iNOS and eNOS expressions, which might be due to thermal injuries of the whole vessel wall. Recently, various hemostatic devices, such as metal or plastic clips, ultrasonic coagulating shears, and electrothermal bipolar vessel sealer, have been widely applied during an operation. The purpose of this study was to analyze the mechanical, histological, and biochemical differences of vessels sealed with various hemostatic devices. Thirty New Zealand White rabbits were randomly allocated into five groups, and short gastric vessels were ligated with metal clip, plastic clip, Harmonic Ace, LigaSure, or tie ligation. These vessels were harvested 3 days after operation and histologically analyzed at the site of ligation (proximal) and 5 mm from it (distal). Perivascular fibrosis was assessed on a score of mild to severe according to the severity. Inducible and endothelial nitric oxide synthase (iNOS and eNOS) mRNA expressions were measured quantitatively by real-time PCR at the sites of ligation. Abdominal aorta and inferior vena cava also were harvested and divided with each tool, and bursting pressures were measured. Bursting pressures were measured in 164 arteries and 141 veins. LigaSure showed significantly lower bursting pressures in arteries (p < 0.001), and plastic clip showed significantly lower bursting pressures in veins (p < 0.001). There was a negative relationship between outer diameters and bursting pressures in both the arteries (rho = -0.505, p < 0.001) and the veins (rho = -0.106, p = 0.24). The degree of perivascular fibrosis was not statistically different in either the proximal (p = 0.447) or distal (p = 0.381) sites. The expressions of iNOS and eNOS were significantly lower in the LS group (p < 0.001, and p < 0.001, respectively). There might be no clinical limitations when applying various hemostatic devices to small vessels under physiologic blood pressures. There were no acute histological differences between the hemostatic devices. However, LS showed the lowest iNOS and eNOS expressions, which might be due to thermal injuries of the whole vessel wall.[PUBLICATION ABSTRACT] Recently, various hemostatic devices, such as metal or plastic clips, ultrasonic coagulating shears, and electrothermal bipolar vessel sealer, have been widely applied during an operation. The purpose of this study was to analyze the mechanical, histological, and biochemical differences of vessels sealed with various hemostatic devices. Thirty New Zealand White rabbits were randomly allocated into five groups, and short gastric vessels were ligated with metal clip, plastic clip, Harmonic Ace, LigaSure, or tie ligation. These vessels were harvested 3 days after operation and histologically analyzed at the site of ligation (proximal) and 5 mm from it (distal). Perivascular fibrosis was assessed on a score of mild to severe according to the severity. Inducible and endothelial nitric oxide synthase (iNOS and eNOS) mRNA expressions were measured quantitatively by real-time PCR at the sites of ligation. Abdominal aorta and inferior vena cava also were harvested and divided with each tool, and bursting pressures were measured. Bursting pressures were measured in 164 arteries and 141 veins. LigaSure showed significantly lower bursting pressures in arteries (p < 0.001), and plastic clip showed significantly lower bursting pressures in veins (p < 0.001). There was a negative relationship between outer diameters and bursting pressures in both the arteries (rho = -0.505, p < 0.001) and the veins (rho = -0.106, p = 0.24). The degree of perivascular fibrosis was not statistically different in either the proximal (p = 0.447) or distal (p = 0.381) sites. The expressions of iNOS and eNOS were significantly lower in the LS group (p < 0.001, and p < 0.001, respectively). There might be no clinical limitations when applying various hemostatic devices to small vessels under physiologic blood pressures. There were no acute histological differences between the hemostatic devices. However, LS showed the lowest iNOS and eNOS expressions, which might be due to thermal injuries of the whole vessel wall. Background Recently, various hemostatic devices, such as metal or plastic clips, ultrasonic coagulating shears, and electrothermal bipolar vessel sealer, have been widely applied during an operation. The purpose of this study was to analyze the mechanical, histological, and biochemical differences of vessels sealed with various hemostatic devices. Methods Thirty New Zealand White rabbits were randomly allocated into five groups, and short gastric vessels were ligated with metal clip, plastic clip, Harmonic Ace, LigaSure, or tie ligation. These vessels were harvested 3 days after operation and histologically analyzed at the site of ligation (proximal) and 5 mm from it (distal). Perivascular fibrosis was assessed on a score of mild to severe according to the severity. Inducible and endothelial nitric oxide synthase (iNOS and eNOS) mRNA expressions were measured quantitatively by real-time PCR at the sites of ligation. Abdominal aorta and inferior vena cava also were harvested and divided with each tool, and bursting pressures were measured. Results Bursting pressures were measured in 164 arteries and 141 veins. LigaSure showed significantly lower bursting pressures in arteries ( p < 0.001), and plastic clip showed significantly lower bursting pressures in veins ( p < 0.001). There was a negative relationship between outer diameters and bursting pressures in both the arteries (rho = −0.505, p < 0.001) and the veins (rho = −0.106, p = 0.24). The degree of perivascular fibrosis was not statistically different in either the proximal ( p = 0.447) or distal ( p = 0.381) sites. The expressions of iNOS and eNOS were significantly lower in the LS group ( p < 0.001, and p < 0.001, respectively). Conclusions There might be no clinical limitations when applying various hemostatic devices to small vessels under physiologic blood pressures. There were no acute histological differences between the hemostatic devices. However, LS showed the lowest iNOS and eNOS expressions, which might be due to thermal injuries of the whole vessel wall. |
Author | Kang, Mee Joo Jang, Jin-Young Lim, Chang-Sup Lee, You Jeong Lee, Seung Eun Kim, Sun-Whe |
Author_xml | – sequence: 1 givenname: Chang-Sup surname: Lim fullname: Lim, Chang-Sup organization: Department of Surgery, Seoul National University College of Medicine – sequence: 2 givenname: Jin-Young surname: Jang fullname: Jang, Jin-Young email: jangjy4@snu.ac.kr organization: Department of Surgery, Seoul National University College of Medicine, Cancer Research Institute, Seoul National University College of Medicine – sequence: 3 givenname: Seung Eun surname: Lee fullname: Lee, Seung Eun organization: Department of Surgery, Chung-Ang University College of Medicine – sequence: 4 givenname: You Jeong surname: Lee fullname: Lee, You Jeong organization: Department of Pathology, Seoul National University College of Medicine – sequence: 5 givenname: Mee Joo surname: Kang fullname: Kang, Mee Joo organization: Department of Surgery, Seoul National University College of Medicine, Cancer Research Institute, Seoul National University College of Medicine – sequence: 6 givenname: Sun-Whe surname: Kim fullname: Kim, Sun-Whe organization: Department of Surgery, Seoul National University College of Medicine, Cancer Research Institute, Seoul National University College of Medicine |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/23468332$$D View this record in MEDLINE/PubMed |
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Cites_doi | 10.1308/003588407X183418 10.1007/s004649900627 10.1007/s00464-002-8833-7 10.1016/S0022-5347(05)63995-X 10.1089/end.2006.20.1054 10.1046/j.0007-1323.2001.01857.x 10.1089/lap.2006.16.149 10.1007/s004640080025 10.1016/S0008-6363(99)00130-3 10.1006/jmcc.1999.0983 10.1089/089277904322959806 10.1007/s00464-007-9345-2 10.1245/s10434-010-1251-5 10.1089/end.2005.19.307 10.1006/jsre.2000.5843 10.1097/SLA.0b013e3181a334f9 |
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Keywords | Hemostatic devices Ultrasonic coagulating shears Hemostasis Electrothermal bipolar vessel sealer |
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Recently, various hemostatic devices, such as metal or plastic clips, ultrasonic coagulating shears, and electrothermal bipolar vessel sealer, have... Recently, various hemostatic devices, such as metal or plastic clips, ultrasonic coagulating shears, and electrothermal bipolar vessel sealer, have been widely... BACKGROUNDRecently, various hemostatic devices, such as metal or plastic clips, ultrasonic coagulating shears, and electrothermal bipolar vessel sealer, have... |
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SubjectTerms | Abdomen Abdominal Surgery Animals Blotting, Western Coronary vessels Drug dosages Equipment Failure Gastroenterology Gynecology Hepatology Laparoscopy Ligation - instrumentation Ligation - methods Male Medical research Medical schools Medicine Medicine & Public Health Nitric Oxide Synthase Type II - analysis Postoperative Complications Proctology Rabbits Random Allocation Risk Factors Sealing compounds Surgeons Surgery University colleges Veins & arteries |
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Title | Comparison of various methods of vessel ligation: what is the safest method? |
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