Lateral thermal damage of mesoappendix and appendiceal base during laparoscopic appendectomy in children: Comparison of the harmonic scalpel (UltracisionTM ), bipolar coagulation (LigaSure™), and thermal fusion technology (MiSealTM )

• Published in: The Journal of surgical research Vol. 212; pp. 101 - 107
• Main Authors: Pogorelić, Zenon, M.D., Ph.D, Katić, Josip, M. D, Mrklić, Ivana, M.D., Ph.D, Jerončić, Ana, M.D., Ph.D, Šušnjar, Tomislav, M.D, Jukić, Miro, M.D, Vilović, Katarina, M.D., Ph.D, Perko, Zdravko, M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.05.2017
• Subjects: Adolescent; Appendectomy; Appendectomy - adverse effects; Appendectomy - instrumentation; Appendicitis - surgery; Appendix - injuries; Appendix - surgery; Child; Child, Preschool; Children; Dissection - adverse effects; Dissection - instrumentation; Female; Hemostasis, Surgical - adverse effects; Hemostasis, Surgical - instrumentation; Humans; Laparoscopy - adverse effects; Laparoscopy - instrumentation; Lateral thermal damage; LigaSure; Male; MiSeal; Postoperative Complications - etiology; Surgery; Thermal injury; Treatment Outcome; Ultracision; Lateral thermal damage; Appendectomy; Thermal injury; LigaSure; Ultracision; Children; MiSeal
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2017.01.014

Abstract Purpose The aim of this study was to compare lateral thermal damage of mesoappendix and appendiceal base using three different instruments for sealing and cutting of mesoappendix. Materials and methods A total number of 99 patients (54 males and 45 females) who underwent laparoscopic appendectomy because of suspected appendicitis between December 2013 and May 2015 were enrolled in the study. The patients were divided in three groups based on instrument used for sealing of mesoappendix: Group 1 (UltracisionTM ; n=36), Group 2 (LigaSure™; n=32) and Group 3 (MiSealTM ; n=31). Lateral thermal damage, intraoperative and postoperative complications, duration of surgery, hospital stay and economic value were compared within groups. Results The median age of patients was 14 years (range 3-17). A histopathological analysis revealed a positive diagnosis of appendicitis in 84 patients (85%). The median lateral thermal damage on appendiceal base using UltracisionTM , LigaSure™ and MiSealTM was 0.10 mm, 0.16 mm and 0.10 mm respectively; and on mesoappendix 0.08 mm, 0.13 mm and 0.08 mm respectively. Significantly higher thermal damage was found on mesoappendix (p=0.015) and appendiceal base (p=0.012) in patients treated with LigasureTM than in patients from other groups. There were no statistical difference among the groups regarding intraoperative and postoperative complications (p=0.098). No significant difference in thermal damage between appendicitis and non-appendicitis group was found (p=0.266). Conclusions Using of UltracisionTM , LigaSure™ and MiSealTM for sealing of mesoappendix in laparoscopic appendectomy in children is safe and useful. LigaSureTM produces significantly greater lateral thermal damage compared to other instruments.