Skip to main content
SpringerLink
Log in

Bipolar sealing of lung parenchyma: tests in an ex vivo model

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Almost every pulmonary lobe resection requires cutting the lung parenchyma in the area of a lung fissure. A monopolar cutter or stapler is often used for this purpose. The seal should be absolutely airtight to prevent post-operative pulmonary fistulas. In the present study, the bipolar sealing technique was evaluated regarding air tightness of the seals during normal ventilation and its burst pressure in an ex vivo animal model.

Materials and methods

The investigations were carried out on paracardial lung lobes obtained from heart–lung preparations taken from freshly killed pigs at a slaughter house. In the laboratory, each individual lobe was perfused with Ringer’s solution at body temperature and protectively ventilated through a tube (frequency: 20 1/min, p insp = 20 mbar, PEEP +5 mbar). Non-anatomic resection was carried out in the periphery of the lung lobe. The two control groups (12 lobes per group; Group 1—stapler, Group 2—parenchyma suture) were compared to three groups in which different bipolar sealing instruments were used. They were Group 3—MARSEAL® 10 mm (KLS Martin, Tuttlingen); Group 4—MARSEAL® 5 mm; and Group 5—MARCLAMP® (KLS Martin, Tuttlingen). The SealSafe® G3 electric current was used in all cases. Ventilation was continued for 20 min following parenchymal resection. Parenchymal sealing was then judged visually in a water bath and given a score (0–3). Burst pressure (mbar) was measured by increasing the inspiration pressure stepwise. Group mean values were compared (nonparametric Mann–Whitney U test, p < 0.005).

Results

Parenchymal seals were airtight under ventilation throughout the observation period in all groups. Mean burst pressures were as follows: Group 1: 47.1 ± 6.2 mbar; Group 2: 32.9 ± 3.9 mbar; Group 3: 38.8 ± 2.2 mbar; Group 4: 25.0 ± 6.4 mbar; and Group 5: 32.9 ± 5.8 mbar. Group 1, the stapler group, thus exhibited the highest burst pressures. Burst pressures for Group 3 were significantly greater than those for Group 2 (p < 0.006). Burst pressures for groups 2 and 5 were similar (p = 0.97). However, the burst pressures for Group 4 were significantly lower than those for Group 2 (p < 0.001).

Conclusion

MARSEAL® 10 mm and MARCLAMP® achieved adequate burst pressures compared to the two control groups and thus might be suitable for clinical use.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Mehran RJ (2012) Lung cancer: an update on current surgical strategies. Tex Heart Inst J 39(6):844–845

    PubMed Central  PubMed  Google Scholar 

  2. Abolhoda A et al (1998) Prolonged air leak following radical upper lobectomy: an analysis of incidence and possible risk factors. Chest 113(6):1507–1510

    Article  CAS  PubMed  Google Scholar 

  3. Seely AJ et al (2010) Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg 90(3):936–942; discussion 942

    Article  PubMed  Google Scholar 

  4. Cerfolio RJ et al (2002) Predictors and treatment of persistent air leaks. Ann Thorac Surg 73(6):1727–1730; discussion 1730–1731

    Article  PubMed  Google Scholar 

  5. Bardell T, Petsikas D (2003) What keeps postpulmonary resection patients in hospital? Can Respir J 10(2):86–89

    CAS  PubMed  Google Scholar 

  6. Liang S et al (2013) Quantifying the incidence and impact of postoperative prolonged alveolar air leak after pulmonary resection. J Thorac Cardiovasc Surg 145(4):948–954

    Article  PubMed  Google Scholar 

  7. Droghetti A et al (2008) A prospective randomized trial comparing completion technique of fissures for lobectomy: stapler versus precision dissection and sealant. J Thorac Cardiovasc Surg 136(2):383–391

    Article  PubMed  Google Scholar 

  8. Fuller C (2013) Reduction of intraoperative air leaks with Progel in pulmonary resection: a comprehensive review. J Cardiothorac Surg 8:90

    Article  PubMed Central  PubMed  Google Scholar 

  9. Filosso PL et al (2013) Efficacy and safety of human fibrinogen-thrombin patch (TachoSil(R)) in the treatment of postoperative air leakage in patients submitted to redo surgery for lung malignancies: a randomized trial. Interact CardioVasc Thorac Surg 16(5):661–666

    Article  PubMed Central  PubMed  Google Scholar 

  10. Anegg U et al (2007) Efficiency of fleece-bound sealing (TachoSil) of air leaks in lung surgery: a prospective randomised trial. Eur J Cardiothorac Surg 31(2):198–202

    Article  PubMed  Google Scholar 

  11. Zhang R et al (2012) TissuePatch as a novel synthetic sealant for repair of superficial lung defect: in vitro tests results. Ann Surg Innov Res 6(1):12

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Brunelli A et al (2004) Predictors of prolonged air leak after pulmonary lobectomy. Ann Thorac Surg 77(4):1205–1210; discussion 1210

    Article  PubMed  Google Scholar 

  13. Ahmed A, Page RD (2008) The utility of intrapleural instillation of autologous blood for prolonged air leak after lobectomy. Curr Opin Pulm Med 14(4):343–347

    Article  PubMed  Google Scholar 

  14. Athanassiadi K, Bagaev E, Haverich A (2009) Autologous blood pleurodesis for persistent air leak. Thorac Cardiovasc Surg 57(8):476–479

    Article  CAS  PubMed  Google Scholar 

  15. Lang-Lazdunski L, Coonar AS (2004) A prospective study of autologous ‘blood patch’ pleurodesis for persistent air leak after pulmonary resection. Eur J Cardiothorac Surg 26(5):897–900

    Article  PubMed  Google Scholar 

  16. Elhao M et al (2009) Efficacy of using electrosurgical bipolar vessel sealing during vaginal hysterectomy in patients with different degrees of operative difficulty: a randomised controlled trial. Eur J Obstet Gynecol Reprod Biol 147(1):86–90

    Article  PubMed  Google Scholar 

  17. Ashkenazi D, Mazzawi S, Rakover Y (2006) Hemostasis and bleeding control in thyroid surgery using electrothermal system (Ligasure): our experience in 317 patients. Harefuah 145(8): 561–564, 632, 631

  18. Macario A et al (2008) Operative time and other outcomes of the electrothermal bipolar vessel sealing system (LigaSure) versus other methods for surgical hemostasis: a meta-analysis. Surg Innov 15(4):284–291

    Article  PubMed  Google Scholar 

  19. Manouras A et al (2005) Electrothermal bipolar vessel sealing system is a safe and time-saving alternative to classic suture ligation in total thyroidectomy. Head Neck 27(11):959–962

    Article  PubMed  Google Scholar 

  20. Shigemura N et al (2004) A new tissue-sealing technique using the Ligasure system for nonanatomical pulmonary resection: preliminary results of sutureless and stapleless thoracoscopic surgery. Ann Thorac Surg 77(4):1415–1418; discussion 1419

    Article  PubMed  Google Scholar 

  21. Tirabassi MV et al (2004) Quantitation of lung sealing in the survival swine model. J Pediatr Surg 39(3):387–390

    Article  PubMed  Google Scholar 

  22. Relave F et al (2010) Thoracoscopic lung biopsies in heaves-affected horses using a bipolar tissue sealing system. Vet Surg 39(7):839–846

    Article  PubMed  Google Scholar 

  23. Mayhew PD et al (2012) Use of the Ligasure vessel-sealing device for thoracoscopic peripheral lung biopsy in healthy dogs. Vet Surg 41(4):523–528

    Article  PubMed  Google Scholar 

  24. Santini M et al (2006) Use of an electrothermal bipolar tissue sealing system in lung surgery. Eur J Cardiothorac Surg 29(2):226–230

    Article  PubMed  Google Scholar 

  25. Macchiarini P et al (1999) Experimental and clinical evaluation of a new synthetic, absorbable sealant to reduce air leaks in thoracic operations. J Thorac Cardiovasc Surg 117(4):751–758

    Article  CAS  PubMed  Google Scholar 

  26. Tan C et al (2011) A prospective randomized controlled study to assess the effectiveness of CoSeal(R) to seal air leaks in lung surgery. Eur J Cardiothorac Surg 40(2):304–308

    PubMed  Google Scholar 

  27. Sugi K et al (2003) Use of the bipolar vessel sealing system in lung resection. Kyobu Geka 56(7):551–554

    CAS  PubMed  Google Scholar 

Download references

Disclosures

Drs. Kirschbaum, Clemens, Steinfeldt, Pehl, Meyer and Bartsch have no conflict of interests or financial ties to disclose.

Author information

Authors and Affiliations

  1. Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Uniklinik Giessen und Marburg GmbH (UKCM), Philipps University Marburg, Baldingerstrasse, 35033, Marburg, Germany

    A. Kirschbaum, A. Clemens, C. Meyer & D. K. Bartsch

  2. Department of Anaesthesiology and Intensive Medicine, Philipps University Marburg, Marburg, Germany

    T. Steinfeldt

  3. Institute of Pathology, Philipps University Marburg, Marburg, Germany

    A. Pehl

Authors
  1. A. Kirschbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Clemens
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Steinfeldt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Pehl
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. K. Bartsch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Kirschbaum.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kirschbaum, A., Clemens, A., Steinfeldt, T. et al. Bipolar sealing of lung parenchyma: tests in an ex vivo model. Surg Endosc 29, 127–132 (2015). https://doi.org/10.1007/s00464-014-3664-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3664-x

Keywords

Search

Navigation