Morbidity reduction using the vessel sealing device LigaSure™ in breast cancer surgery

Prospective comparison of suture ligation and electrothermal sealing for the control of perivascular lymphatics in kidney transplant recipients

Background

The use of sutures as ligatures has proven to be safe and reliable for the control of lymphatic vessels. The electrothermal bipolar vessel sealer (EBVS) is a relatively new type of device that can be used to seal lymphatics. We conducted a study to evaluate the safety and efficacy of EBVS for preparation of the recipient vessel during renal transplantation.

Methods

In this prospective randomized controlled study, EBVS (Medtronic) was compared with conventional ligature for the control of perivascular lymphatics in kidney transplant recipients. A total of 52 kidney transplant recipients were randomly assigned to two groups. In group 1, EBVS was used to control perivascular lymphatics, while conventional silk ligatures were used in group 2. Demographic characteristics, as well as preoperative, perioperative, and postoperative variables, were noted and compared between the groups.

Results

The mean recipient vessel preparation time was 8.3±1.9 minutes in group 1 and 14.5±4 minutes in group 2 (P<0.001). The mean anastomosis time was 28.2±5.4 minutes in group 1 and 28.2±4.2 minutes in group 2 (P=1.000). The mean estimated blood loss was 101.54±44.60 mL in group 1 and 125.19±74.17 mL in group 2 (P=0.270), and the mean drain output was 51.42 mL per day and 57.50 mL per day in groups 1 and 2, respectively (P=0.590).

Conclusions

EBVS can be employed safely and effectively for recipient iliac lymphatic vessel dissection and sealing. EBVS is a fast, secure, and effective choice to permanently fuse the vessels and is a good option to avoid posttransplant lymphatic complications.

Reduced morbidity by using LigaSure compared to conventional inguinofemoral lymphadenectomy in vulvar cancer patients: A randomized controlled trial

BACKGROUND

Inguinofemoral lymphadenectomy (IFL) is part of the surgical treatment of different malignancies of the genital tract and/or the lower limb including vulvar carcinoma, penile carcinoma and melanoma. IFL is associated with morbidity in up to 85% of the patients. The aims of this MAMBO-IC study (Morbidity And Measurement of the Body) are to study the feasibility of using LigaSure for IFL and to assess the differences in the incidence of short-term complications using LigaSure versus conventional IFL randomized within each individual patient.

METHODS

In this multicenter randomized controlled trial (RCT), women diagnosed with squamous cell carcinoma of the vulva with an indication for bilateral IFL were included. It was randomly assigned for which groin the LigaSure was used; the other groin was treated with conventional IFL (sharp/diathermia). We estimated the incidence of ≥1 complication(s) per groin using logistic regression and compared this between the two surgical methods, adjusting for possible confounders.

RESULTS

We included 40 groins of 20 patients. The estimated incidence of ≥1 complication(s) was 29% after LigaSure versus 70% after conventional IFL (risk difference 41% (95% CI 19-62), p < 0.001). Patients' reported restriction of daily living activities and maximum pain score were equal for both treatment methods. There were no differences in the surgeon reported workload scores.

CONCLUSIONS

This RCT shows that LigaSure for IFL is feasible and associated with significantly less short-term surgical complications compared to conventional IFL. Further studies with a larger sample size are needed to validate our findings. ISRCTN15057626.