Advanced bipolar vessel sealing devices vs conventional bipolar energy in minimally invasive hysterectomy: a systematic review and meta-analysis

PURPOSE

To compare conventional bipolar electrosurgery with advanced bipolar vessel sealing (ABVS) devices for total laparoscopic hysterectomy (TLH).

METHODS

A systematic review was conducted by searching Scopus, PubMed/MEDLINE, ScienceDirect, and Cochrane Library from January 1989 to November 2021. We identified all studies comparing ABVS devices with conventional bipolar electrosurgery in TLH and reporting at least one of the following outcomes: total blood loss, total operative time, hospital stay, perioperative complications, or costs. Meta-analysis was conducted with a random effect model reporting pooled mean differences and odds ratios (ORs) with related 95% confidence intervals (CIs).

RESULTS

Two randomized controlled trials and two retrospective studies encompassing 314 patients were included out of 615 manuscripts. The pooled estimated total blood loss in the ABVS devices group was lower than conventional bipolar electrosurgery of 39 mL (95% CI - 65.8 to - 12.6 mL; p = .004). The use of ABVS devices significantly reduced the total operative time by 8 min (95% CI - 16.7 to - 0.8 min; p = .033). Hospital stay length did not differ between the two groups, and a comparable overall surgical complication rate was observed [OR of 0.9 (95% CI 0.256 - 3.200; p = .878].

CONCLUSIONS

High-quality evidence comparing ABVS devices with conventional bipolar electrosurgery for TLH is lacking. ABVS devices were associated with reduced total blood loss and operative time; however, observed differences seem clinically irrelevant. Further research is required to clarify the advantages of ABVS devices over conventional bipolar electrosurgery and to identify cases that may benefit more from their use.

Comparing adverse events associated with LigaSure and Harmonic devices in head and neck surgery

OBJECTIVE

To characterize adverse events, provide a safety profile, and understand patient outcomes after complications arising from LigaSure and Harmonic use in the head and neck region.

METHODS

Retrospective analysis of adverse events from the Manufacturer and User Facility Device Experience (MAUDE) between January 2013 and 2023.

RESULTS

A total of 158 LigaSure and 159 Harmonic events were extracted. There were significantly more reports of Harmonic device overheating (6.9% vs. 0.6%, p = 0.003) and spontaneous self-activation (4.4% vs. 0%, p = 0.032). Although intra-operative and post-operative complications were similar among both groups, there were significantly more intra-operative bleeding events for LigaSure as compared to Harmonic (8.2% vs. 0.0%, p = 0.001).

CONCLUSION

Understanding technical complications and adverse events attributable to LigaSure and Harmonic devices enables the development of clinically relevant risk mitigation strategies. Surgeons should avoid improper use by remaining vigilant of device functionality and temperature changes.

Detection of the Lateral Thermal Spread during Bipolar Vessel Sealing in an Ex Vivo Model-Preliminary Results

Background: As an unwanted side effect, lateral thermal expansion in bipolar tissue sealing may lead to collateral tissue damage. Materials and Methods: Our investigations were carried out on an ex vivo model of porcine carotid arteries. Lateral thermal expansion was measured and a calculated index, based on thermographic recording and histologic examination, was designed to describe the risk of tissue damage. Results: For instrument 1, the mean extent of the critical zone > 50 °C was 2315 ± 509.2 µm above and 1700 ± 331.3 µm below the branches. The width of the necrosis zone was 412.5 ± 79.0 µm above and 426.7 ± 100.7µm below the branches. For instrument 2, the mean extent of the zone > 50 °C was 2032 ± 592.4 µm above and 1182 ± 386.9 µm below the branches. The width of the necrosis zone was 642.6 ± 158.2 µm above and 645.3 ± 111.9 µm below the branches. Our risk index indicated a low risk of damage for instrument 1 and a moderate to high risk for instrument 2. Conclusion: Thermography is a suitable method to estimate lateral heat propagation, and a validated risk index may lead to improved surgical handling.

Use of energy device in general surgical operations: impact on peri-operative outcomes

BACKGROUND

The introduction of energy devices has significantly expanded the scope of surgical expedition. The LigaSure™ vessel sealing system is a bipolar electrosurgical device, recently introduced to our practice. Its impact on peri-operative outcomes in a variety of major operations was evaluated in this study.

METHODS

A retrospective review of operations performed following the adoption of the LigaSure™ vessel sealing device was carried out. Five categories of operations were evaluated (Thyroidectomies, Gastrectomies, Colectomies, Pancreaticoduodenectomies, and Anterior/Abdomino-perineal resection [A/APR of the rectum). Peri-operative outcomes (duration of operation, intra-operative blood loss, blood transfusion rates) were compared with a cohort of similar operations performed using conventional techniques. Data analysis and comparisons were done on a subgroup basis.

RESULTS

A total of 117 operations were performed using the LigaSure™ device with thyroidectomies being the most common (66/117-56.4%). Compared to cases done using conventional techniques of suture and knot with electrocautery (120 cases), the use of LigaSure™ was associated with a significant reduction in operation time in all categories of operations. Intraoperative blood loss was also lower in all categories of cases, but this was only statistically significant following A/APR and Thyroidectomies. Generally, there was a trend towards a reduction in blood transfusion rates.

CONCLUSIONS

The use of energy devices for surgical operations is feasible in a resource-limited setting. It has the potential of improving outcomes.

LigaSure Impact™ reduces complications after abdominoplasty in weight loss patients

PURPOSE

Bariatric surgery is on the rise worldwide. With the desired weight loss after bariatric surgery, patients frequently develop massive skin flaps resulting in the need of abdominoplasty. In these patients, this surgical technique is frequently associated with perioperative complications. Strategies to minimize complications are sought after. The objective of our study was to compare two different dissection techniques and their impact on postoperative outcome.

METHODS

We included 66 patients in our study who underwent abdominoplasty after massive weight loss following bariatric surgery. In group 1, abdominoplasty was performed using the conventional technique of diathermia (n = 20). In group 2, abdominoplasty was performed using LigaSure Impact™ (n = 46). The duration of the surgical procedure and perioperative complications were recorded as primary endpoints. Secondary endpoints were length of hospital stay and assessment of additional risk factors.

RESULTS

Baseline characteristics were comparable between groups. The duration of surgery was significantly shorter in group 2. Postoperative complications were significantly less frequent in group 2 (p = 0.0035). Additional risk factors, e.g., smoking and diabetes mellitus, were not associated with increased rates of perioperative complications.

CONCLUSIONS

The choice of technical device for dissection in abdominoplasty alone will not guarantee minimized complication rates. Yet, the utilization of LigaSure Impact™ in refined surgical techniques may facilitate reduced rates of complications, especially wound infections, and a shortened duration of surgery.

LigaSure versus monopolar cautery for recipient hepatectomy in liver transplantation: a propensity score-matched analysis

Background

Recipient hepatectomy during liver transplantation (LT) is one of the most challenging aspects of surgery due to the possibility of massive bleeding. This study aimed to compare and analyze the effectiveness between LigaSure and monopolar cautery in recipients.

Methods

We reviewed 187 recipients who underwent LT from March 2019 to June 2020. We compared the surgical outcomes of the 69 recipients who underwent recipient hepatectomy with LigaSure (LigaSure group) and 118 recipients who underwent with monopolar cautery. Propensity score matching (PSM) was performed using the nearest-neighbor method at a ratio of 1:1 based on 14 baseline characteristics and possible factors that influence postoperative bleeding.

Results

A total of 187 adult recipients were reviewed retrospectively. In the propensity score-matched analysis, The rates of bleeding and infectious complication were significantly lower in the LigaSure group than in the monopolar cautery group (3/69, 4.35% versus 13/69, 18.8%; P=0.015 and 1/69, 1.45% versus 9/69, 13.0%; P=0.017). The length of postoperative hospital stay was shorter in the LigaSure group (mean: 23.1±16.1 versus 39.6±58.2 days; P=0.024).

Conclusions

Recipient hepatectomy with LigaSure is associated with a short hospital stay due to low re-operation rates, postoperative bleeding, and secondary infection related to bleeding.

Complications associated with energy-based devices during thyroidectomy from 2010–2020

Objective

Harmonic Focus (Ethicon, Johnson and Johnson, Cincinnati, OH, USA), LigaSure Small Jaw (Medtronic, Covidien Products, Minneapolis, MN, USA), and Thunderbeat Open Fine Jaw (Olympus, Japan) are electrosurgical instruments used widely in head and neck surgery. The study aims to compare device malfunctions, adverse events to patients, operative injuries, and interventions related to Harmonic, LigaSure, and Thunderbeat use during thyroidectomy.

Methods

The US Food and Drug Administration's Manufacture and User Facility Device Experience (MAUDE) database was queried for adverse events associated with Harmonic, LigaSure, and Thunderbeat from January 2005 to August 2020. Data were extracted from reports pertaining to thyroidectomy.

Results

Of the 620 adverse events extracted, 394 (63.5%) involved Harmonic, 134 (21.6%) LigaSure, and 92 (14.8%) Thunderbeat. The reported device malfunctions most frequently associated with Harmonic was damage to the blade (110 (27.9%)), LigaSure was inappropriate function (47 (43.1%)), Thunderbeat was damage to the tissue or Teflon pad (27 (30.7%)), respectively. Burn injury and incomplete hemostasis were the most commonly reported adverse events. The operative injury reported most frequently when using Harmonic and LigaSure was burn injury. No operator injuries were reported with Thunderbeat use.

Conclusion

The most frequently reported device malfunctions were damage to the blade, inappropriate function, and damage to the tissue or Teflon pad. The most frequently reported adverse events to patients was a burn injury and incomplete hemostasis. Interventions aimed at improving physician education may help reduce adverse events attributed to improper use.

Ligasure™ Impact and Ligasure™ Small Jaw in Body Contouring after Massive Weight Loss: A New Perspective

BACKGROUND

The most effective dissection technique for elevating flaps in body contouring is still controversial, particularly in high-risk massive weight loss (MWL) patients. LigaSure (Medtronic, Dublin, Ireland) is an energy device commonly used among different surgical specialties to reduce morbidity and improve outcomes. The aim of this study is to investigate the effectiveness of LigaSure Impact and LigaSure Small Jaw in body contouring after MWL compared with conventional technique.

MATERIAL AND METHODS

Patients who underwent abdominoplasty, mastopexy, brachioplasty and thigh lift after MWL at a single center from 1 December 2018 to 1 March 2020 were retrospectively reviewed. In each procedure patients were divided into two groups according to the dissection technique: LigaSure group and monopolar electrosurgery group. Patients characteristics, perioperative details and postoperative complications were evaluated.

RESULTS

Fourty-five patients underwent abdominoplasty, twenty-six mastopexy, twenty brachioplasty and sixteen medial thigh lift. Using LigaSure, operative time was longer in abdominoplasty and thigh lift, but shorter in mastopexy and brachioplasty. Although not statistically significant, the amount of blood and serum recorded from drains in the first 36 hours was reduced in LigaSure groups. Additional analgesic intake was reduced with LigaSure as well as postoperative subjective pain. In all body contouring procedures statistically significant difference was found in days of hospital stay favoring LigaSure groups. Complications occurred most frequently in control groups compared to LigaSure groups.

CONCLUSION

LigaSure Impact and LigaSure Small Jaw may be beneficial in improving outcomes because they might reduce fluids drainage, analgesics intake, hospital stay and postoperative complications.