Download PDF
Thorac Cardiovasc Surg 2017; 65(05): 356-361
DOI: 10.1055/s-0036-1584951
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Suture or Stapling Are Superior in Comparison to Bipolar Sealing for Closing the Bronchi

Andreas Kirschbaum
1   Department of Surgery, University Hospital Marburg, Marburg, Germany
,
Katharina Waubke
1   Department of Surgery, University Hospital Marburg, Marburg, Germany
,
Anika Pehl
2   Department of Pathology, University Hospital Marburg, Marburg, Germany
,
Thorsten Steinfeldt
3   Department of Anaesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany
,
Detlef K. Bartsch
1   Department of Surgery, University Hospital Marburg, Marburg, Germany
› Author Affiliations
Further Information

Publication History

12 August 2015

30 May 2016

Publication Date:
05 July 2016 (online)

    Permissions and Reprints All articles of this category

Abstract

Background Every anatomical lung resection requires the airtight closure of at least one bronchus. In current clinical practice, these bronchi are sealed with sutures or staplers. This study investigated in an ex vivo pig model whether a new bipolar sealing device MARSEAL (KLS Martin, Tuttlingen, Germany) could be an alternative for this purpose.

Methods Complete bronchial trees were prepared free from pig heart–lung blocks that were removed at a slaughterhouse. These preparations were taken to the laboratory, and main, lobar, and segmental bronchi were closed using sutures, staples, or bipolar sealing. Each trachea was then intubated and connected to a ventilating device. The initial airtight closure of the bronchus was first tested with lung-protective ventilation. After 15 minutes of ventilation, the inspiratory ventilation pressure was slowly increased and the burst pressure (in mbar) was recorded. Each group included 12 bronchus closures. Group mean burst pressures were compared using a nonparametric test (Mann–Whitney U test). The significance level was p < 0.05.

Results The main bronchi closed both stapler magazines or sutures were all initially airtight during ventilation. The mean burst pressure was 60 ± 0 mbar for staplers and 57.92 ± 5.8 mbar for sutures. In contrast, 50% of main bronchi sealed with MARSEAL devices (5 or 10 mm) leaked air from the beginning. This was also noted in all lobar bronchi sealed with the MARSEAL 5-mm device and 80% of those sealed with the MARSEAL 10-mm device. The mean burst pressure of initially airtight lobar bronchi was 12.7 ± 7.25 mbar. In contrast, all segmental bronchi (mean width: 1.6 cm) were airtight when ventilated. Mean burst pressure was 14.64 ± 9.1 mbar with the MARSEAL 5-mm device and 29.64 ± 21.3 mbar with the MARSEAL 10-mm device. Histological investigation of the preparations (with hematoxylin and eosin staining) showed intact cartilaginous structures that were largely unaffected by bipolar coagulation. The airtight sealing of the segmental bronchi resulted from fusion of the peribronchial tissue and not the cartilage.

Conclusion Bipolar sealing is an inappropriate tool for the closure of the bronchi in comparison to suture or stapling.

Keywords

bronchial tree - surgical techniques - bronchial closure - bipolar sealing - bronchial stapling
 

  • References

  • 1 Asamura H, Kondo H, Goya T, Tsuchiya R, Naruke T, Suemasu K. Bronchopleural fistulas developing after pulmonary resections for lung cancer predisposing factors, management, and prognosis [in Japanese]. Nippon Kyobu Geka Gakkai Zasshi 1991; 39 (10) 1894-1901
    PubMedGoogle Scholar
  • 2 de Perrot M, Licker M, Robert J, Spiliopoulos A. Incidence, risk factors and management of bronchopleural fistulae after pneumonectomy. Scand Cardiovasc J 1999; 33 (03) 171-174
    CrossrefPubMedGoogle Scholar
  • 3 Hubaut JJ, Baron O, Al Habash O, Despins P, Duveau D, Michaud JL. Closure of the bronchial stump by manual suture and incidence of bronchopleural fistula in a series of 209 pneumonectomies for lung cancer. Eur J Cardiothorac Surg 1999; 16 (04) 418-423
    CrossrefPubMedGoogle Scholar
  • 4 Wright CD, Wain JC, Mathisen DJ, Grillo HC. Postpneumonectomy bronchopleural fistula after sutured bronchial closure: incidence, risk factors, and management. J Thorac Cardiovasc Surg 1996; 112 (05) 1367-1371
    CrossrefPubMedGoogle Scholar
  • 5 Péterffy A, Calabrese E. Mechanical and conventional manual sutures of the bronchial stump. A comparative study of 298 surgical patients. Scand J Thorac Cardiovasc Surg 1979; 13 (01) 87-91
    PubMedGoogle Scholar
  • 6 Bof AM, Rapoport A, Paulo DN, Leiro LC, Gomes MR, Pando-Serrano RR. Comparative study of the resistance of manual and mechanical sutures in the bronchial stump of dogs submitted to left pneumonectomy. J Bras Pneumol 2007; 33 (02) 141-147
    CrossrefPubMedGoogle Scholar
  • 7 Ludwig C, Behrend M, Hoffarth U, Schüttler W, Stoelben E. Resistance to pressure of bronchial closures. Comparison of pressure resistance of manual and stapler bronchial closures depending on the angle to the cartilaginous rings [in German]. Chirurg 2004; 75 (09) 896-899
    CrossrefPubMedGoogle Scholar
  • 8 Luo QQ, Lin H, Tan Q, Huang J, Xu L. Analysis of clinical application of thoracoscopic lobectomy for lung cancer. World J Surg Oncol 2014; 12: 157
    CrossrefPubMedGoogle Scholar
  • 9 Butskiy O, Wiseman SM. Electrothermal bipolar vessel sealing system (LigaSure) for hemostasis during thyroid surgery: a comprehensive review. Expert Rev Med Devices 2013; 10 (03) 389-410
    CrossrefPubMedGoogle Scholar
  • 10 Chiappa A, Zbar AP, Bertani E. , et al. The Ligasure vessel sealer in liver resection: a pilot study. Hepatogastroenterology 2007; 54 (80) 2353-2357
    PubMedGoogle Scholar
  • 11 Dhepnorrarat RC, Witterick IJ. New technologies in thyroid cancer surgery. Oral Oncol 2013; 49 (07) 659-664
    CrossrefPubMedGoogle Scholar
  • 12 Knell S, Venzin C. Partial pancreatectomy and splenectomy using a bipolar vessel sealing device in a cat with an anaplastic pancreatic carcinoma. Schweiz Arch Tierheilkd 2012; 154 (07) 298-301
    CrossrefPubMedGoogle Scholar
  • 13 Manouras A, Markogiannakis HE, Kekis PB, Lagoudianakis EE, Fleming B. Novel hemostatic devices in thyroid surgery: electrothermal bipolar vessel sealing system and harmonic scalpel. Expert Rev Med Devices 2008; 5 (04) 447-466
    CrossrefPubMedGoogle Scholar
  • 14 Overhaus M, Schaefer N, Walgenbach K, Hirner A, Szyrach MN, Tolba RH. Efficiency and safety of bipolar vessel and tissue sealing in visceral surgery. Minim Invasive Ther Allied Technol 2012; 21 (06) 396-401
    CrossrefPubMedGoogle Scholar
  • 15 Romano F, Garancini M, Caprotti R. , et al. Hepatic resection using a bipolar vessel sealing device: technical and histological analysis. HPB (Oxford) 2007; 9 (05) 339-344
    CrossrefPubMedGoogle Scholar
  • 16 Aydin C, Yildiz A, Kasap B, Yetimalar H, Kucuk I, Soylu F. Efficacy of electrosurgical bipolar vessel sealing for abdominal hysterectomy with uterine myomas more than 14 weeks in size: a randomized controlled trial. Gynecol Obstet Invest 2012; 73 (04) 326-329
    CrossrefPubMedGoogle Scholar
  • 17 Soreefan AH, Beebeejaun MS. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial. BJOG 2013; 120 (06) 776-777
    PubMedGoogle Scholar
  • 18 Trivedi P, D'Costa S, Shirkande P, Wahi M, Kumar S. Do new vessel sealing devices and harmonic ace increase ureteric injury in total laparoscopic hysterectomy?. J Gynecol Endosc Surg 2009; 1 (02) 83-88
    PubMedGoogle Scholar
  • 19 Lyons SD, Law KS. Laparoscopic vessel sealing technologies. J Minim Invasive Gynecol 2013; 20 (03) 301-307
    CrossrefPubMedGoogle Scholar
  • 20 Box GN, Lee HJ, Abraham JB. , et al. Comparative study of in vivo lymphatic sealing capability of the porcine thoracic duct using laparoscopic dissection devices. J Urol 2009; 181 (01) 387-391
    PubMedGoogle Scholar
  • 21 Richter S, Kollmar O, Neunhoeffer E, Schilling MK, Menger MD, Pistorius G. Differential response of arteries and veins to bipolar vessel sealing: evaluation of a novel reusable device. J Laparoendosc Adv Surg Tech A 2006; 16 (02) 149-155
    CrossrefPubMedGoogle Scholar
  • 22 Latimer CA, Nelson M, Moore CM, Martin KE. Effect of collagen and elastin content on the burst pressure of human blood vessel seals formed with a bipolar tissue sealing system. J Surg Res 2014; 186 (01) 73-80
    CrossrefPubMedGoogle Scholar
  • 23 Martin K, Krugman K, Latimer C, Moore C. The impact of atherosclerosis and vascular collagen on energy-based vessel sealing. J Surg Res 2013; 185 (02) 485-492
    CrossrefPubMedGoogle Scholar
  • 24 Sindram D, Martin K, Meadows JP. , et al. Collagen-elastin ratio predicts burst pressure of arterial seals created using a bipolar vessel sealing device in a porcine model. Surg Endosc 2011; 25 (08) 2604-2612
    CrossrefPubMedGoogle Scholar
  • 25 Graeber GM, Collins Jr JJ, DeShong JL, Murray GF. Are sutures better than staples for closing bronchi and pulmonary vessels?. Ann Thorac Surg 1991; 51 (06) 901-904 , discussion 904–905
    CrossrefPubMedGoogle Scholar
  • 26 Santini M, Vicidomini G, Baldi A. , et al. Use of an electrothermal bipolar tissue sealing system in lung surgery. Eur J Cardiothorac Surg 2006; 29 (02) 226-230
    CrossrefPubMedGoogle Scholar