Prospective comparison of four laparoscopic vessel ligation devices.

PURPOSE The merits of laparoscopic sealing devices have been poorly characterized. The purpose of this study was to compare two bipolar sealing devices [LigaSure V (LS) and Gyrus PK (GP)], an ultrasonic device [Harmonic Scalpel ACE (HS)] and a novel device using nanotechnology [EnSeal PTC (ES)]. MATERIALS AND METHODS The ability of all four 5 mm devices to seal 5 mm bovine arteries was tested under controlled temperature and humidity in accordance with manufacturer specifications. Study endpoints included lateral thermal spread, time to seal, burst pressure, smoke production and subjective (blinded review of video clips) and objective (measured using an aerosol monitor) effect upon visibility. RESULTS The HS demonstrated the least thermal spread. The LS (10.0 secs) and GP (11.1 secs) had the fastest sealing times (p<0.001 for both) when compared to ES (19.2 sec) and HS (14.3 sec). Mean burst pressure values were: LS 385 mm Hg, GP 290 mm Hg, ES 255 mm Hg and HS 204 mm Hg. The HS had the best subjective visibility score and the lowest objective smoke production (2.88 ppm) compared to the GP (74.1 ppm), ES (21.6 ppm) and LS (12.5 ppm), (p<0.01 for all). CONCLUSIONS The LS has the highest burst pressure and fastest sealing time and was the highest rated overall. The HS produced the lowest thermal spread and smoke but had the lowest mean burst pressure. The GP had the highest smoke production, and variable burst pressures. Despite employing nanotechnology, the ES device was the slowest and had variable burst pressures.