HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Cameron Wright Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wright, C. Search for Related Content PubMed PubMed Citation Articles by Wright, C. Related Collections Esophagus - cancer Related Article

---

New Technology

Invited commentary

Department of Thoracic Surgery, Massachusetts General Hospital, Blake 1570, 55 Fruit St, Boston, MA 02114

(Email: wright.cameron{at}mgh.harvard.edu).

The authors [1] describe the use of the LigaSure system device (Valleylab, Boulder, CO) in 30 patients undergoing esophagectomy and compare the early results with another 30 patients during the same time period. It is unclear if this was a randomized study and how standardized the surgical teams were in this study as well. Use of the LigaSure device (Valleylab) to seal tissue pedicles in both the chest and abdominal phases of the esophagectomy was associated with reduced operation time (47 minutes) and blood loss (143 mL). The amount of reduction of operative time seems generous. Esophagectomy requires many repetitive divisions of tissue pedicles in mobilizing the stomach and freeing the esophagus. This has usually been performed by traditional clamping and suture ligation. Several other devices are available, including the LDS device (Autosuture, Norwalk, CT) and the Harmonic Scalpel (Johnson & Johnson, New Brunswick, NJ). The LDS device clips both ends of a narrow tissue pedicle with a titanium clip and divides it between the two clips. The Harmonic Scalpel (Johnson & Johnson) seals the tissue by heat generated by ultrasonic energy and divides it when done. The LigaSure device and the Harmonic Scalpel are also available in endoscopic models. The use of these devices is most advantageous in taking down the short gastric vessels on the typical rather obese patient with a Barrett’s adenocarcinoma where exposure is difficult and the penalty for injuring the spleen is high. Surgeons must weigh their own comfort and ease of use of these devices and balance the cost of the devices against the cost of operating room time and possible improvements in patient care.

In my hospital, the cost of the two most popular devices for tissue "welding" (Harmonic Scalpel and LigaSure device) is approximately the same. Thus surgeons who are interested in trying these new devices should investigate both and decide which works best in their hands. Although tying knots is easy and quick in the anterior abdomen, these devices offer an advantage high on the greater curve of the stomach and bear careful scrutiny by a surgeon to decide whether to tie or to knot.

	References

Top References

 

1. Eroglu A, Turkyilmaz A, Aydin Y, Erdem AF, Tokur M, Karaoglanoglu N. The use of the LigaSure vessel sealing system in esophageal cancer surgery Ann Thorac Surg 2007;84:2076-2080.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Cameron Wright Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wright, C. Search for Related Content PubMed PubMed Citation Articles by Wright, C. Related Collections Esophagus - cancer Related Article