Double Bipolar Sealing of the Pulmonary Artery Improves the Bursting Pressures

Background In every anatomic lung resection, branches of the pulmonary artery have to be divided. In open surgery, this can be done with ligatures or staplers. In endoscopic surgery, only an endostapler can be used. By routing we ligate the vessels double. Bipolar sealing had yielded promising results, so we wanted to know if we can improve the bursting pressures especially in case of larger vessels by double sealing. Methods Experiments were performed on preparations of the left pulmonary artery extracted at the slaughterhouse. A pressure sensor was implanted at the central end to provide digital measurement of the pneumatic load on the vessel seal and thus establish bursting pressure in each case. Vessels were sealed with MARSEAL 5 (Gebrüder Martin GmbH & Co KG, Tuttlingen, Germany) and SealSafe G3 electric current. The vessels investigated were separated into three sizes: 1 to 6 mm, 7 to 12 mm, and >12 mm. The groups (n = 12 in each) were investigated for each vessel size—Group 1: ligature; Group 2: single seal; Group 3: double seals separated by gap of 0.5 cm; and Group 4: double seals separated by gap of 1.0 cm. Mean bursting pressure (mbar) was calculated for each group. Differences between groups were calculated with Mann–Whitney U test; differences with p < 0.05 were considered significant. Results The ligated vessels in the 1 to 6 mm group showed the highest bursting pressures (mean 515.7 ± 39.6 mbar). Mean bursting pressure in the single seal group was 231.6 ± 47.5 mbar. This was not significantly different from the group with double seals placed 0.5 cm apart. However, bursting pressures were significantly higher in the group with double seals placed 1 cm apart (p < 0.001). Mean value in this case was 308.5 ± 44.5 mbar. In the 7 to 12 mm vessels, mean bursting pressure was highest with ligation at 361 ± 67.1 mbar but was significantly higher in both groups with double bipolar seals (180.3 ± 52.1 mbar with 0.5-cm separation and 277.0 ± 64.5 with 1-cm separation) than in the single seal group (102.7 ± 16.1 mbar). In large vessels (>12 mm), mean bursting pressures were low (66.3 ± 12.7 mbar) with single seals but were significantly higher with double seals (162.3 ± 35.8 mbar [0.5-cm separation] and 137.3 ± 22.9 mbar [1-cm separation]). Conclusions In the ex vivo model of the pulmonary artery, double seals revealed significantly higher bursting pressures than single seals. If there is enough vessel length, the two seals should be placed 1 cm apart.

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Bipolar impedance-controlled sealing of the pulmonary artery with SealSafe G3 electric current: determination of bursting pressures in an ex vivo model

Journal of Surgical Research ◽

10.1016/j.jss.2014.07.014 ◽

2014 ◽

Vol 192 (2) ◽

pp. 611-615 ◽

Cited By ~ 1

Author(s):

Andreas Kirschbaum ◽

Julia Kunz ◽

Thorsten Steinfeldt ◽

Anika Pehl ◽

Christian Meyer ◽

...

Keyword(s):

Pulmonary Artery ◽

Electric Current ◽

Ex Vivo ◽

Ex Vivo Model ◽

Bursting Pressures

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Stapler-less burst pressure in an ex vivo human gastric tissue: a randomized controlled trial

Updates in Surgery ◽

10.1007/s13304-021-00975-y ◽

2021 ◽

Author(s):

Gianmattia del Genio ◽

Claudio Gambardella ◽

Salvatore Tolone ◽

Luigi Brusciano ◽

Domenico Parmeggiani ◽

...

Keyword(s):

Ex Vivo ◽

Controlled Trial ◽

Burst Pressure ◽

Bursting Pressure ◽

Gastric Tissue ◽

Ex Vivo Model ◽

Surgical Stapling ◽

Surgical Closure ◽

Surgical Suture ◽

Temporary Closure

AbstractStapler-less laparoscopic sleeve gastrectomy (LSG) is emerging as a new potential affordable cost-effective alternative procedure. However, no pre-clinical data are currently available on human tissue. We aimed to evaluate whether traditionally suturing without the use of surgical stapling may produce a comparable bursting pressure on human gastric tissue. A prospective cohort of consecutive patients undergoing LSG was divided in two groups to compare a barbed extra-mucosal running suture (stapler-less) versus a standard stapler line. A burst pressure test was applied to the gastric specimen employing high-resolution manometric catheter. Type, location and features of the leak were described. We enrolled a total of 40 obese patients, 20 patients for each group. Median burst pressures of the stapler-less group resulted statistically significant increased (p < 0.0001) than the one in standard stapler group. In all cases, leak occurred along the surgical closure site independently from the used technique (group 1 vs 2; p = N.S.), more often at the proximal stomach (p < 0.05). In human ex vivo model, traditional surgical suture (i.e. running hand-sewn) produced an effective temporary closure, with superior resistance to increasing volume and pressure. How this may impact on clinical LSG outcomes needs further evaluations and was not the object of this study.

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Effect of three different needle holders on gastrointestinal anastomosis construction time and bursting pressure in equine jejunal segments

BMC Veterinary Research ◽

10.1186/s12917-021-02871-4 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Kate Averay ◽

Gaby van Galen ◽

Michael Ward ◽

Denis Verwilghen

Keyword(s):

Intestinal Resection ◽

Bursting Pressure ◽

Construction Time ◽

Needle Holder ◽

Group 4 ◽

Bursting Pressures ◽

Group 3 ◽

Group 2 ◽

The Impact ◽

Group 1

Abstract Background Equine small intestinal resection and anastomosis is a procedure where optimizing speed, without compromising integrity, is advantageous. There are a range of different needle holders available, but little is published on the impact surgical instrumentation has on surgical technique in veterinary medicine. The objectives of this study were to investigate if the needle holder type influences the anastomosis construction time, the anastomosis bursting pressure and whether the bursting pressure is influenced by the anastomosis construction time. Single layer end-to-end jejunojejunal anastomoses were performed on jejunal segments harvested from equine cadavers. These segments were randomly allocated to four groups. Three groups based on the needle holder type that was used: 16.5 cm Frimand (Group 1), 16 cm Mayo-Hegar (Group 2) or 20.5 cm Mayo-Hegar (Group 3) needle holders. One (Group 4) as control without anastomoses. Anastomosis construction time was recorded. Bursting pressure was determined by pumping green coloured fluid progressively into the lumen whilst recording intraluminal pressures. Maximum pressure reached prior to failure was recorded as bursting pressure. Construction times and bursting pressures were compared between needle holder, and the correlation between bursting pressure and construction time was estimated. Results Construction times were not statistically different between groups (P = 0.784). Segments from Group 2 and Group 3 burst at a statistically significantly lower pressure than those from Group 4; P = 0.031 and P = 0.001 respectively. Group 4 and Group 1 were not different (P = 0.125). The mean bursting pressure was highest in Group 4 (189 ± 61.9 mmHg), followed by Group 1 (166 ± 31 mmHg) and Group 2 (156 ± 42 mmHg), with Group 3 (139 ± 34 mmHg) having the lowest mean bursting pressure. Anastomosis construction time and bursting pressure were not correlated (P = 0.792). Conclusions The tested needle holders had a significant effect on bursting pressure, but not on anastomosis construction time. In an experimental setting, the Frimand needle holder produced anastomoses with higher bursting pressures. Further studies are required to determine clinical implications.

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Local lung coagulation post resection: an ex-vivo porcine model

Lasers in Medical Science ◽

10.1007/s10103-021-03280-7 ◽

2021 ◽

Author(s):

A. Kirschbaum ◽

Th. M. Surowiec ◽

A. Pehl ◽

Th. Wiesmann ◽

D. K. Bartsch ◽

...

Keyword(s):

Nd:Yag Laser ◽

Ex Vivo ◽

Lung Resection ◽

Lung Parenchyma ◽

Laser Wavelength ◽

Lesion Group ◽

Air Leakage ◽

Group 3 ◽

Group 2 ◽

Group 1

AbstractFollowing non-anatomical resection of lung parenchyma with a Nd:YAG laser, a coagulated surface remains. As ventilation starts, air leakage may occur in this area. The aim of the present study was to investigate, whether additional coagulation either before or after ventilation has an additional sealing effect. Freshly slaughtered porcine heart-lung blocks were prepared. The trachea was connected to a ventilator. Using a Nd:YAG laser (wavelength: 1320 nm, power: 60 W), round lesions (1.5 cm in diameter) with a depth of 1.5 cm were applied to the lung using an 800-μm laser fiber (5 s per lesion). Group 1 (n = 12) was control. Additional coagulation was performed in group 2 (n = 12) without and in group 3 (n = 12) with ventilation restarted. Air leakage (ml) from the lesions was measured. The thickness of each coagulation layer was determined on histological slices. Differences between individual groups were analyzed by one-way ANOVA (significance p < 0.05). After resection, 26.2 ± 2.7 ml of air emerged from the lesions per single respiration in group 1. Air loss in group 2 was 24.6 ± 2.5 ml (p = 0.07) and in group 3 23.7 ± 1.8 ml (p = 0.0098). In comparison to groups 1 and 2 thickness of the coagulation layers in group 3 was significantly increased. After non-anatomical porcine lung resection with a Nd:YAG laser, additional coagulation of the ventilated resection area can reduce air leakage.

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Metastatic Non-Small-Cell Lung Cancer in the Setting of Unilateral Agenesis of the Left Pulmonary Artery: A Case Report and Comprehensive Literature Review

Case Reports in Oncological Medicine ◽

10.1155/2019/4752835 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

John Agzarian ◽

Jakub Kadlec ◽

Lori Whitehead ◽

Yaron Shargall

Keyword(s):

Lung Cancer ◽

Pulmonary Artery ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Lung Resection ◽

Rare Condition ◽

Left Pulmonary Artery ◽

Small Cell ◽

Small Cell Lung ◽

High Index Of Suspicion

Unilateral absence of the pulmonary artery (UAPA) represents a rare condition that is often associated with cardiac congenital abnormalities but can also be relatively asymptomatic and indolent. There is a lack of consensus regarding the management of UAPA. However, in the setting of associated complications and ongoing infection, pulmonary resection is advocated. Although rare, the association between UAPA and bronchogenic carcinoma has been previously reported in seven published cases. In the majority of these, anatomic lung resection (most commonly with pneumonectomy) was curative. We present the first reported case of ipsilateral metastatic non-small-cell lung cancer- (NSCLC-) associated UAPA in a 47-year-old patient with ventilator-dependent hypoxic respiratory failure and bronchorrhea, who had been lost to follow-up for 8 years. Initial investigations did not yield evidence of malignancy, and confirmation of metastatic disease was made intraoperatively at the time of thoracotomy. The findings demonstrated evidence of diffuse metastatic pleural disease with lymphangitic carcinomatosis and superimposed infection. The patient was palliated and passed away shortly thereafter. In the setting of UAPA, clinicians should have a high index of suspicion for the possibility of malignancy, and if proven, they should consider early resection following appropriate staging.

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Ex-vivo mechanical sealing properties and toxicity of a bioadhesive patch as sealing system for fetal membrane iatrogenic defects

Scientific Reports ◽

10.1038/s41598-020-75242-y ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Talita Micheletti ◽

Elisenda Eixarch ◽

Sergio Berdun ◽

Germán Febas ◽

Edoardo Mazza ◽

...

Keyword(s):

Ex Vivo ◽

Hydroxypropyl Methylcellulose ◽

Fetal Surgery ◽

Fetal Membrane ◽

Fetal Membranes ◽

Maximum Pressure ◽

Bursting Pressure ◽

Cell Toxicity ◽

Bursting Pressures ◽

Prelabor Rupture Of Membranes

Abstract Preterm prelabor rupture of membranes (PPROM) is the most frequent complication of fetal surgery. Strategies to seal the membrane defect created by fetoscopy aiming to reduce the occurrence of PPROM have been attempted with little success. The objective of this study was to evaluate the ex-vivo mechanical sealing properties and toxicity of four different bioadhesives integrated in semi-rigid patches for fetal membranes. We performed and ex-vivo study using term human fetal membranes to compare the four integrated patches composed of silicone or silicone-polyurethane combined with dopaminated-hyaluronic acid or hydroxypropyl methylcellulose (HPMC). For mechanical sealing properties, membranes were mounted in a multiaxial inflation device with saline, perforated and sealed with the 4 combinations. We measured bursting pressure and maximum pressure free of leakage (n = 8). For toxicity, an organ culture of membranes sealed with the patches was used to measure pyknotic index (PI) and lactate dehydrogenase (LDH) concentration (n = 5). All bioadhesives achieved appropriate bursting pressures, but only HPMC forms achieved high maximum pressures free of leakage. Concerning toxicity, bioadhesives showed low PI and LDH levels, suggesting no cell toxicity. We conclude that a semi-rigid patch coated with HPMC achieved ex-vivo sealing of iatrogenic defects in fetal membranes with no signs of cell toxicity. These results warrant further research addressing long-term adhesiveness and feasibility as a sealing system for fetoscopy.

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An analysis of anatomical variations of the left pulmonary artery of the interlobar portion for lung resection by three-dimensional CT pulmonary angiography and thin-section images

Japanese Journal of Radiology ◽

10.1007/s11604-020-01024-1 ◽

2020 ◽

Vol 38 (12) ◽

pp. 1158-1168

Author(s):

Makiko Murota ◽

Yuka Yamamoto ◽

Katashi Satoh ◽

Mariko Ishimura ◽

Naoya Yokota ◽

...

Keyword(s):

Pulmonary Artery ◽

Thin Section ◽

Lung Resection ◽

Three Dimensional ◽

Anatomical Variations ◽

Left Pulmonary Artery ◽

Pulmonary Angiography ◽

Ct Pulmonary Angiography

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Initial Load Stability of Different Trachea Suture Techniques: Tests on an Ex Vivo Model

Otolaryngology ◽

10.1177/0194599818757723 ◽

2018 ◽

Vol 158 (6) ◽

pp. 1079-1083 ◽

Cited By ~ 1

Author(s):

Andreas Kirschbaum ◽

Helen Abing ◽

Nikolas Mirow

Keyword(s):

Tensile Stress ◽

Ex Vivo ◽

Tensile Load ◽

Suture Technique ◽

Suture Techniques ◽

Maximum Pressure ◽

Ex Vivo Model ◽

Suture Group ◽

Group 2 ◽

Load Stability

Objective Tracheal anastomosis can be performed with different suture techniques. In this experimental work, the resilience of anastomotic techniques to pressure and tensile stress was studied. Study Design Ex vivo pig model. Setting Experimental. Subjects and Methods The trachea with the 2 main bronchi in freshly slaughtered pigs was isolated and intubated (CH 8.0). Both main bronchi were closed distally by a stapler. After resection of the trachea, an anastomosis (n = 15 per group) was created: group 1, single interrupted sutures; group 2, continuous running suture; group 3, mixed technique. A continuous tensile stress of 0, 500, 1000, or 1500 g was applied to the preparations. Mechanical ventilation with a maximum pressure of 70 mbar was initiated. The airtightness of the anastomosis was verified by submerging the entire preparation under water. Results At tensile loads of 0.5 and 1.0 kg, all anastomoses created in the single-stitch technique were airtight; at 1.5 kg, 93.3% were without leaks. In the continuous suture technique, the airtightness of anastomoses decreased with increasing tensile load: from 93.3% at 500 g to 73.3% at 1 kg and 66.6% at 1.5 kg ( P = .02 at 1.5 kg). Anastomoses in the mixed technique were airtight in 80% at 500 g, 66.6% at 1 kg, and 46.6% at 1.5 kg ( P = .01 in comparison with single stitches). Conclusion Anastomoses created with single interrupted sutures showed the highest resilience against combined pressure and tensile stress.

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Correlation of γ-radioactivity and Scanning Electron Microscopy in measurement of retention of 111Indium-labeled canine endothelial cells on synthetic vascular grafts

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100156419 ◽

1989 ◽

Vol 47 ◽

pp. 886-887

Author(s):

E.J. Prendiville ◽

S. Laliberté Verdon ◽

K. E. Gould ◽

K. Ramberg ◽

R. J. Connolly ◽

...

Keyword(s):

Blood Flow ◽

Ex Vivo ◽

Vascular Grafts ◽

Retention Data ◽

Vascular Prostheses ◽

Group 4 ◽

Human Fibronectin ◽

Insufficient Time ◽

Group 3 ◽

Group 2

Endothelial cell (EC) seeding is postulated as a mechanism of improving patency in small caliber vascular grafts. However the majority of seeded EC are lost within 24 hours of restoration of blood flow in previous canine studies . We postulate that the cells have insufficient time to fully develop their attachment to the graft surface prior to exposure to hemodynamic stress. We allowed EC to incubate on fibronectin-coated ePTFE grafts for four different time periods after seeding and measured EC retention after perfusion in a canine ex vivo shunt circuit.Autologous canine EC, were enzymatically harvested, grown to confluence, and labeled with 30 μCi 111 Indium-oxine/80 cm 2 flask. Four groups of 5 cm x 4 mm ID ePTFE vascular prostheses were coated with 1.5 μg/cm.2 human fibronectin, and seeded with 1.5 x 105 EC/ cm.2. After seeding grafts in Group 1 were incubated in complete growth medium for 90 minutes, Group 2 were incubated for 24 hours, Group 3 for 72 hours and Group 4 for 6 days. Grafts were then placed in the canine ex vivo circuit, constructed between femoral artery and vein, and subjected to blood flow of 75 ml per minute for 6 hours. Continuous counting of γ-activity was made possible by placing the seeded graft inside the γ-counter detection crystal for the duration of perfusion. EC retention data after 30 minutes, 2 hours and 6 hours of flow are shown in the table.

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