Advanced bipolar vessel sealing

Advanced bipolar sealers combine pressure with energy. The jaws appose the vessel walls while collagen and elastin denature into a seal. Compatible LigaSure and ENSEAL instruments can seal vessels up to and including 7 mm. LigaSure adjusts energy using tissue-impedance feedback.

Earlier ENSEAL instruments regulated the tissue interface to about 100°C, with reported lateral spread of about 2 mm. Heat injury changes with tissue, vessel size and use; a reported spread is not a safe clearance margin.

One important correction: the 1.5–3.2 mm range in the original LigaSure cue belongs to PlasmaKinetics in the cited porcine study. Carbonell et al. tested 8–17 arteries per device in each size group. Mean lateral thermal injury with LigaSure was 1.2,2.4 and 2.5 mm in 2–3,4–5 and 6–7 mm arteries. PlasmaKinetics means were 1.5,2.4 and 3.2 mm. Spread increased with vessel size, with no significant difference between devices in each group.

In a 2008 bench study, Person et al. compared harvested vessels from 4 pigs. ENSEAL had higher burst pressures than LigaSure V, LigaSure Atlas and Harmonic ACE. That bench result did not establish clinical superiority. Burst strength and lateral heat injury answer different questions.

References

Benitez, Johnston & Tobias, Veterinary Surgery: Small Animal,2nd ed., PDF pp.582–585,864. Carbonell et al.2003, PMID 14733701. Person et al.2008, PMID 18097720. Medtronic LigaSure and Ethicon ENSEAL X 1 instructions for use.