In search of the autologous clip: a case for experimental standardization.

Background: In an effort to enable faster and, at times, more challenging surgeries without compromising patient or physician safety, medical device manufacturers have created myriad solutions to vascular ligation through the development of novel tools. The speed of development, FDA approval, and dissemination of these devices into the hands of surgeons often outpaces the ability of investigators to critically evaluate comparative effectiveness of these devices.

Database: The Medline database was searched for energy-based vessel ligation devices.

Operative time and other outcomes of the electrothermal bipolar vessel sealing system (LigaSure) versus other methods for surgical hemostasis: a meta-analysis.

A meta-analysis was performed of 29 prospective, randomized trials (published January 1, 2000, to August 14, 2007) comparing an electrothermal bipolar vessel sealing system (EBVS-LigaSure, Covidien) (total n = 1107 patients) with either clamping with suture ligation/ electrocauterization (n = 1079 patients) or ultrasonic energy (eg, Harmonic Scalpel, Johnson & Johnson). Hemorrhoidectomy (12 articles), hysterectomy (4 articles), and thyroidectomy (3 articles) were the most common procedures. For 15 of 26 studies reporting standard deviations, the normalized mean operative time reduction for EBVS equaled 28% (95% confidence interval [CI] 18%-39%, P < .

Superiority of using bipolar radiofrequency energy for internal mammary artery harvesting.

Purpose: The purpose of this study was to observe the acute effects of harvesting the porcine internal mammary artery using a novel bipolar (BP) radiofrequency energy device.

Description: The internal mammary artery from 16 porcine subjects was harvested using monopolar electrosurgery, BP electrosurgery, ultrasonic coagulation, and mechanical dissection with clips. Segments were evaluated with respect to endothelial function and integrity and the strength of side-branch sealing.

Method for creating ideal tissue fusion in soft-tissue structures using radio frequency (RF) energy.

Bipolar radiofrequency (RF) energy can successfully seal vascular structures up to 7 mm by fusing collagen and elastin in the lumen. Valleylab has created a system to expand this technology beyond vessel sealing with the development of a closed-loop, feedback-control RF generator that closely monitors tissue fusion. This generator, operating with a loop time of approximately 250 micros, continuously adjusts energy output, creating optimized soft-tissue fusion through structural protein amalgamation.

Comparison of healing process following ligation with sutures and bipolar vessel sealing.

Local hemostasis is critical for successful surgical intervention and may be accomplished with a variety of techniques ranging from direct pressure to lasers. Critical assessment of the clinical situation is required to determine the appropriate technology necessary to achieve effective hemostasis. As a general rule, ligatures remain the mainstay for effecting hemostasis in all but the smallest isolated vessels.