Cystectomy

The LigaSure™ vessel sealing system is a unique energy-based ligation method. Complete hemostasis is achieved by reforming the collagen and elastin in vessel walls to form an autologous seal. The following are vessels typically within the recommended vessel sealing range (up to and including 7 mm in diameter), that can be sealed with the LigaSure™ system.

• Inferior cesical artery and vein
• Obturator artery and vein
• Superior gluteal artery and vein
• Cooper’s ligament

Equipment

Recommended instrument

LigaSure™ generator power setting

2-3 bars

Published Articles & Presentations

Technology

A comparison of laparoscopic bipolar vessel sealing devices in the hemostasis of small-, medium-, and large-sized arteries.
Carbonell AM, Joels CS, Kercher KW, Matthews BD, Sing RF, Heniford BT. J Laparoendosc Adv Surg Tech A. 2003;13:377-80. [ Abstract ]

Comparison of healing process following ligation with sutures and bipolar vessel sealing.
Peterson SL, Stranahan PL, Schmaltz D, Mihaichuk C, Cosgriff N. Surg Technol Int. 2002;10:55-60. [ Cite ]

The ability to seal large vessels quickly and effectively, combined with an associated decrease in needle passes on the operating field, suggest benefits directly associated with the use of the electrothermal vessel sealing system. Perhaps a more promising finding lies in the shorter duration associated with the inflammatory response. The potential for seals composed of the patient’s native tissue to reduce the inflammatory response may translate to a decrease in post-surgical adhesions. Clinical studies are currently in progress to quantify the relationship between seals made with the LigaSure™ vessel sealing system and the incidence of post-surgical adhesions.

Comparison of thermal spread after ureteral ligation with the Laparo-Sonic ultrasonic shears and the Ligasure™ system.
Goldstein SL, Harold KL, Lentzner A, Matthews BD, Kercher KW, Sing RF, Pratt B, Lipford EH, Heniford BT. J Laparoendosc Adv Surg Tech A. 2002;12:61-3. [ Abstract ]

Comparison of ultrasonic energy, bipolar thermal energy, and vascular clips for the hemostasis of small-, medium-, and large-sized arteries.
Harold KL, Pollinger H, Matthews BD, Kercher KW, Sing RF, Heniford BT. Surg Endosc. 2003;17:1228-30. [ Abstract ]

High-burst-strength, feedback-controlled bipolar vessel sealing.
Kennedy JS, Stranahan PL, Taylor KD, Chandler JG. Surg Endosc. 1998;12:876-878. [ Abstract ]

How safe is high-power ultrasonic dissection?
Emam TA, Cuschieri A. Ann Surg. 2003;237:186-91. [ Abstract ]

Initial results with an electrothermal bipolar vessel sealer.
Heniford BT, Matthews BD, Sing RF, Backus C, Pratt B, Greene FL. Surg Endosc. 2001;15:799-801. [ Abstract ]

Real-time thermography during energized vessel sealing and dissection.
Campbell PA, Cresswell AB, Frank TG, Cuschieri A. Surg Endosc. 2003;17:1640-5. [ Abstract ]

Reducing Needlestick Injuries in the Operating Room.
Boulder, CO: Valleylab white paper; 2003. [ PDF ]

Procedure

Evaluation of a new vessel sealing device in urologic cancer surgery.
Crawford DE. Boulder, CO: Valleylab white paper; 2000. [ PDF ]

Radical cystectomy in females.
Olsson CA, Olsson LE, Benson MC. Curr Surg Tech Urol. 2001;14:1-8.

While the use of two new technologies, EndoGIA™ and the LigaSure™ system, is not widespread, there are clearly areas of difficulty in the conduct of an anterior pelvic exeneration, which these technologies facilitate greatly. Obviously, there is not much blood loss to be experienced in the taking of the round ligament or ovarian vessels. However, control of the bladder pedicles by means of serial applications of the EndioGIA™ stapler is helpful. Furthermore, sacrifice of the anterior vaginal wall or control of the posterolateral venous pedicles of the bladder in preserving the anterior wall of the vagina is truly aided by the LigaSure™ device, as is the dorsal venous complex.

Use of the LigaSure vessel sealing system in urologic cancer surgery.
Crawford ED. Grand Rounds Urology. 1999;1:10-7.