A new technological approach to nonanatomical pulmonary resection: saline enhanced thermal sealing

This is the first clinical report on the feasibility study of two new devices (monopolar Floating Ball and bipolar Sealing Forceps; TissueLink Medical Inc, Dover NH) that incorporated the novel technology of saline enhanced thermal sealing.

From December 2000 to December 2001, 25 patients (mean age, 54.8 years) with peripheral lung nodules planned for either diagnostic or therapeutic wedge resection were recruited for the study. When the nodule lay deep to a flat lung surface, video-assisted thoracic surgical resection using the modified Perelman technique with the Floating Ball (TissueLink Medical Inc) was preferred. In other patients, the Sealing Forceps (TissueLink Medical Inc) were used for video-assisted thoracic surgical wedge resection.

There were no mortality or major intraoperative complications. The Floating Ball was used exclusively in 11 patients; the Sealing Forceps were used in 9 patients; and a combination of the two devices was used in 5 patients. The mean operation time was 70.3 minutes. Average chest drain duration was 3.9 days, and postoperative hospital stay was 5.2 days. There were 2 patients with persistent air leak more than 1 week, one who resolved spontaneously, and the other who required reoperation for control. One patient had pulmonary embolism after a technically uneventful procedure. There have been no late complications after an average follow-up of 10 months.

The devices appear to be technically safe. The Floating Ball has definite advantages over the conventional diathermy and can be adapted to the Perelman procedure using the video-assisted thoracic surgical approach. The Sealing Forceps hold promise to reduce overall consumable costs compared with conventional staplers. These devices should complement the surgeon's existing armamentarium. Comparative studies with conventional instruments are warranted to further define the role of these new devices in thoracic operations.