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Evaluation of a vessel-sealing device for small intestinal resection and anastomosis in normal horses
Marilyn L Rumbaugh1, Daniel J Burba, Claudio Natalini
1Equine Health Studies Program, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA.
Objectives:
To compare arterial bursting pressure after vessel closure using a vessel-sealing device (LigaSure Atlas Laparoscopic Sealer/Divider Instrument; Valleylab, Boulder, CO), a ligate-and-divide stapling device (LDS), and 2-0 polydioxanone suture. To evaluate the LigaSure Atlas as a method for ligation of the mesenteric vasculature during small intestinal resection in normal horses.
Study Design:
Experimental study.
Animals:
Part A: jejunal segments from 19 horses. Part B: 6 horses, aged 1 to 18 years, weighing 330 to 509 kg.
Methods:
Part A: Jejunal segments with mesenteric vessels were collected from 19 horses. After closure by 1 of 3 methods (LigaSure Atlas, LDS, 2-0 polydioxanone) arteries were cannulated, and bursting pressure was measured by incrementally increasing intraluminal pressure until failure. Part B: Six horses had jejunal resection and anastomosis using a vessel-sealing device (LigaSure Atlas) to provide hemostasis of the mesenteric vasculature. Horses were monitored clinically for 4 weeks.
Results:
Part A: Mean +/- SEM bursting pressure after 2-0 polydioxanone ligation (1,014.50 +/- 279.05 mm Hg) was significantly greater than mean bursting pressure after LigaSure (554.25 +/- 228.79 mm Hg), which was significantly greater than the mean bursting pressure after LDS (373.25 +/- 183.69). Part B: No major operative or postoperative hemorrhage occurred after application of the LigaSure Atlas for sealing and transecting mesenteric vasculature during small intestinal resection in normal horses.
Conclusions:
The LigaSure Atlas appears to be a safe method for hemostasis of the mesenteric vasculature during small intestinal resection in normal horses.
Clinical Relevance:
Benefits of the LigaSure Atlas vessel-sealing device include reduced time required to provide hemostasis, acceptable arterial bursting pressure, no remaining foreign material, and no risk for ligature slippage. In our experience, use of the LigaSure Atlas during small intestinal resection and anastomosis in horses is safe for ligation of vessels less than or equal to 7-mm diameter.
