Safety and efficacy of the electrothermal bipolar vessel sealer in trauma

The electrothermal bipolar vessel sealer (EBVS) was developed as an alternative to sutures, clips, and the ultrasonic scalpel for haemostasis during open and laparoscopic surgery. The purpose of this prospective clinical study was to objectively evaluate the performance of the EBVS during trauma surgery. Data from trauma cases, in which the EBVS was used, was collected prospectively for 19 consecutive months. Data collected included: total number of EBVS applications, need for additional haemostatic devices after application, calculated time savings or loss, and hemorrhagic complications. The EBVS was used in 23 trauma cases consisting of 13 small bowel resections, 4 ileocolectomies, 2 left hemicolectomies, 1 transverse colectomy, 1 right hemicolectomy with roux-en-Y gastrojejunostomy and duodenostomy, 1 Hartmann's procedure, and 1 splenorrhaphy with omental injury repair. A total of 631 applications of the device were used, averaging 27.4 applications per case. An additional suture ligature or clip placed for an inadequate EBVS seal (failure) was needed in only 1.5% of the total EBVS applications. All of these (10) occurred in one patient undergoing Hartmann's procedure for massive colonic injury. An additional 45 sutures or clips for non-EBVS failure were used in 5 cases due to proximity of bleeding to critical vascular, biliary, or bowel structures. In 17 trauma cases (74%) with intestinal resection no other means of hemostasis (sutures or clips) was required except the EBVS. The mean calculated time savings using the EBVS was 26.8 min (range 9.8-48) per case. There were no haemorrhagic complications. The EBVS is safe and effective for intestinal resections and haemostasis in trauma surgery. This novel energy source reliably seals major mesenteric vessels with little need for sutures or clips. Using the EBVS can substantially shorten operative time.