Patients underwent surgery under general anesthesia with single-lung ventilation using double or single lumen intubation with bronchial blockade or 2-lung ventilation, using artificial pneumothorax (5–10 mmHg, 1 L/min CO2 flow). The procedure was performed in a bimanual fashion. The surgeon used 2 instruments through 2 ports, whereas the camera was controlled by the assistant through the third port placed in the middle. Vessels, fissures, and bronchi were divided and sealed one-by-one with a hemolock, cautery hook, and Enseal (Ethicon Endo-Surgery, Inc., Cincinnati, OH) or LigaSure or endostapler, (Covidien, CT). The details were described in our previous study.[21 (link)]
Enseal
Manufactured by Johnson & Johnson
Sourced in United States
Enseal is a surgical instrument designed for sealing blood vessels and small tissue structures during surgical procedures. It utilizes advanced electrosurgical technology to provide precise and controlled tissue sealing. The core function of Enseal is to facilitate hemostasis and minimize bleeding during operations.
Automatically generated - may contain errors
Lab products found in correlation
Ligasure, by Medtronic (5 mentions)
Thunderbeat, by Olympus (4 mentions)
Harmonic scalpel, by Johnson & Johnson (3 mentions)
Sils port, by Medtronic (2 mentions)
Da vinci si, by Intuitive Surgical (2 mentions)
Harmonic, by Johnson & Johnson (1 mentions)
Roticulator, by Medtronic (1 mentions)
Vicryl, by Johnson & Johnson (1 mentions)
9 protocols using enseal
1
Minimally Invasive Lung Surgery Technique
2
Laparoscopic Sleeve Gastrectomy Reversal
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Five standard ports were used, including three 12-mm ports (for the camera, right and left working ports) and two 5-mm ports (for liver retraction and the assistant). Pneumo-peritoneum was created after using optical trocars for entry while paying attention to the presence of adhesions from previous surgery. Dissection of adhesions around the gastric sleeve was performed using the energy device EnSeal® (Ethicon Endo-Surgery, Cincinnati, OH, USA). During reversion LSG, the stomach was resected 6 cm from the pylorus using a 40 French bougie with five standard ports. BLSG and NBLSG were reinforced and oversewed using absorbable 3/0 v-loc-sutures (Covidien, Mansfield, MA, USA).
For the BLSG group, peri gastric dissection was performed 4–5 cm from the gastroesophageal junction, and a size 7.5 (1.75 cm internal diameter) MiniMizer Gastric Ring® (Bariatric Solutions International, Switzerland) was placed loosely around the pouch. Non-absorbable sutures were used to fix the ring to the stomach passing through the built-in holes in the ring. Concomitant operative procedures included crural repair when hiatal hernia was present using unidirectional barbed 2/0 V-Loc non-absorbable sutures (Covidien, Mansfield, MA, USA), and cholecystectomy using the same ports.
For the BLSG group, peri gastric dissection was performed 4–5 cm from the gastroesophageal junction, and a size 7.5 (1.75 cm internal diameter) MiniMizer Gastric Ring® (Bariatric Solutions International, Switzerland) was placed loosely around the pouch. Non-absorbable sutures were used to fix the ring to the stomach passing through the built-in holes in the ring. Concomitant operative procedures included crural repair when hiatal hernia was present using unidirectional barbed 2/0 V-Loc non-absorbable sutures (Covidien, Mansfield, MA, USA), and cholecystectomy using the same ports.
3
Standardized Laparoscopic Distal Gastrectomy Protocol
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LDG was performed by 10 surgeons, including 3 who were board-certified by the Japanese Society of Endoscopic Surgery. Surgical procedures were standardized for LDG and have been described in detail elsewhere [25 (link)–27 (link)]. LDG was performed using an ABD (LigaSure™; Medtronic plc, Dublin, Ireland, or Enseal®; Ethicon Endo-Surgery, Cincinnati, OH, USA) or USAD (Harmonic®; Ethicon Endo-Surgery or Sonicision™; Medtronic plc) as the main energy device for dissection, at each surgeon’s preference.
Most of the surgical procedures using ABD were similar to those using USAD, except for the clipless sealing procedure of certain small-caliber vessels. Intracorporal Billroth I reconstruction with functional end-to-end anastomosis or Roux-en-Y reconstruction was performed following distal gastrectomy [28 (link), 29 (link)]. A portable drain was routinely inserted at the upper border of the pancreas.
Most of the surgical procedures using ABD were similar to those using USAD, except for the clipless sealing procedure of certain small-caliber vessels. Intracorporal Billroth I reconstruction with functional end-to-end anastomosis or Roux-en-Y reconstruction was performed following distal gastrectomy [28 (link), 29 (link)]. A portable drain was routinely inserted at the upper border of the pancreas.
4
Single-Port Laparoscopic Surgery Techniques
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The SPA laparoscopic surgeries were performed in the same surgical procedures and steps by the two surgeons. After incising the skin at about 2.0–2.5 cm, subcutaneous tissue and anterior abdominal fascia were opened by Bovie electrocauterization in 40-W, monopolar coagulation mode (Bovie Medical Corporation, Inc., Melville, NY, USA) using the open Hasson technique. Entering the peritoneum, a single-port access was created by inserting a polyurethane multi-channel single-port system. The previously described platform which consisted of a wound retractor and a surgical glove was used during the earlier period of the study13 (link),14 (link), then it was replaced by a number of commercial platforms including The One Port (LapaKorea, Inc., Seoul, South Korea), OCTO Port (DalimSurgNet, Inc., Seoul, South Korea), SILS Port (Covidien, Inc., Norwalk, CT, USA) and LabSingle (Sejong Medical, Inc., Paju, South Korea). The carbon dioxide pneumoperitoneum was kept at 13 mmHg throughout the operations. The instruments used during the operations included monopolar scissors, laparoscopic energy devices such as ENSEAL (Ethicon, Inc., Somerville, NJ, USA), THUNDERBEAT (Olympus, Inc., Tokyo, Japan), or LigaSure (Medtronic, Inc., Minneapolis, MN, USA), myoma screws, laparoscopic needle holders and articulating graspers (Roticulator, Covidien, Inc., Norwalk, CT, USA).
5
Minimally Invasive Right Colectomy Technique
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Access to the abdominal cavity was obtained by a 2- to 3-cm incision through the umbilicus. The linea alba was incised, and either a SILS port (Covidien, Mansfield, Massachusetts) or GelPoint device (Applied Medical, Rancho Santo Margarita, California) was placed in the abdominal cavity. Visualization was obtained with either a 5-mm 30° angled laparoscope (Karl Storz, Tuttlingen, Germany) or a 5-mm flexible-tip Olympus Endo Eye laparoscope (Olympus, Tokyo, Japan). The procedure was carried out in standard laparoscopic fashion, both by mobilizing the retroperitoneal attachments to the right colon and distal small bowel and by taking the mesenteric vessels with a radiofrequency energy device (Enseal; Ethicon Endo-Surgery, Cincinnati, Ohio). A primary vascular (medial-to-lateral) approach was preferred. After completion of the dissection, the specimen was extracted through the periumbilical incision and a stapled side-to-side functional end-to-end anastomosis performed. The periumbilical incision was lengthened to allow for extraction of larger specimens.
6
Robotic Distal Pancreatectomy Operative Technique
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The operative technique at our institution has been described in detail previously.[21 24 (link)27 (link)28 (link)] Briefly, robotic distal pancreatectomy was performed using three robotic arms (two left, one right) and a robotic camera system (Da Vinci Si, Intuitive Surgical, Sunnyvale, California, USA). The robotic instruments used included a combination of some of the following instruments: harmonic scalpel, Cadiere forceps, fenestrated bipolar, Hem-o-lok clip® applicator and a large needle driver. The bedside assistant used conventional laparoscopic suckers, bowel graspers and endostaplers through a 12-mm assistant port placed in the left iliac fossa.
LDP was performed using various laparoscopic energy devices over the study period depending on the individual surgeon preference including the harmonic scalpel (Ethicon Endo-Surgery, Cincinnati, OH, USA), ENSEAL (Ethicon Endo-Surgery, Cincinnati, OH, USA), LigaSure (Covidien, Boulder, CO, USA) or Thunderbeat (Olympus, Tokyo, Japan). In general, dissection of the pancreas proceeded from the medial to the lateral position in most cases except for distal lesions in the pancreatic tail. Endoscopic staplers were used to transect the pancreas and in selected cases, these were reinforced with sutures.
LDP was performed using various laparoscopic energy devices over the study period depending on the individual surgeon preference including the harmonic scalpel (Ethicon Endo-Surgery, Cincinnati, OH, USA), ENSEAL (Ethicon Endo-Surgery, Cincinnati, OH, USA), LigaSure (Covidien, Boulder, CO, USA) or Thunderbeat (Olympus, Tokyo, Japan). In general, dissection of the pancreas proceeded from the medial to the lateral position in most cases except for distal lesions in the pancreatic tail. Endoscopic staplers were used to transect the pancreas and in selected cases, these were reinforced with sutures.
7
Operative Techniques in Laparoscopic Pancreatectomy
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Various operative techniques were adopted depending on the individual surgeon preference. Our operative technique for laparoscopic or robotic pancreatectomies has been described previously.[11 13 14 (link)] In general, the patient was placed in the reverse Trendelenburg position with the left shoulder elevated with or without the legs apart. Various laparoscopic energy devices were utilised such as the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH, USA), ENSEAL (Ethicon Endo-Surgery, Cincinnati, OH, USA), LigaSure (Covidien, Boulder, CO, USA) or Thunderbeat (Olympus, Tokyo, Japan). Dissection of the pancreas proceeded from the medial to lateral position in most cases except for distal lesions in the pancreatic tail. Endoscopic staplers were used to transect the pancreas and were reinforced with sutures in selected cases.
8
Robotic and Laparoscopic Pancreatic Distal Resection
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The operative technique at our institution has been described in detail previously.5 (link),16 (link)-18 (link, link) Briefly, at present, RDP was performed using three robotic arms (2 left, 1 right) and the robotic camera system (Da Vinci Si, Intuitive Surgical). The robotic instruments used included a combination of some of the following instruments: Harmonic Scalpel, cardiere forceps, fenestrated bipolar, hemolok applicator and large needle driver. The bedside assistant used conventional laparoscopic suckers, bowel graspers and endostaplers via a 12-mm assistant ports placed in the left iliac fossa.
LDP was performed using various laparoscopic energy devices over the study period depending on the individual surgeon preference including the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH, USA), ENSEAL (Ethicon Endo-Surgery, Cincinnati, OH, USA), LigaSure (Covidien, Boulder, CO, USA) or Thunderbeat (Olympus, Tokyo, Japan). In general, dissection of the pancreas proceeded from the medial to lateral position in most cases except for distal lesions in the pancreatic tail. Endoscopic staplers were used to transect the pancreas and in selected cases these were reinforced with sutures.
LDP was performed using various laparoscopic energy devices over the study period depending on the individual surgeon preference including the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH, USA), ENSEAL (Ethicon Endo-Surgery, Cincinnati, OH, USA), LigaSure (Covidien, Boulder, CO, USA) or Thunderbeat (Olympus, Tokyo, Japan). In general, dissection of the pancreas proceeded from the medial to lateral position in most cases except for distal lesions in the pancreatic tail. Endoscopic staplers were used to transect the pancreas and in selected cases these were reinforced with sutures.
9
Standardized Sleeve Gastrectomy Technique
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A standardized operating technique was performed by three experienced bariatric surgeons (> 500 cases each). First, the greater omentum was dissected from the greater curvature of the stomach using Enseal® (Ethicon, Somerville USA). Then, the stomach and angle of His were mobilized, using a posterior approach. This was completed by dissection of the anterior part of the angle of His and small gastric vessels. Next, transection of the stomach was performed using lengthwise stapling along a 40 French calibration bougie positioned along the lesser curvature, starting 4 cm proximal of the pylorus until the cardia (Echelon Flex™ Powered Plus Stapler, Ethicon, Somerville USA). A bougie size of 40 Fr is associated with a significant lower leak rate and similar weight loss results compared to smaller bougie sizes [18, (link)19] (link). The remnant of the stomach was retrieved through an enlarged port incision in the left flank. This port was closed with Vicryl (Ethicon, Somerville USA) using a suture retriever. Finally, the skin was closed with agraves.
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