Enseal g2

We obtained an Institutional Animal Care and Use Committee approval to perform the study experiments. We evaluated five VSDs: the Caiman 5 (C5; Aesculap, Inc., Center Valley, PA), Harmonic Scalpel Ace Plus (HA; Ethicon Endosurgery, Cincinnati, OH), Harmonic Ace +7 (HA7; Ethicon Endosurgery), LigaSure (LS; Covidien, Mansfield, MA), and Enseal G2 (ES; Ethicon Endosurgery). We used each VSD according to the settings recommended by the manufacturer.
There were three phases to the study methodology, including in vivo dissection, ex vivo testing of bursting pressure, and finally histopathologic examination of vessel seals.
We used 15 Yorkshire pigs (30–35 kg) to evaluate the 5 devices (total 3 pigs per device). The surgeons performing the testing (Z.O. and J.L.) were experienced with all the energy devices. Despite surgeon familiarity, one pig was utilized to train the surgeons on tissue and vessel sealing in the porcine model to mitigate any device-specific learning curve.

The Pringle maneuver was routinely used to minimize blood loss during hepatic surgery by clamping the vascular pedicle as tightly as possible. The line of transection was marked with electrocautery and parenchymal transection performed with a laparoscopic Cavitron ultrasonic surgical aspirator (CUSA) (Valleylab, Boulder, CO, USA) or by the crushing method using a BiClamp (ERBE, Tubingen, Germany). An articulating sealing device (Enseal; G2, Ethicon Endo-Surgery, Cincinnati, OH, USA) was also used during laparoscopic hepatectomy. The surgical margin of the resection was confirmed with laparoscopic ultrasound during hepatectomy. Hem-o-Lok clips (Weck Surgical Instruments, Teleflex Medical, Durham, NC, USA) were applied to larger vessels. The specimen was placed in a retrieval bag and extracted through a pre-existing scar or an extension of a port site wound. An intrabdominal drain was routinely placed. Prophylactic systemic antibiotic therapy with 1 g cefmetazole was administered routinely immediately before surgery and twice daily for the first two post-operative days.