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The utility of a reusable bipolar sealing instrument, BiClamp^®, for pulmonary resection

^a Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine Saga University, Saga, Japan
^b Department of Pathology, Faculty of Medicine Saga University, Saga, Japan

Received 22 February 2008; received in revised form 7 May 2008; accepted 19 May 2008.

^_* Corresponding author. 5-1-1 Nabeshima, Saga 849-8501, Japan. Tel.: +81 952 34 2345; fax: +81 952 34 2061. (Email: sakuragi{at}cc.saga-u.ac.jp).

Objective: To assess the use of a combination of bipolar sealing and electrosurgical coagulation for pulmonary resection. Methods: The procedure was used in both dogs and humans. Initially, lung wedge resections were performed on six healthy, Beagle dogs using a voltage controlled electrosurgical system. The area of lung tissue to be resected was first coagulated to provide a distinct line of seal. The lung was then resected along the peripheral site of the sealing scar. Efficiency of sealing was assessed using a tracheally applied air pressure of 30 cmH₂O. The electro-cauterized tissue was compared histologically to tissue sealed by a standard stapling technique. In the clinical phase, lung resections were performed after cauterization in 17 patients. Bullectomies were performed using video-assisted thoracic surgery in 4 patients, and thoracotomic procedures in 13 (1 bullectomy, 5 wedge resections, and 7 fissure separations). Results: Dogs: Tissue sealing was highly successful, without any air leakage, in all six dogs. Histologically, the clamped lesion showed tissue-fusion probably due to both the compression and thermal effects. The proximal zone adjacent to the clamped lesion revealed both collapsed alveolar spaces and fused alveolar walls. In comparison, the stapled lesions showed no tissue-fusion. Humans: There were no major complications. The median operation time was 189 min, and estimated median hemorrhage volume was 67 ml. Median chest drainage duration was 3 days (range: 1–7) and no patient suffered from prolonged air leakage (>7 days). Conclusions: Lung parenchymal tissue resection following bipolar sealing and electrosurgical coagulation instead of staples was efficient and simple. Furthermore, the technique reduced the use of staples, reducing the cost of the surgery.

Key Words: Pulmonary resection • Reusable • Bipolar • Ecosurgery • Electrosurgical system • BiClamp^®