Evaluation of the appropriate LigaSureTM device to transect the appendix - A comparison of 5mm and 10mm laparoscopic devices in an ex vivo trial

Background. The idea was to evaluate whether a transection of the appendix using LigaSureTM Vessel Sealing System (LVSS) is feasible and if so which laparoscopic device is optimal. Methods. An ex vivo trial was performed on appendectomy specimens after routine laparoscopic appendectomy for acute appendicitis. Two laparoscopic LigaSure devices, LigaSureTM 5mm and LigaSure Atlas TM 10mm hand switching devices, were compared. The end points were handling, eligibility, durability, air-tightness, integrity and resistance to bursting of the appendicular stump. A written consent was obtained from all parents. The children operated on for acute appendicitis were assigned based on clinical and ultrasonographic criteria. Results. On 10 appendectomy specimens, both of the LigaSureTM devices were used to transect the appendix in one attempt. While the 5mm instrument was not able to transect the appendix in one attempt in any of the cases, the 10mm device could be applied without any handling difficulties. Using the 5mm device, it was not possible to grasp the appendix, since the appendix slipped out of the jaw parts of the instrument. All of the stumps were sealed completely using the 10mm device. There was no leakage on air-tightness. The resistance to bursting pressure was on average 600mmHg without any sign of perforation. Conclusions. Using the 10mm laparoscopic Liga- SureTM device for transection of the appendix seems to be feasible, safe and resistant to normal bursting pressure. In contrast, the 5mm LigaSureTM instrument is completely inadequate to seal the appendix in humans.