Optimizing the dissection of small-diameter pulmonary vessels using vessel-sealing systems

Although vessel-sealing systems have been shown useful for dissection of small-diameter vessels, no studies to date have evaluated the optimal angle of dissection. Lateral thermal damage to a canine pulmonary artery was assessed microscopically. Burst pressure was compared in swine carotid arteries undergoing orthogonal and oblique dissections to determine the safer dissection technique. Histological analysis of a canine model revealed a thermal spread of approximately 1.3 mm. Burst pressure comparison showed no significant differences between orthogonal and oblique dissection angles (829.2 mmHg [range 608-1214 mmHg] vs. 949.1 mmHg [range, 593-1306 mmHg], P = 0.206). In a surrogate arterial model, burst pressure did not differ between orthogonal and oblique cuts. Given histologically limited lateral thermal spread on PA, angle may be less critical than avoiding vessel tension. These findings may contribute to the safer application of vessel-sealing systems in patients undergoing minimally invasive thoracic surgery.