THE USE OF A BIPOLAR SEALER FOR HAEMOSTASIS IN MAJOR ORTHOPAEDIC SURGERY (TOTAL HIP AND KNEE ARTHROPLASTY AND SPINAL SURGERY)

Abstract

Background: Authors used a new bipolar sealer system (TissueLink Medical Inc., Dover, New Hampshire) for electrocoagulation in major orthopaedic surgery such as total hip and knee arthroplasty and spinal surgery. The bipolar sealer is an electrosurgical device which delivers radiofrequency energy to saline for haemostatic sealing and coagulation of soft tissue at the operative site providing haemostasis at much lower temperatures than conventional electrocautery (< 100°C).

Materials and Methods: Since October 2004 through June 2007 the authors conducted a randomized study on 800 patients – total hip or Knee arthroplasty or spinal surgery–to compare the clinical outcomes in two groups. In the study cohort the bipolar sealer device was used, in the matching group conventional electrocautery. Both cohorts were evaluated for intraoperative blood loss, transfusion rate, postoperative drainage, number of transfusions and haemoglobin levels. Patients with known coagulation and peripheral circulation disorders were excluded. No preoperative autologous blood donation was utilized.

Results: All patients recovered without complications and no re-operations became necessary in both groups. A significant reduction in post-operative and total blood loss (p=0.05 and p=0.02, respectively) occurred, as well as absence of tissue charring and smoke production in the bipolar sealer group. The mean decline in haemoglobin was significantly lower for the treatment group compared to the control group. The allogenic blood transfusion rates were extremely low in both groups (4.4% control vs. 0% treatment group). The mean volume of post-operative drainage was 451 milliliters (range, 1500 to 815 milliliters) for the standard electrocautery group and 256 milliliters (range, 0 to 743 milliliters) for the bipolar sealer group (p=0.002).

Discusssion and conclusion: Results suggest that use of this bipolar sealing device is at least as effective as standard cautery devices and may reduce blood loss, tissue damage and smoke production in major orthopaedic surgery without affecting outcome. Lesser bleeding results in faster recovery of the patient, better wound healing and lower complication rates