Electrothermal Bipolar Vessel Sealer in Endoscope-Assisted Latissumus Dorsi Flap Harvesting Erdem Gu ¨ ven, MD, Karaca Bas ¸aran, MD, Memet Yazar, MD, Burcu C ¸ elet O ¨ zden, MD, Samet Vasfi Kuvat, MD, and Hu ¨ lya Aydın, MD Abstract LigaSureÔ is a new bipolar vascular sealing system commonly used in various fields of surgery. However, no reports have been published about its use in plastic surgery, particularly for endoscopic flap harvesting. In this study, we present the use of LigaSure in endoscope-assisted latissimus dorsi (LD) flap harvesting for breast reconstruction. Between 2006 and 2008, 11 female patients with the mean age of 33.4 (range, 20–49 years) who had previously undergone mastectomy operations were included in the study. First stage of reconstruction was performed with the ipsilateral LD harvested by the help of LigaSure and a tissue expander placed beneath the LD and pectoralis major muscles. Secondary reconstruction was done by a definitive silicon gel–filled implant placed after an average of 6.6 months of expansion (range, 6–9 months). Data concerning the hospitalization and operation times, drainage amounts, complications, etc., were recorded. Mean follow-up was 13 months (range, 8–18 months). Mean flap harvesting time was recorded as 74.2 minutes (range, 50–125 minutes), which short- ened as the surgeon got used to the procedure. Patients were hospitalized for 3–7 days, with a mean hospi- talization period of 5.5 days. The total mean drainage amount postoperatively was found to be 950 mL (range, 725–975 mL), which is relatively lower than the previously reported values. LigaSure use in endoscope-assisted LD harvesting is easy, safe, and time sparing with almost no complications observed in this small initial series. Although more controlled studies with larger number of patients need to be done to verify its effectiveness in terms of hospitalization, drainage amounts, etc., it holds promise for a wide spectrum of operations in the field of plastic surgery. Introduction B eginning in the early 1980s, pedicled musculocuta- neous flaps, such as the latissimus dorsi (LD) and trans- verse rectus abdominis musculocutaneous flaps, have been used extensively for postmastectomy breast reconstruction. In the last decade, with the development of microsurgery, free perforator flaps, such as the deep inferior epigastric artery and superior gluteal artery, have been added to the armamentar- ium of the reconstructive surgeon. However, the requirement of microsurgical skills and a trained staff in a large center, longer operation time, unique contraindications for free flaps, and the relatively high cost make pedicled flaps more cost- effective overall. Although one of these pedicled flaps, the LD flap, is com- monly used in breast reconstruction, this procedure has sev- eral disadvantages. One drawback is the relatively poor aesthetic and functional outcome of the donor site. 1,2 In a study, 22% of patients rated their donor site scar unaccept- able. 3 Endoscopy-assisted LD harvesting, which has been developed to overcome this problem, is the surgery of choice for many reconstructive surgeons. 4–7 Electrothermal bipolar vessel sealer (EBVS; LigaSure; Vessel Sealing System) has been used in various surgical specialties, including general surgery, urology, obstetrics, and gynecology. Many studies have demonstrated the gen- eral safety and effectiveness of this hemostasis device. 8,9 However, no reports have been published about the use of EBVS in plastic surgery, particularly for endoscopic flap harvesting. In this study, we present our early experience with the EBVS system in reconstructive plastic surgery. We demon- strate the effectiveness of this new surgical tool in 11 breast cancer patients who, following mastectomy, had their breasts reconstructed using an endoscope-assisted LD flap with an expandable prosthesis. Department of Plastic, Reconstructive, and Aesthetic Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Volume 20, Number 9, 2010 ª Mary Ann Liebert, Inc. DOI: 10.1089/lap.2010.0056 735