Clipless Hand-assisted Laparoscopic Total Colectomy Using LigaSure Atlas

Abstract

Hand-assisted laparoscopic total colectomy for ulcerative colitis has allowed less invasive operations in acute severe colitis and poor risk, and has not yet been widely applied for the reason of prolong the operating time in comparison with open surgery. We present the advantages of the use of the LigaSure Atlas vessel sealing for vascular control during laparoscopic surgery. A retrospective study was conducted to compare 15 patients who underwent hand-assisted laparoscopic total colectomy using an ultrasonic coagulator from January 1988 to September 2002 (US group) with 18 patients who were operated using LigaSure Atlas (LS group) from October 2002 to December 2003. There was no significant difference in the background factors of patients between both groups. The operating time was 225 +/- 58 min in the LS group and less than 280 +/- 105 min in the US group. Intraoperative blood loss was 91 +/- 22 ml in the LS group and less than 212 +/- 178 ml in the US group. Postoperative bleeding did not occur in the LS group, but occurred in 1 patient in the US group (6.6%) and this patient required re-operation. Postoperative seroma formation in the abdomen was found in 3 patients of the US group (20%). The procedure using LigaSure Atlas reduced the operating time, intraoperative bleeding and operator's stress in comparison with standard ultrasonic coagulation.

Energy Sources for Laparoscopic Colectomy: A Prospective Randomized Comparison of Conventional Electrosurgery, Bipolar Computer-Controlled Electrosurgery and Ultrasonic Dissection. Operative Outcome and Costs Analysis

“…Ligasure has been described as the only tool required for splenectomy, 6 hysterectomy, 5 hepatectomy, 14 live-donor kidney, 15 and hand-assisted colectomy. 7 It was this lack comparative studies that prompted the present study. Our results clearly show that advanced technology reduces not only blood loss but also operative time, consequently reducing the final bill compared with procedures performed with conventional electrosurgical energy.…”

Electrothermal bipolar vessel sealing device vs. ultrasonic coagulating shears in laparoscopic colectomies: a comparative study

“…Akari et al [1] conducted a retrospective study to compare 15 hand-assisted total colectomies using UCS to 18 using the EBVS Atlas 10 mm. The operating time was 55 min longer with the UCS, but a major rebleeding episode requiring reoperation occurred in the EBVS group.…”

Ultrasonic and Nonultrasonic Instrumentation

“…The 2 additional operations in the ultrasonic group were (1) in a patient undergoing transanal endoscopic microsurgery and simultaneous right hemicolectomy and (2) in a patient undergoing a hand-assisted laparoscopic total colectomy procedure for postoperative bleeding. 17,18 Fewer conversions from laparoscopic to open procedures were required with ultrasonic instrumentation use except in solid organ procedures. Drainage output, duration of drainage, or both were reported for mastectomy, head and neck, and solid organ procedures and were reported less frequently with ultrasonic instrumentation use.…”