Comparison of Monopolar Electrocoagulation, Bipolar Electrocoagulation, Ultracision, and Ligasure

Diamantis, Theodore; Kontos, Michael C.; Arvelakis, Antonios; Syroukis, Spiridon; Koronarchis, D.; Papalois, Αpostolos; Agapitos, Emmanuel; Bastounis, Elias; Lazaris, Andreas C.

doi:10.1007/s00595-006-3254-1

Cited by 149 publications

(149 citation statements)

References 32 publications

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“…The output is feedbackcontrolled so that a reliable seal is achieved in minimal time, independently of the type or amount of tissue in the jaws. The thermal spread is significantly less than with traditional bipolar systems and comparable with that of ultrasonic coagulation [23].…”

Section: Discussionmentioning

confidence: 83%

“…All the studies were read in their entirety to assess their appropriateness for inclusion in the metaanalysis. All studies that compared EBVS and UE in an experimental setting [23], EBVS/UE with other energy sources [24,25], or two instruments for dissection and vessel sealing [26] in laparoscopic colorectal surgery were included in the metaanalysis.…”

Section: Methodsmentioning

confidence: 99%

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Radiofrequency versus ultrasonic energy in laparoscopic colorectal surgery: a metaanalysis of operative time and blood loss

et al. 2012

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Background Various energy sources are available for tissue dissection and vessel sealing in laparoscopic colorectal surgery. The electrothermal bipolar vessel sealing system (EBVS) and ultrasonic energy (UE) devices are widely used to provide hemostatic dissection in laparoscopic procedures. Nevertheless, available evidencedbased data comparing their operative results still are scarce. This study conducted a metaanalysis of controlled clinical trials comparing EBVS and UE in terms of operative time and intraoperative blood losses in laparoscopic colorectal surgery Methods The MEDLINE and Embase databases were searched using medical subject headings and free text words. All randomized controlled trials (RCTs) and controlled clinical trials using EBVS and UE in laparoscopic colorectal surgery were considered for inclusion in the study. Random effects models were used in case of heterogeneity to obtain summary statistics for the overall difference in operating time and blood loss between instruments.Results Four studies comparing EBVS with UE for 397 patients (200 EBVS vs. 197 UE patients) were included in the study. The findings showed that EBVS was associated with a significantly shorter operative time and less intraoperative blood loss than UE (p \ 0.05). Conclusions The metaanalysis indicated that EBVS is associated with a shorter operative time and less blood loss than UE in laparoscopic colorectal surgery. However, these results should be interpreted with caution due to the high heterogeneity of the included trials and the limited number of studies with a high level of evidence. More adequately designed RCTs with a larger number of patients are required to confirm the results of this metaanalysis.

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Section: Discussionmentioning

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Radiofrequency versus ultrasonic energy in laparoscopic colorectal surgery: a metaanalysis of operative time and blood loss

et al. 2012

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“…Additionally, UC created less full-thickness damage in the bladder, peritoneum, stomach, and colonic tissues. In contrast, Diamantis et al [23] compared the effects of UC and BP on rabbits' short gastric vessels. They reported greater thermal injury and inflammatory response after UC than after BP during the second postoperative week.…”

Section: Discussionmentioning

confidence: 98%

Histopathological Response and Adhesion Formation After Omentectomy with Ultrasonic Energy, Bipolar Sealing, and Suture Ligation

2013

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This study was designed to evaluate the histopathological response and intra-abdominal adhesion formation after an omentectomy in rats using the bipolar vesselsealing device, ultrasonic coagulator, and suture ligation techniques. Forty Wistar albino rats were used, divided into four random groups. The rats underwent a midline laparotomy, and a partial omentectomy was performed using a 3-0 silk suture with suture ligation in group 1, bipolar device in group 2, and ultrasonic coagulator in group 3; only a laparotomy was performed on the control group. Lateral thermal damage was examined the same day, and a piece of the omentum was left in the animals to be examined on postoperative day 15. A relaparotomy was performed to assess adhesion formation and histopathological response.

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“…Minimizing thermal damage to surrounding tissues without compromising safety and tissue integrity is of importance in surgery. Ultrasonic instruments are tried to be safer than traditional diathermy [7,20,[24][25][26]. The Ultrasonic shears incorporate piezoelectric transducers that induce a vibration frequency at the functional tip and transduces a lower amount of energy to the tissue than high-frequency current or laser techniques, resulting in reduced lateral thermal damage and penetration depth owing to lower temperatures [7,20,27].…”

Section: Thermal Damage In Laparoscopy-an In-depth Reviewmentioning

confidence: 99%

“…Both technologically advanced, they have been suggested to have excellent results and minimal lateral thermal injury. [6,7,18,20,24,26]. Laparoscopic ultrasonic instruments obtain the same cutting and coagulation objectives but in different manners.…”

Section: Thermal Damage In Laparoscopy-an In-depth Reviewmentioning

confidence: 99%

Surgical Efficacy Among Laparoscopic Ultrasonic Dissectors: Are We Advancing Safely? A Review of Literature

Devassy

Gopalakrishnan

Wilde

2015

J Obstet Gynecol India

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The specialty of laparoscopy has evolved with the advent of new technologies over the last few years. Energy-based devices and Ultrasonic dissectors are used with a lot of factors in play-including ergonomics and economics during surgery. Here an attempt is based to review the surgical efficacy and safety of these dissectors with importance to plume production and lateral thermal damage. The factors contributing to adversities to the dissectors are also to be noted. The strategy adopted was aimed at finding relevant studies from PubMed from 1995 to 2014. The basic principle of plume production and thermal damage are studied in this review. Factors contributing to the same that can lead to adversities during laparoscopic surgeries are identified. Summarizing key points that increase lateral thermal damage and plume production amongst different ultrasonic shears and suggesting a technique to identify the right balance between the existing dissectors was possible. The RF Device and USS are both useful and widely used and are more safer than monopolar devices. RF Device is considerably slower than USS, as it cannot achieve coagulation and cutting at the same time. Although USS definitely improvises dissection and has less thermal injury than RF Device, the clinical implications in balancing dissection efficacy with hemostasis need to be investigated further. The ideal haemostatic energy-based shear device would be one with excellent hemostatic results and visual acuity while allowing none or minimal thermal energy escape at the point of application. In our current setting, a combined use of both RF and USS device usage as applied in the particular situations has potential.

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Comparison of Monopolar Electrocoagulation, Bipolar Electrocoagulation, Ultracision, and Ligasure

Cited by 149 publications

References 32 publications

Radiofrequency versus ultrasonic energy in laparoscopic colorectal surgery: a metaanalysis of operative time and blood loss

Radiofrequency versus ultrasonic energy in laparoscopic colorectal surgery: a metaanalysis of operative time and blood loss

Histopathological Response and Adhesion Formation After Omentectomy with Ultrasonic Energy, Bipolar Sealing, and Suture Ligation

Surgical Efficacy Among Laparoscopic Ultrasonic Dissectors: Are We Advancing Safely? A Review of Literature

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