Energy source instruments for laparoscopic colectomy

Tou, Samson; Malik, Ali Irqam; Wexner, Steven D.; Nelson, Richard L.

doi:10.1002/14651858.cd007886

Cited by 14 publications

(16 citation statements)

References 12 publications

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“…These devices expedite normally labor-intensive surgical procedures such as lobectomy, 1,2 nephrectomy, 3 gastric bypass, 4-6 splenectomy, 7,8 thyroidectomy, [9][10][11][12][13][14] hysterectomy, 15 and colectomy. [16][17][18][19] However, both electrosurgical and ultrasonic devices have limitations, including the potential for undesirable charring and unnecessarily large collateral thermal damage zones. [20][21][22] For example, more thermal energy is required to seal large blood vessels with such devices, and stray thermal energy escaping the seal area can lead to unintended lateral tissue thermal damage.…”

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confidence: 99%

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

et al. 2013

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Abstract. Suture ligation of blood vessels during surgery can be time-consuming and skill-intensive. Energy-based, electrosurgical, and ultrasonic devices have recently replaced the use of sutures and mechanical clips (which leave foreign objects in the body) for many surgical procedures, providing rapid hemostasis during surgery. However, these devices have the potential to create an undesirably large collateral zone of thermal damage and tissue necrosis. We explore an alternative energy-based technology, infrared lasers, for rapid and precise thermal coagulation and fusion of the blood vessel walls. Seven near-infrared lasers (808, 980, 1075, 1470, 1550, 1850 to 1880, and 1908 nm) were tested during preliminary tissue studies. Studies were performed using fresh porcine renal vessels, ex vivo, with native diameters of 1 to 6 mm, and vessel walls flattened to a total thickness of 0.4 mm. A linear beam profile was applied normal to the vessel for narrow, full-width thermal coagulation. The laser irradiation time was 5 s. Vessel burst pressure measurements were used to determine seal strength. The 1470 nm laser wavelength demonstrated the capability of sealing a wide range of blood vessels from 1 to 6 mm diameter with burst strengths of 578 AE 154, 530 AE 171, and 426 AE 174 mmHg for small, medium, and large vessel diameters, respectively. Lateral thermal coagulation zones (including the seal) measured 1.0 AE 0.4 mm on vessels sealed at this wavelength. Other laser wavelengths (1550, 1850 to 1880, and 1908 nm) were also capable of sealing vessels, but were limited by lower vessel seal pressures, excessive charring, and/or limited power output preventing treatment of large vessels (>4 mm outer diameter). © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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confidence: 99%

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

et al. 2013

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“…Current bipolar and ultrasonic laparoscopic instruments allow adequate surgical dissection without bleeding thanks to the satisfactory vessels sealing without injury to the surrounding tissues [5], and tend to diminish the surgical time because of their efficacy [6]. Among the available equipment in the market are the Harmonic scalpel™, Ligasure™ and Trissector™, with an average functioning time that varies from 3 to 11 seconds, with vessel sealing diameter from 3 to 7 mm, and shutting pressures to rupture of the blood vessels from 363 to 536mmHg [7].…”

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confidence: 99%

Use of the radiofrequency Caiman® Aesculap® Grasper in three different laparoscopic urologic procedures with video

Soto‐Vega¹,

Torres-Pérez²,

Arroyo³

2018

Trends Med

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Introduction: The Caiman grasper is a radiofrequency instrument that allows cutting and sealing of tissues and blood vessels, with the added benefit of a distal closure that allows a stable pressure in its 26.5mm long tip, with a less than 1mm thermic injury of the adjacent tissues, with energy regulation depending on the tissue characteristics, allowing to seal up to 7mm vessels. All the above makes dissection easier and diminishes surgical time, making the laparoscopic procedures safer and faster, including urologic surgeries.

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“…A review of the literature did not reveal one energy type or device to be superior for laparoscopic colectomy or associated with a lower rate of inadvertent or missed organ injury. 119 Blunt dissection is a useful adjunct to release thin adhesions or to create more space between organs and the abdominal wall for energy device use. The general principle of working from known to unknown structures in open surgery also applies to minimally invasive adhesiolysis to maximize safety during dissection.…”

Section: Avoiding Organ Injury: Surgical Techniquementioning

confidence: 99%

Role of Minimally Invasive Surgery in the Reoperative Abdomen or Pelvis

Feigel

Sylla

2016

Clinics in Colon and Rectal Surgery

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Laparoscopy has become widely accepted as the preferred surgical approach in the management of benign and malignant colorectal diseases. Once considered a relative contraindication in patients with prior abdominal surgery (PAS), as surgeons have continued to gain expertise in advanced laparoscopy, minimally invasive approaches have been increasingly incorporated in the reoperative abdomen and pelvis. Although earlier studies have described conversion rates, most contemporary series evaluating the impact of PAS in laparoscopic colorectal resection have reported equivalent conversion and morbidity rates between reoperative and non-reoperative cases, and series evaluating the impact of laparoscopy in reoperative cases have demonstrated improved short-term outcomes with laparoscopy. The data overall highlight the importance of case selection, careful preoperative preparation and planning, and the critical role of surgeons' expertise in advanced laparoscopic techniques. Challenges to the widespread adoption of minimally invasive techniques in reoperative colorectal cases include the longer learning curve and longer operative time. However, with the steady increase in adoption of minimally invasive techniques worldwide, minimally invasive surgery (MIS) is likely to continue to be applied in the management of increasingly complex reoperative colorectal cases in an effort to improve patient outcomes. In the hands of experienced MIS surgeons and in carefully selected cases, laparoscopy is both safe and efficacious for reoperative procedures in the abdomen and pelvis, with measurable short-term benefits.

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Energy source instruments for laparoscopic colectomy

Cited by 14 publications

References 12 publications

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

Infrared laser thermal fusion of blood vessels: preliminaryex vivotissue studies

Use of the radiofrequency Caiman® Aesculap® Grasper in three different laparoscopic urologic procedures with video

Role of Minimally Invasive Surgery in the Reoperative Abdomen or Pelvis

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