Safety and efficacy of new integrated bipolar and ultrasonic scissors compared to conventional laparoscopic 5-mm sealing and cutting instruments

Abstract

BackgroundHemostasis is a central issue in laparoscopic surgery. Ultrasonic scissors and bipolar clamps are commonly used, with known advantages with each technique.MethodsThe prototype of new surgical scissors, delivering ultrasonically generated frictional heat energy and bipolar heat energy simultaneously (THUNDERBEAT® [TB]), was compared to ultrasonic scissors (Harmonic ACE® [HA]) and an advanced bipolar device (LigaSure® [LS]) using a pig model. As safety parameters, temperature profiles after single activation and after a defined cut were determined. As efficacy parameters, seal failures and the maximum burst pressure (BP) were measured after in vivo sealing of vessels of various types and diameters (categories 2–4 and 5–7 mm). Moreover, the vertical width of the tissue seal was measured on serial histological slices of selected arteries. The cutting speed was measured during division of isolated arteries and during dissection of a defined length of compound tissue (10 cm of mesentery). Burst-pressure measurement and histological analysis were performed by investigators blinded to the used sealing device.ResultsUsing the TB, the burst pressure in larger arteries was significantly higher (734 ± 64 mmHg) than that of the HA (453 ± 50 mmHg). No differences in the rate of seal failures were observed. The cutting speed of the TB was significantly higher than that of all other devices. Safety evaluation revealed temperatures below 100 °C in the bipolar device. The maximum temperature of the HA and the TB was significantly higher. No relevant differences were observed between the HA and the TB.ConclusionsThe ultrasonic and bipolar technique of the TB has the potential to surpass the dissection speed of ultrasonic devices with the sealing efficacy of bipolar clamps. However, heat production that is comparable to conventional ultrasonic scissors should be minded for clinical use.

Single incision gastrectomy for gastric cancer

“…In our early experience, one patient was readmitted after discharge because of splenic artery pseudoaneurysm, and underwent reoperation with intensive care. This type of unique complication that might result from thermal damage by the various energy device was already reported even in a previous large scale study of laparoscopic distal gastrectomy with lymph node dissection (34,35). In particular, during SIDG, use of an energy-based device should be minded with much more caution because there is no effective assistance to avoid possible thermal injury to adjacent tissues, including major vessels.…”

Vessel Sealing Device in Parotid Gland Surgery: Clinical and Pathological Study

“…Moreover, the possibility of heat damage from the ultrasonic wave surgical knife has also been pointed out (Kim et al, 2008). LigaSure TM Small Jaw could be used instead of hand ligation, because it was reported that heat damage was comparatively slight (Seehofer et al, 2012).…”

Estudo Comparativo da Eficácia e Segurança entre 2 Instrumentos de Energia Bipolar (EnSeal® e LigasureTM) na Selagem Vascular em Modelo Suíno Ex-Vivo

“…4). 15 Tal como verificado anteriormente, [15][16][17] existe uma distribuição relativamente ampla de BP para cada tesoura. Uma razão para esta distribuição poderá ser a tração aplicada durante ativação dos instrumentos, descrita na literatura especialmente nos dispositivos ultrassónicos, que são mais passíveis de serem influenciados por esta característica.…”