Ultracision in gynaecological laparoscopic surgery

Abstract

The Ultracision harmonic scalpel and laparosonic coagulating shears use high-frequency ultrasound energy and can be used as a substitute for electrosurgery, lasers and steel scalpels in both laparoscopic and conventional gynaecological surgery. Its unique mechanism of action allows cutting and coagulation without causing a significant rise in temperature at the tissue level. Its safety has been tested extensively in animal experiments and there is now ample evidence to suggest that it produces less thermal damage in vitro compared to electrosurgery and lasers. Although these results have been extrapolated to human beings, there are no in vivo studies in humans to corroborate the above observations. This review highlights the mechanism of action, tissue effects, safety aspects, applications, versatility and limitations of this novel technique. The many advantages demonstrated by this instrument over other energy sources used in laparoscopic surgery should make it more popular in forthcoming years.

Temperature safety profile of laparoscopic devices: Harmonic ACE (ACE), Ligasure V (LV), and plasma trisector (PT)

“…Conversely, other investigators (Kunde and Welch) demonstrated that the ultrasonic energy could be safely applied without a significant rise in local temperature [12]. Also, Landman et al [13] reported in a comparative study in a porcine model that the least acute collateral tissue injury was achieved by the Harmonic Scalpel when compared to Ligasure, and other bipolar devices.…”

Efficacy and safety of ultrasonically activated shears in thyroid surgery

“…The UAS have been used for several years in laparoscopic surgery, [6][7][8][9] but also in general and gynecological surgery. [10][11][12][13][14][15] In our prospective study, we performed a comparative analysis of 2 patient groups with no differences in age, sex, and underlying disease. The operations were performed following the same steps, the only difference being that hemostasis and tissue division in group A were achieved by UAS, whereas in group B they were performed by the conventional ligations and by suturing the divided margin of the gland by continuous absorbable suture in lobectomies.…”

Comparison of lateral thermal spread using monopolar and bipolar diathermy, the Harmonic Scalpel™ and the Ligasure™

“…Monopolar and bipolar diathermy are the most commonly utilized modalities, with the latter thought capable of more accurate control of the electric current, thereby limiting the spread of thermal energy to surrounding tissues. Newer instruments, such as the Harmonic Scalpel TM (Ethicon Endo-Surgery, Cincinnati, Ohio, USA) and Ligasure TM (Valleylab, Boulder, Colorado, USA), are thought to be safer than traditional diathermy 2,3 . The Harmonic Scalpel TM system consists of a current generator, an ultrasonic transducer and an instrument to direct the tissue effect.…”