Clinical experience with bipolar multifunctional coagulation scissors in laparoscopic surgery

Abstract

Basic surgical procedures include dissection of tissue structures and achievement of hemostasis. In laparoscopic surgery, the common methods of achieving hemostasis by the use of clamps and ligatures are not applicable. Therefore, the authors created a multifunctional instrument that can compress tissue in the same manner as a clamp while simultaneously applying bipolar coagulation voltage. Furthermore, this instrument can be used as regular scissors without the need to change instruments. The authors have used the described instrument to perform multiple operations including 80 colonic resections of different types, 33 Nissen fundoplications, 34 gastric banding operations, and 19 divisions of adhesions. A metallic clip was used only once to dissect the main stem of the inferior mesenteric artery. No after-bleeding occurred in any case. In one case, however, a stomach wall perforation occurred during a Nissen procedure. The main operative time for a colonic resection was approximately 185 min, whereas the Nissen procedures required about 110 min. The results demonstrate very good feasibility of operations using the described instrument within a short operating time. Furthermore, this instrument provided great safety with regard to hemostasis because there was no after-bleeding. The multifunctionality of the instrument allows not only a time-saving procedure for laparoscopic surgery, but also an avoidance of costly equipment.