Electrothermal Bipolar Vessel Sealer Research Articles

Outcomes of the Electrothermal Bipolar Vessel Sealing Device and Electrocautery in Modified Radical Mastectomy Patients.

Introduction With the rising trends in breast cancer throughout the world, the traditional modus of intraoperative tissue dissection using a scalpel, scissors, or electrocautery needs to be re-evaluated in the wake of newer modalities, such as electrothermal bipolar vessel sealing (EBVS) devices, which may theoretically reduce the postoperative complications and morbidity in these patients. Aimand objective The objective of this study is to compare an EBVS device to electrocautery (diathermy) in modified radical mastectomy (MRM), based on selected intraoperative and postoperative outcomes. Study procedure This was a comparative cross-sectional section study that included 60 patients with operable breast cancer (stages I and II, TNM classification, and post-neoadjuvant stage III disease). Patients were divided into two groups for surgery: one group underwent an MRM using the EBVS device (Group A), while the other group had the procedure performed using conventional electrocautery (Group B), as per the surgeon's choice depending on theatre slot and equipment availability. Intraoperatively, the total operative time, time for raising the flaps, time taken for breast tissue dissection, time for axillary dissection, and blood loss were recorded. Postoperative parameters included total drainage volume, number of days of drainage, seroma formation, and other complications. Patients were followed up for one month after surgery, with early postoperative complications such as wound infection, upper limb lymphedema, seroma, flap necrosis, and nerve injuries being documented. Results The groups were found to be comparable in terms of the age distribution, TNM staging, stage grouping, and nodal status of the patients. The EBVS device group demonstrated statistically significant advantages in total operative time, axillary dissection time, flap raising time, breast tissue dissection time, intraoperative blood loss, total drainage volume, and days of drainage. However, no statistically significant difference was found between the two devices in terms of seroma formation, early postoperative complications, and duration of postoperative stay at the hospital. Conclusion While the use of EBVS in MRM provides a considerable decrement in the total operative duration, duration of the various steps of surgery, intraoperative blood loss, and postoperative volume and duration of drainage, these devices do not offer an evident advantage in terms of the postoperative complications or morbidity.

Electrothermal Vessel Sealing Versus Conventional Suturing in Abdominal Hysterectomy: A Randomised Trial.

The present randomised controlled trial was conducted to compare haemostatic efficiency, operative time, and overall performance of the electrothermal bipolar vessel sealing (EBVS) system with conventional suturing in abdominal hysterectomy. The trial was designed with standard parallel arms, i.e., vessel sealing and suture ligature arms. Sixty patients were block randomised into either arms with 30 patients in each. A hand-held vessel sealing instrument was used to perform a hysterectomy in the vessel sealing arm and the quality of the uterine artery seal achieved at the first attempt was graded on an ordinal scale of 1-3 to quantify haemostatic efficiency. Operative time, intra-operative blood loss, and peri-operative complications were compared between the two arms. Significantly reduced mean operative time (26.97±8.92vs 33.67±8.62 minutes; p=0.005) and intra-operative blood loss (111±53.31 mL vs 320±193.90 mL; p=0.001) was observed in the Vessel Sealing Arm compared to Suture Ligature Arm. Of total 60 uterine seals (from bilateral uterine artery transaction in 30 hysterectomies in the Vessel Sealing Arm), 83.34% were Level 1 with Complete Seal and no residual bleeding, 8.33% were Level 2 or Partial Seals with minimal bleeding, requiring the use of vessel sealers for a second time, while 8.33% had Seal Failure (Level 3) with significant bleeding requiring additional re-security of stumps with sutures. Modal pain scores on the first three postoperative days and duration of hospital staywere significantly less in the Vessel Sealer Arm, reflecting reduced postoperative morbidity. Outcomes were comparable across operators. Vessel Sealing System gives superior surgical results with lesser operative time, minimal blood loss, and reduced morbidity.

Comparative evaluation of three laparoscopic cholecystectomy techniques in rabbit's model.

The aim of this randomized study was to compare the complications and perioperative outcome of three different techniques of laparoscopic cholecystectomy (LC). Changes in the liver function test after LC techniques were investigated. Also, we compared the degree of postoperative adhesions and histopathological changes of the liver bed. Thirty rabbits were divided into three groups: group A) Fundus-first technique by Hook dissecting instrument and Roeder Slipknot applied for cystic duct (CD) ligation; group B) conventional technique by Maryland dissecting forceps and electrothermal bipolar vessel sealing (EBVS) for CD seal; group C) conventional technique by EBVS for gallbladder (GB) dissection and CD seal. Group A presented a longer GB dissection time than groups B and C. GB perforation and bleeding from tissues adjacent to GB were similar among tested groups. Gamma-glutamyl transferase and alkaline phosphatase levels increased (p ≤ 0.05) on day 3 postoperatively in group A. By the 15th postoperative day, the enzymes returned to the preoperative values. Transient elevation of hepatic transaminases occurred after LC in all groups. Group A had a higher adherence score than groups B and C and was associated with the least predictable technique. LC can be performed using different techniques, although the use of EBVS is highly recommended.

Prospective comparison of suture ligation and electrothermal sealing for the control of perivascular lymphatics in kidney transplant recipients.

The use of sutures as ligatures has proven to be safe and reliable for the control of lymphatic vessels. The electrothermal bipolar vessel sealer (EBVS) is a relatively new type of device that can be used to seal lymphatics. We conducted a study to evaluate the safety and efficacy of EBVS for preparation of the recipient vessel during renal transplantation. In this prospective randomized controlled study, EBVS (Medtronic) was compared with conventional ligature for the control of perivascular lymphatics in kidney transplant recipients. A total of 52 kidney transplant recipients were randomly assigned to two groups. In group 1, EBVS was used to control perivascular lymphatics, while conventional silk ligatures were used in group 2. Demographic characteristics, as well as preoperative, perioperative, and postoperative variables, were noted and compared between the groups. The mean recipient vessel preparation time was 8.3±1.9 minutes in group 1 and 14.5±4 minutes in group 2 (P<0.001). The mean anastomosis time was 28.2±5.4 minutes in group 1 and 28.2±4.2 minutes in group 2 (P=1.000). The mean estimated blood loss was 101.54±44.60 mL in group 1 and 125.19±74.17 mL in group 2 (P=0.270), and the mean drain output was 51.42 mL per day and 57.50 mL per day in groups 1 and 2, respectively (P=0.590). EBVS can be employed safely and effectively for recipient iliac lymphatic vessel dissection and sealing. EBVS is a fast, secure, and effective choice to permanently fuse the vessels and is a good option to avoid posttransplant lymphatic complications.

Comparative study between conventional hemorrhoidectomy and electrothermal bipolar vessel sealer for Grade IV hemorrhoids

Background: Hemorrhoids are vascular formations in the anal canal that is also known as piles. They serve as a cushioning of anterior venous channels and connective tissue in its natural condition, which aids in stool management. During defecating, internal hemorrhoids are frequently accompanied by painless, bright crimson rectal discharge. External hemorrhoids can cause discomfort and edema in the anus region. Aims and Objectives: The objectives of this study are to “compare between electrothermal bipolar vessel sealer hemorrhoidectomy versus conventional hemorrhoidectomy in patient of Grade IV hemorrhoids. Materials and Methods: The present study conducted in patients admitted in Gandhi medical college associated Hamidia Hospital, Bhopal carried out in the Department of General Surgery from April 2015 to September 2017. A total of 80 patients were included in the study with comparison between conventional hemorrhoidectomy (n=36) and electrothermal bipolar vessel sealer (ETBVS) (n=44) and comparison of recurrence of complications in them. Results: The mean surgical time was much shorter in ETBVS, as was post-operative pain, which was primarily reduced on the third and 4th post-operative days: discomfort also vanished quicker in ETBVS than in conventional procedure. ETBVS patients had less time off work, a shorter hospital stay, and a reduced risk of total problems. When compared to conventional procedures, the average length of operation in ETBVS was also much shorter (P&lt;0.0001). Conclusion: When a considerable amount of tissue needs to be removed, ETBVS hemorrhoidectomy is a good option. This research confirms its usage as a first-line therapy for Grade IV hemorrhoids.

Sutureless versus conventional abdominal hysterectomy: a randomized controlled trial

ObjectiveThis study aimed to compare electrothermal bipolar-vessel sealing (EBVS) with the conventional suturing during the abdominal hysterectomy, as well as to compare the conventional bipolar-sealing system with the advanced one.BackgroundGynecologic surgery is frequently complicated by hemorrhage. Thus, it is mandatory to adopt adequate techniques of hemostasis during surgery.Patients and methodsThe study was conducted on 60 patients with indications for abdominal hysterectomy, they were divided equally into two groups: group I consisted of 30 patients who underwent abdominal hysterectomy with the use of the EBVS, either advanced; LigaSure (15 patients), or conventional; Seal, and group II consisted of 30 patients who underwent conventional abdominal hysterectomy. The primary outcome was the differences between the study and control group regarding the operative events and postoperative outcome, and the secondary outcome was the differences between the two subgroups of group I regarding the same parameters.ResultsThe conventional hysterectomy group showed significantly higher operative time, blood loss, length of hospital stay, the days needed for returning to the usual activities, pain scores, and lower Ht (%). No significant differences were noted between both subgroups of group I, except in the day 3 pain score.ConclusionEBVS is an expensive but effective alternative to the conventional sutures in the abdominal hysterectomy for a benign condition. The advanced bipolar system (LigaSure) is comparable to the conventional one (Seal).

Efficacy and Safety of Electrothermal Bipolar Vessel Sealer vs ENSEAL in Total Laparoscopic Hysterectomy for Large Uterus: A Comparative Study in Mysuru, South India

Efficacy and Safety of Electrothermal Bipolar Vessel Sealer vs ENSEAL in Total Laparoscopic Hysterectomy for Large Uterus: A Comparative Study in Mysuru, South India

Impact of Electrothermal Bipolar Vessel Sealing System in Breast Surgery with Axillary Lymph Node Dissection and in Stage III Melanoma Patients: A Review of Current Evidence for its use in Surgical Practice

To consolidate the feasibility, safety and effectiveness in performing axillary lymph node dissection in breast surgery and in patients with stage III melanoma, using the electrothermal bipolar vessel sealing system, we revisit and analyze the main studies on the subject, in order to identify its use as the best in this surgical practice.

Ex vivo comparison of leakage pressures and leakage location with a novel technique for creation of functional side-to-side canine small intestinal anastomoses.

To determine the ability of functional side-to-side small intestinal anastomoses (FSS-SIA) created with an electrothermal bipolar vessel sealing (EBVS) device to resist leakage. Experimental, ex vivo. Jejunal segments (n = 130) from 10 healthy canine cadavers. Four types of anastomoses were created (two segments/construct and 15 constructs/group): EBVS (group A), EBVS + transverse stapling (group B), stapled (group C), and EBVS + suture augmentation (group D). Initial leakage pressure (ILP), initial leakage location (ILL), and maximal intraluminal pressure were compared between groups, and five group A constructs were analyzed histologically. Initial leakage pressure was greater in group D than in groups A, B, and C (P < .011). There was a difference in ILL among groups (P = .003). Leakage occurred at the side-to-side intestinal anastomosis fusion line in 13 of 15 (87%) constructs for groups A and B and in nine of 15 (60%) constructs for group D. Maximal intraluminal pressure was greater in group C than in groups A, B, and D (P < .004). Histological examination was consistent with collagenous fusion without cavitation defects. Functional side-to-side small intestinal anastomosis was consistently achieved with an EBVS device. Augmentation of EBVS anastomoses with simple interrupted sutures along the anastomotic fusion line increased ILP compared with stapled anastomoses. Despite the success and feasibility of creating an FSS-SIA with an EBVS device, additional in vivo studies are required to determine the effectiveness of intestinal fusion prior to clinical implementation.

Bipolar Vessel Sealing System Versus Suture Ligation in Selective Neck Dissection

To evaluate whether the use of electrothermal bipolar vessel sealing system reduces the blood loss and operating time, with lesser complications as compared to suture ligation in selective neck dissection in patients with oral cancer. The study was conducted in the Department of Oral and Maxillofacial Surgery of our institute from January 2015 to December 2016. The sample consisted of 60 patients, divided into Groups I and II with 30 subjects in each. In Group I electrothermal bipolar vessel sealer and in Group II suture ligation were used. The outcome measures recorded were: blood loss, operating time, quality of surgical field, postoperative pain on days 1, 2, and 3, drainage volume at 24, 48, and 72h, edema, complications, and duration of hospital stay. There were 36 males and 24 females with a mean age of 50.76±12.6years. Blood loss was significantly less for Group I than for Group II (p=0.001); the operating time was significantly less in Group I than in Group II (p=0.001); Group I had better quality of surgical field (p=0.001); less pain on postoperative evening, day 2 and day 3 (p<0.05); and less drainage volume at 24 and 48h (p<0.05). Postoperative edema, complications, need for perioperative blood transfusion, and duration of hospital stay postsurgery were similar in both groups. The electrothermal bipolar vessel sealer was efficacious in terms of reducing blood loss and operating time while providing a better surgical field and patient compliance without increasing the perioperative morbidity.

Comparison of Industry-Leading Energy Devices for Use in Gynecologic Laparoscopy: Articulating ENSEAL versus LigaSure Energy Devices

Study ObjectiveTo compare 2 laparoscopic bipolar electrosurgical devices used in total laparoscopic hysterectomy (TLH). An articulating advanced bipolar device (ENSEAL G2; Ethicon Endo-Surgery, Cincinnati, OH) and an electrothermal bipolar vessel sealer (LigaSure; Medtronic, Minneapolis, MN) were analyzed for differences in surgeon perception of ease of instrument use and workload using the NASA Raw Task Load Index (RTLX) scale. A second objective was to examine differences in operative time, estimated blood loss (EBL), and perioperative complication rates between the 2 devices. DesignSingle-institution, single-blinded, randomized controlled trial (Canadian Task Force classification I). SettingDivision of Minimally Invasive Gynecologic Surgery in a university hospital. PatientsEligibility required planned TLH, over age 18 years, and able to give informed consent; exclusions were stage III or IV endometriosis, known gynecologic malignancy, and early decision for conversion to laparotomy. One hundred seventy-eight patients screened, 142 enrolled, 2 withdrew, and 140 completed the study. Patients were followed 1 month postoperatively. InterventionsPreoperative randomization to articulating advanced bipolar device or electrothermal bipolar vessel sealer to be used during TLH. Measurements and Main ResultsAt the end of each hysterectomy the primary surgeon completed an ergonomic assessment tool, the RTLX. Results were analyzed to detect differences in workload between the 2 devices. For each case the time to ligation of the bilateral uterine arteries, EBL, and complications (including device failure, blood transfusion, or other injury) were recorded. Statistical analysis was performed using the t test for normally distributed data, χ2 test for categorical data, and Mann-Whitney U-test for nonparametric data. There were no differences in age, body mass index, parity, prior surgery, uterine weight, race, indication, pathology, and comorbidities between the 2 groups. A statistically significant increase in RTLX scores (p < .0001), device failures (p = .0031), and time to ligation of bilateral uterine arteries (p = .0281) was noted in the articulating device group. No significant differences in EBL or complication rates were noted between the groups. ConclusionsThe articulating advanced bipolar device was shown to have a statistically significant increase in surgeon-perceived workload and rate of device failure when used in TLH; however, clinical and surgical outcomes were equivalent.

Safety and Efficacy of Advanced Bipolar Vessel Sealing in Vaginal Hysterectomy: 1000 Cases

Study ObjectiveTo determine the safety and efficacy of advanced electrothermal bipolar vessel sealing (EBVS) during vaginal hysterectomy by evaluating urinary complications, overall complications, and reoperation rate. DesignA retrospective cohort (Canadian Task Force classification III). SettingHigh-volume gynecologic surgeon practice, private hospital. PatientsOne thousand consecutive patients who have undergone vaginal hysterectomy for benign conditions carried out with EBVS between January 2002 and December 2012. InterventionsVaginal hysterectomy performed using an EBVS device. Measurements and Main ResultsOne thousand consecutive patients underwent vaginal hysterectomy with advanced EBVS between January 2002 and December 2012 with an average age of 51.4 ± 8.9 years (range, 31–88) and mean weight and body mass index of 57.4 ± 7.2 kg (range, 42–105) and 25.8 ± 4.2 kg/m2 (range, 19.1–38.9), respectively. Eighty-five percent of patients (852/1000) were healthy without any severe systemic disease. A single experienced surgeon performed all vaginal hysterectomies with EBVS, specifically by not applying traction during thermofusion to avoid hemorrhage, amputating the cervix to transform the uterus to an apple shape to facilitate a vaginal approach and rotation of the uterus, and placing bi-clamp forceps on the edge of the uterus and not at a 45- or 90-degree angle. Wound closure was completed with a continuous suture. Eleven urinary complications (1.1%) were recorded (10 bladder mechanical injuries and 1 vesicovaginal fistula). This was not statistically different from the rate of .64% previously reported in the FINHYST study (p = .15). The overall rate of complications was 5.3%, and 20 patients (2.0%) required reoperation. The presence of uterine scar tissue (odds ratio, 5.5; 95% confidence interval, 1.6–19.2) and larger uterus size (odds ratio, 2.5; 95% confidence interval, 1.01–19.2) were associated with a higher risk of urinary complications. ConclusionThe use of EBVS during vaginal hysterectomy results in urinary and overall complication rates of 1.1% and 5.3%, respectively, statistically similar to previously reported series that did not use EBVS. The use of advanced EBVS is a safe and effective method of achieving hemostasis during vaginal hysterectomy.

Harmonic Scalpel and Electrothermal Bipolar Vessel Sealing System in Head and Neck Surgery: A Prospective Study on Tissue Heating and Histological Damage on Nerves.

Define and compare the thermal nerve injury caused by 3 different vessel sealing and dissection devices: the harmonic scalpel (HS), the electrothermal bipolar vessel sealing system (EBVS), and the bipolar electrosurgery unit (BE). First we recorded the heating variations in pig tissue caused by a BE unit, HS, and EBVS after an activation for 5, 10, and 15 seconds at minimum and at maximum power. In the second part, we evaluated the histological damage caused by HS and EBVS on 20 in vivo human nerves, 10 per device. The 2 scalpels were placed and activated at 3 different distances from the nerve (1, 3, and 5 mm). The extension and the degree of the nerve lesion was then calculated. The instrument determining the highest rise in temperature was the BE unit, followed by HS and then EBVS. Comparison between the extension and degree of nerve injury caused by the 2 scalpels showed no statistically significant differences. Based on these evaluations, we established a relative safety limit at 3 mm and an absolute safety limit at 5 mm for both scalpels. Our data suggest EBVS and HS can be considered valid and safe devices for ENT surgery.

Use of an Electrothermal Bipolar Vessel Sealing Device During Recipient Hepatectomy for Liver Transplantation

Use of an Electrothermal Bipolar Vessel Sealing Device During Recipient Hepatectomy for Liver Transplantation

Rationale, bench testing and in vivo evaluation of a novel 5 mm laparoscopic vessel sealing device with homogeneous pressure distribution in long instrument jaws

BackgroundIn 1998, an electrothermal bipolar vessel sealing (EBVS) system was introduced and quickly became an integral component of the surgical armamentarium in various surgical specialties. Currently available EBVS instruments use a scissor-like jaw configuration and closing mechanism, which causes decreasing compression pressure from the proximal to the distal end of the jaws. A new EBVS system is described here which utilizes a different instrument jaw configuration and closing mechanism to enable a more homogeneous pressure distribution despite longer instrument jaws.MethodsResults of jaw pressure distribution measurements as well as sealing experiments with subsequent burst pressure measurements ex vivo on bovine uterine arteries are demonstrated. Furthermore, an in vivo evaluation of the new EBVS system in a canine and porcine model including histological examination is presented.ResultsThe device revealed an even pressure distribution throughout the whole jaw length. The ex vivo burst pressure measurements revealed high average burst pressures, above 300 mmHg, independent of the outer diameter (1 to 7 mm) of the tested vessels. Histological evaluation of sealed vessels 21 days postoperatively demonstrated sealed and fused vessels without adjacent tissue damage.ConclusionsThe even pressure distribution leading to a sufficient tissue sealing in combination with the novel closing mechanism and extended jaw length differentiates the novel device from other available EBVS systems. This might offer a reduction of the overall procedure time, which should be further evaluated in a clinical study.

A Less Invasive Technique for Spaying Pet Pigs

To determine if ovariectomy (OVE) by electrothermal bipolar vessel sealing (EBVS) is a safe alternative to ovariohysterectomy (OVH) by hand-tied ligatures as a method of spaying in pigs. Retrospective case series. Intact female pigs (n = 14). Medical records (2001-2010) of pigs admitted for sterilization were reviewed for signalment, surgical technique, intra- and postoperative complications, length of hospitalization, and outcome. Long-term follow-up was obtained by owner questionnaire. Mean ± SD age and mean weight was 131 ± 86 days and 13.0 ± 6.2 kg, respectively. There were 5 OVH pigs and 9 OVE pigs; age and weight were not significantly different between groups. When comparing OVE to OVH, mean incisional length was less (12 ± 6 cm OVE; 22 ± 6 cm OVH; P < .01) and surgical time was short (50 ± 9 min OVE; 103 ± 15 min OVH; P < .01). Intraoperative hemorrhage occurred in 1 OVH pig. Postoperative complications included hemorrhage (n = 1), fever (3), hypothermia (2), surgical site infection (1), and inappetence (3). Return to normal behavior and appetite was significantly shorter for OVE pigs (1.10 ± 0.93 days; 4.30 ± 0.94 days OVH; P < .01). After a mean follow-up of 36 months, no difference between groups could be observed. OVE using EBVS is a faster surgical technique with less perioperative complications when compared to OVH with ligatures. OVE can potentially replace OVH as a spaying method in pigs.

Comparison of various methods of vessel ligation: what is the safest method?

Recently, various hemostatic devices, such as metal or plastic clips, ultrasonic coagulating shears, and electrothermal bipolar vessel sealer, have been widely applied during an operation. The purpose of this study was to analyze the mechanical, histological, and biochemical differences of vessels sealed with various hemostatic devices. Thirty New Zealand White rabbits were randomly allocated into five groups, and short gastric vessels were ligated with metal clip, plastic clip, Harmonic Ace, LigaSure, or tie ligation. These vessels were harvested 3 days after operation and histologically analyzed at the site of ligation (proximal) and 5 mm from it (distal). Perivascular fibrosis was assessed on a score of mild to severe according to the severity. Inducible and endothelial nitric oxide synthase (iNOS and eNOS) mRNA expressions were measured quantitatively by real-time PCR at the sites of ligation. Abdominal aorta and inferior vena cava also were harvested and divided with each tool, and bursting pressures were measured. Bursting pressures were measured in 164 arteries and 141 veins. LigaSure showed significantly lower bursting pressures in arteries (p < 0.001), and plastic clip showed significantly lower bursting pressures in veins (p < 0.001). There was a negative relationship between outer diameters and bursting pressures in both the arteries (rho = -0.505, p < 0.001) and the veins (rho = -0.106, p = 0.24). The degree of perivascular fibrosis was not statistically different in either the proximal (p = 0.447) or distal (p = 0.381) sites. The expressions of iNOS and eNOS were significantly lower in the LS group (p < 0.001, and p < 0.001, respectively). There might be no clinical limitations when applying various hemostatic devices to small vessels under physiologic blood pressures. There were no acute histological differences between the hemostatic devices. However, LS showed the lowest iNOS and eNOS expressions, which might be due to thermal injuries of the whole vessel wall.

Bipolar Vessel Sealer versus Harmonic Scalpel in Laparoscopic Supracervical Hysterectomy

Aim: The aim of this study was to compare the use of Electrothermal Bipolar Vessel Sealer (EBVS) with Harmonic Scalpel (HS) during laparoscopic supracervical hysterectomy (LSH) with respect to operation time, estimated blood loss and related complications. Methods: A randomized clinical study was conducted in the OB/GYN Department, Maternity Hospital, Kuwait, from March 2009 till January 2011. Forty candidates for Laparoscopic Supracervical Hysterectomy were enrolled and divided randomly into two equal groups of 20 patients each. Twenty hysterectomies (LSH) were performed using the Harmonic Shears (HS) (group I) and the other twenty patients (group II) had LSH operation using Electro-Thermal Blood Vessel Sealer (EBVS) technology. All the operations were performed by the same surgeon. Data about the characteristics of the patients, operation time, estimated blood loss, related complications and length of hospital stay were registered and compared. Results: Mean operation time, Hemoglobin (Hb) and Hematocrite value (Ht) drop, and hospital stay were significantly less in the bipolar vessel sealer group. There was significant reduction in operation time using the EBVS technique (64.15 ± 12.02) minutes as compared to HS technique (138.25 ± 23.41) minutes. Blood loss during operation was significantly lower in group (II) patients compared to group (I) demonstrated by significant greater drop in hemoglobin and hematocrite in the latter compared to the former group. The mean Hemoglobin drop in group (I) patients was (3.15 ± 0.82) while hematocrite drop was (3.72 ± 0.74). The mean hemoglobin drop for group (II) patients was (0.43 ± 0.33), while hematocrite drop was (0.74 ± 0.41). The mean hospital stay time for group (I) patients was 2.0 ± 1.52 days. The mean hospital stay for group (II) was 1.65 ± 0.58 days; the difference was not statistically significant. Conclusion: The bipolar vessel sealer technique seems to be less time-consuming during operation and caused less bleeding when compared with harmonic shears. Further studies with larger number of patients are required for stronger evaluation of the technique.

Use of an electrothermal bipolar sealing device in ligation of major mesenteric vessels during laparoscopic colorectal resection

A variety of approaches are available for division of major vascular structures during laparoscopic colorectal resection. Ultrasonic coagulating shears (UCS), vascular staplers, plastic or titanium clips and electrothermal bipolar vessel sealing (EBVS) are currently available. We report our experience with an EBVS device, LigaSure™ (Covidien AG), used in division of the ileocolic, middle colic and inferior mesenteric arteries during laparoscopic colorectal resection. We report the immediate outcome of 802 consecutive unselected patients who underwent elective laparoscopic colorectal cancer resection performed with use of the LigaSure™ (5 and 10 mm) at our institution over a 5-year period. Operative procedures included right hemicolectomy (n = 180), left hemicolectomy (n = 96), sigmoid colectomy (n = 347) and anterior resection (n = 179). Data were collected from a prospectively maintained cancer database and operative records. The procedures were performed primarily by three consultant surgeons with an interest in laparoscopic colorectal resection. Of 802 cases in which the LigaSure™ device was employed to divide major vascular structures, immediate effective vessel sealing was achieved in 99.8% (n = 800). Two patients experienced related adverse events both following division of the inferior mesenteric artery with a 5 mm LigaSure™. Both patients had immediate uncontrolled haemorrhage that required laparotomy. Use of the LigaSure™ device to seal and divide the major mesenteric vessels during laparoscopic colorectal resection is very effective, with a high success rate of 99.8%. Caution should be exercised in elderly atherosclerotic patients, particularly when using the 5-mm LigaSure™ device.

Comparative Study of an Electrothermal Bipolar Vessel Sealing System (LigaSure®), a Harmonic Curved Shears (Harmonic Focus™), and Traditional Technique in Total Thyroidectomy

Comparative Study of an Electrothermal Bipolar Vessel Sealing System (LigaSure®), a Harmonic Curved Shears (Harmonic Focus™), and Traditional Technique in Total Thyroidectomy