|May 2003 · Vol. 15, No. 5
Energy-based techniques to ensure hemostasis and limit damage during laparoscopy
An experienced practitioner details the technical aspects of 3 modalities and advises an orderly protocol, rather than reflex alone, to minimize risk.
Dr. Brill is professor of obstetrics and gynecology and director, gynecologic endoscopy, University of Illinois, Chicago, Ill.
Inspect all vascular sites with and without insufflation before assuming hemostasis is complete.
In monopolar electrosurgery, electrode contact using low-voltage current leads to deeper, more effective penetration than higher-voltage current.
To minimize unwanted thermal damage during bipolar electrosurgery, stop current flow at the end of the visible vapor phase, apply current in a pulsatile fashion, and secure pedicles by alternating between partial desiccation and incremental cutting.
Since ultrasonic energy does not generate the high temperatures created by electrosurgery, it is less dependable for deep-tissue coagulation.
Compared with laparotomy, laparoscopic surgery achieves better hemostasis with less blood loss. Not only does this approach avoid an abdominal incision and the trauma associated with traction, manual manipulation, mechanical dissection, and larger tissue pedicles, but its illumination and magnification afford superior anatomical clarity, allowing the surgeon to seal a vessel before it is incised.
Still, keen surgical judgment remains critical—despite the availability of innovative electrosurgical, ultrasonic, and mechanical laparoscopic devices. Incomplete hemostasis or incision of an active vascular core can occur even with ideal application.