|September 2009 · Vol. 21, No. 09
UPDATE ON TECHNOLOGY:
This overview of vessel-sealing devices for laparoscopic procedures should help you select a system that meets the particular needs of your practice
The ideal vessel-sealing device produces minimal thermal spread, is effective on vessels ≤7 mm in diameter, works quickly, produces consistent results, and can be used multiple times
Two studies found the Harmonic Scalpel to be the most user-dependent device
Dr. Levy is Medical Director of the Women’s Health and Breast Center for the Franciscan Health System in Federal Way, Wash. She serves on the OBG Management Board of Editors.
Dr. Levy is a consultant to Covidien (parent company of Valleylab) and to Ethicon Women’s Health and Urology.
When Harry Reich performed the first laparoscopically assisted vaginal hysterectomy in 1989, he advocated the use of sutures for control of the uterine vessels. Monopolar, bipolar, and laser instruments available at that time were inherently risky to use along the pelvic sidewall because of their potential for 1) considerable thermal energy spread beyond the area of treatment (bipolar, NG:YAG laser, monopolar) and 2) unreliable hemostasis (CO2 laser).
Minimally invasive surgical practice has driven meaningful advances in instrumentation and technique over the past 20 years. The constraints inherent in laparoscopic surgery, although somewhat mitigated by robotics, have generated a proliferation of technologies to obtain reliable hemostasis. Every device now on the market claims to “seal” vessels. In this article, I review the mechanism of action of these instruments and compare their strengths and weaknesses, based on high-quality scientific evidence.