November 2009 · Vol.21, No.11Advanced energy systems for laparoscopic gynecology procedures
Multifunctional technology yields reliable outcomes, enhances patient safety, and increases procedure efficiency
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Fast Track
Patient safety has fueled advances in instrumentation.
Durable vessel seals can be obtained without significant thermal change to tissue.
When we lower the voltage and decrease the amount of energy, we must be more aware of our surgical technique.
Compression is key to maximizing seal strength.
When you “follow the bubbles,” tissue becomes easier to cut.
Variables such as the power setting, blade edge, and tissue tension and density must be evaluated.
The days of clamp-cut-tie are gone.
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Dr Brill: Probably no surgical instrument defines the gynecologist more than the Kleppinger forceps, the first bipolar device used for tubal ligation. It remains an important part of our armamentarium despite thermal spread, smoke, char, tissue sticking, and inconsistent hemostasis,1-5 shortcomings that have led to the development of newer bipolar electrosurgical devices—the LigaSure™ Vessel Sealing System, PlasmaKinetic (PK) platform, and ENSEAL®. These energy-based surgical devices offer added functionality—coagulation and cutting in a single instrument—as well as increased efficiency. These instruments offer specific features that appeal to gynecologic surgeons who have different needs and preferences. Ultrasonic energy technology has also advanced significantly, with instruments such as the Harmonic ACE®, which both cuts and coagulates at the point of impact for use in soft-tissue incisions and transections.
Despite our collective surgical experience, the comparative strengths and weaknesses of these devices have yet to be clearly established in an unbiased and reproducible fashion. Ex vivo studies have attempted to quantify the comparative effectiveness of these devices with wide variances in results, primarily based on the use of non-standardized protocols. We must await the results of well-designed in vivo studies that compare efficiency, sealing time, lateral thermal spread, smoke product, and burst pressures to define their relative use for ligating and cutting vascular tissue.
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