Page 30 - World Journal of Laparoscopic Surgery

Anshika Lekhi et al

Fig. 5: Enseal articulating forceps Fig. 6: Gyrus plasmakinetic probe

as charring of the tissue and adherence of tissue to the effects are accomplished at temperature of 50 to 60°C
device jaws is reduced. 3 due to mechanical effect of vibrations. These are FDA
These energy sources were the first to be endorsed affirmed to seal vessels 5 mm in diameter. The device
by the US Food and Drug Administration (FDA) to seal available is the Harmonic ACE+ (Fig. 7, ethicon), and it
vessels up to 7 mm in width inferable from innovative has “Adaptive Tissue Technology” that gives a sound sign
advances, e.g., tissue impedance observing up to 4000 to the specialist when changes in the objective tissue are
times each second (LigaSure); temperature-delicate sensed – this is an aberrant evaluation and less depend-
material in the gadget jaws that optimizes tissue tempera- able than the tissue capacitance monitoring utilized by
tures at ~100°C (EnSeal); delivery of pulsed energy with cutting-edge bipolar devices to demonstrate endpoint.
nonstop input control to counteract tissue overheating More as of late the new up-to-date model have been
(PK Framework); and jaw outline that advances mechani- specifically produced for larger vessel fixing and cutting,
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cal pressure to the vascular pedicle (LigaSure, EnSeal). this gadget has been evaluated by the FDA to seal vessels
Although the capacity of these more up-to-date devices up to 7 mm in diameter. 3
to seal vessels up to 7 mm in width is unchallenged, the These tissue impacts are accomplished without the
normal minimization of thermal spread attributable to passage of electric current through the patient or the
these advancements has yet to be demonstrated in clinical tissue held by the device. Points of interest of ultrasonic
trials. Some devices incorporate a cutting blade into the devices incorporate less instrument movement, inferable
device jaws (LigaSure, EnSeal) that decreases the need from the blend of vessel-fixing and tissue cutting, and
for a laparoscopic scissor. less smoke. The dissection capacity is great, yet not as
Hence, the decision to use a particular bipolar device much as that of monopolar scissors or Maryland bipolar
will depend on the specialist need and choice. Albeit forceps. The detriment is that the obscure harmful tissue
progressive bipolar energy sources are costly, they are gets vaporized in the smoke and can get scattered.
by far available in all the hospitals. 3

Ultrasonic Devices

Previously called the “laparoscopic scalpel”; it has the
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double usefulness of tissue cutting and vessel sealing.
Ultrasonic energy sources convert electrical energy into
ultrasonic energy (vibrations) in the handpiece of the
device which then gets converted to the thermal energy
at frequencies more than 10000 cycles per second. These
vibrations are produced by piezoelectric crystals present
in the handpiece that oscillate the nonarticulating jaw of
the instrument. Tissue is compressed between the two
jaws to achieve the desired tissue effects from combina-
tion of thermal and mechanical energy. Desiccation and
vessel sealing (coagulation) is achieved at lower setting,
and tissue cutting occurs at higher setting. The tissue Fig. 7: Harmonic scalpel
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