Page 19 - Peer Reviewed Laparoscopic Jornal

10.5005/jp-journals-10033-1185
Vinayak Mishra
REVIEW ARTICLE
Comparative Study between Harmonic Scalpel and

LigaSure Vessel Sealing System: In Open and

Laparoscopic Surgery

Vinayak Mishra

ABSTRACT low voltage that of 180 V as compared to conventional
electrosurgery. Its unique combination of pressure energy
Background: Energy sources have been an important part of causes fusion of vessels. The fusion is because of melted
surgery in achieving hemostasis and bloodless field to operate.
Nowadays the most recent and commonly used are the collagen and elastin in the vessels which forms a permanent,
bipolar vessel sealing system (LigaSure) and the harmonic plastic like seal. LVSS has a unique property of active tissue
scalpel (HS). response which is a feedback from tissue that controls the
Purpose: To do a comparative review between the LigaSure energy delivery and automatically discontinues it when the
vessel sealing system and harmonic scalpel to make surgery seal cycle completes. This eliminates the guesswork of
faster, safer and better.
operating surgeon and provides minimal lateral thermal
Materials and methods: The literature regarding this review damage to approximately 2 mm. There is no sticking of the
article was searched online on various websites like Google,
PubMed, World Journal of Gastrointestinal Surgeons, YouTube. instruments on tissues with least charring of the tissues.
Search words used were LigaSure vs harmonic scalpel, The seal withstands thrice of normal systolic blood pressure.
LigaSure vessel sealing system, role of vessel sealer and HS The LVSS generator detects the characteristic of the tissue
in laparoscopic surgery.
in the jaws of the instruments and delivers energy
Conclusion: LigaSure vessel sealing system (LVSS) proves accordingly to provide a permanent seal. LVSS promises
to have a hand above the HS as it depends of the surgeon’s
convenience to use which of the energy sources when it comes to provide a secure seal of blood vessels measuring up to 7
to handling and maneuverability during surgery resulting in an mm in diameter. Various probes both for laparoscopic and
overall faster, safer and a bloodless experience. open surgeries are available which are compatible to this
Keywords: LigaSure vs harmonic scalpel, LigaSure vessel electrosurgical generator.
sealing system, Role of vessel sealer and harmonic scalpel in Harmonic scalpel (HS) is manufactured and marketed
laparoscopic surgery.
by Ethicon across the globe. It uses ultrasonic energy as
How to cite this article: Mishra V. Comparative Study between
Harmonic Scalpel and LigaSure Vessel Sealing System: In Open its principle and, hence, dissection by ultrasonic probes is
and Laparoscopic Surgery. World J Laparosc Surg 2013;6(2): called ultracision. The HS is a high power system which
74-76. works at a frequency of 55.5 kHz or 55,500 vibrations/sec.
Source of support: Nil It comprises of a generator, blade and a hand piece. The
Conflict of interest: None declared hand piece has an ultrasonic transducer which consists of
stacked piezoelectric crystals sandwiched under pressure
INTRODUCTION among metal cylinders. The sealing of the vessels is
achieved due to denatured protein coagulum which occurs
Energy sources have been an important part of surgery in
achieving hemostasis and bloodless field to operate. The due to tamponade and coaptation. The ultrasonic generator
energy sources are required to cut, coagulate, desiccate, converts ultrasonic energy into mechanical energy. HS
dissect and evaporate tissue. There have been tremendous mainly has three compatible probes both for open and
upgrades in the technology used in energy sources which laparoscopic surgery that are the shear, blade and a hook.
targets on better, faster and safe hemostasis with minimal The shear has opposite silicon padding which the blade
lateral thermal spread or damage. Lateral thermal damage and hook lacks. The shear can coagulate vessels up to 5
confers to the damage to the tissues just adjacent to the mm, whereas the hook and blade only 2 mm in diameter.
target site. Nowadays, the two most used energy sources The HS probes reach the temperature of 80ºC and even on
used are the LigaSure vessel sealing system (LVSS) (Fig. 1) prolonged use stays below 250ºC which is far less than
and the harmonic scalpel (HS) (Fig. 2). other electrosurgical and laser energy sources resulting
LVSS manufactured by Covidien under the brand name in reduced lateral thermal spread and charring. Vibration
of Valleylab is a bipolar apparatus for sealing vascular of the active probe prevents sticking of coagulated tissue
tissues. It seals tissue by administration of high current and over it.
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