Page 21 - Peer Reviewed Laparoscopic Jornal

Vinayak Mishra

Two cohort studies comparing a bipolar vessel sealer blood loss: 115 vs 370, 150 vs 455 and 185 vs 495 ml for
(BVS) with the ultrasonic coagulating shears (UCS) for RC, LC and LAR between the EBVS LigaSure group and
laparoscopic colectomy reported a slightly reduced length the UCS harmonic scalpel group respectively. 6,7
of surgery and decreased blood loss in the BVS groups. 6
One of these studies included 30 patients with colon cancer CONCLUSION
who underwent laparoscopic transverse colectomy and After reviewing the above articles, we found that LVSS as
sigmoidectomy using either the electrothermal bipolar vessel compared to HS, LVSS provides a better, safer and much
sealer (EBVS) (LigaSure) or UCS (harmonic scalpel). The secure seal than HS that is up to 7 mm. The postoperative
EBVS and the UCS were used for the mesocolon dissection
in the transverse and sigmoid colon. The incidence of pain, when used in open surgery, is less as compared to HS.
rebleeding was significantly lower in the EBVS group than Even blood loss was comparatively less while using LVSS
in the UCS group for both surgical procedures (0.3 vs 1.2 than HS. HS made the surgery faster with low smoke
in transverse colectomy, 0.3 vs 2.0 in sigmoidectomy production as compared to LVSS. Lateral thermal spread
respectively). The required time for mesocolon dissection of HS is quite less as compared to LVSS but LVSS as
was also significantly shorter when the EBVS was used in compared to other electrosurgical generators was quite less.
both laparoscopic transverse colectomy and sigmoidectomy At the end though LVSS proves to have a hand above the
(7.9 vs 18.4, 15.0 vs 27.6 respectively). Another report HS, it depends of the surgeon’s convenience to use which
demonstrated the outcome of 200 consecutive unselected of the energy sources when it comes to handling and
patients who underwent laparoscopic colorectal resections, maneuverability during surgery resulting in an overall faster,
of which 100 were performed with EBVS (LigaSure) and safer and a bloodless experience.
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100 with UCS (harmonic scalpel). Only right colectomy
(RC), left colectomy (LC) and low anterior resections (LAR) REFERENCES
were performed during this study. There were no deaths in 1. Kwok SY, et al. A double-blind, randomized trial comparing
either group. One conversion to open surgery and two major LigaSure and harmonic scalpel hemorrhoidectomy. Dis Colon
complications occurred in the UCS harmonic scalpel group. Rectum 2005 Feb;48(2):344-348.
There were no differences in the mean length of surgery 2. Smith R, Pasic R. The role of vessel sealing technologies in
laparoscopic surgery. Surg Technol Int 2008;17:208-212.
(111 vs 133, 140 vs 176 and 153 vs 201 minutes) or in the 3. Cakan A, Yoldas B, Samancilar O, et al. LigaSure vessel sealing
mean postoperative hospital stay (5.2 vs 6.1, 6.5 vs 7.1 and system versus harmonic scalpel for sutureless nonanatomical
6.8 vs 7.3 days) for RC, LC and LAR between EBVS pulmonary resections in a rabbit model. Which one is safer?
LigaSure group and UCS harmonic scalpel group Eur Surg Res 2009;43(1):24-28.
respectively. There were, however, differences in the mean 4. Zarebczan B, Mohanty D, Chen H. A comparison of the
LigaSure and harmonic scalpel in thyroid surgery: a single
institution review. Ann Surg Oncol 2011 Jan;18(1):214-218.
5. RandDMagazine. Available from: http://www.youtube.com/
watch?v=TtEZtvUBMdU. On Jun 17, 2009.
6. Takada M, Ichihara T, Kuroda Y. Comparative study of electro-
thermal bipolar vessel sealer and ultrasonic coagulating shears
in laparoscopic colectomy. Surg Endosc 2005;19(7):226-228.
7. Campagnacci R, de Sanctis A, Baldarelli M, Rimini M,
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ABOUT THE AUTHOR

Vinayak Mishra
Laparoscopic Surgeon, Department of Minimal Access Surgery
Fig. 3: Screenshots taken from infrared recordings of probes of Hanumant Endosurgery Center, Lucknow, Uttar Pradesh, India, Phone:
HS and LVSS respectively 8853042226, e-mail: drvinayakmishra@gmail.com

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