Page 37 - World Journal of Laparoscopic Surgery

Shelar Sharad Shivdas

The advantage of the new instrument is that it can be
used as a tissue holding without trauma, cutting, coagulation,
hemostasis of a bleeder as well as blunt dissection without
changing the instrument. If a pedicle is having big vessel
one can coagulate it in gradual steps and cutting under vision
to confirm complete hemostasis and with out charring of
tissue and minimum lateral thermal tissue damage.
The instrument can be used to hold structure like bowel,
adnexa for manipulation. The scissors can be used for
continuous cutting of peritoneum, avascular bands, adhesion
Fig. 3: Scissors with hidden bipolar and sharp dissection.
The other advantages of the instrument are, it is cheap
and doesent require costly endosurgical unit or ultrasonic
device. The instrument can be reused, autoclavable and has
minimum maintenance.
The scissors is not damaged by charring and frequent
cleaning as in roboscissors, Multifunctional bipolar
5,6
scissors and ligasure where sliding blade becomes blunt.
4
Few pediatric laparoscopic surgeon use single stapler for
appendix along with mesoappendix. This method may be
risky in case of thick turgid or very thin appendix as stapler
Fig. 4: Bipolar cautery forceps pin may not hold the tissue firmly.

the tissue is released. Now keeping the instrument in same CLINICAL USE
position the knob of the scissors is pressed with thumb of A laparoscopic surgeon can use the said instrument for
same hand thus projecting out the scissors (Fig. 3). The coagulation, cutting and dissection as a single step or in
scissor unit will automatically get locked. Now put the combination as per requirement.
thumb of same hand in ring of scissors which will operate
Method of Coagulation
the jaws. Once the tissue is cut a button at the backside of
the bipolar U arm is pressed, unlocking the unit and the A tissue, vessel or a pedicle to deal with is held between the
scissors will be retracted inside. Now the instrument is ready two jaws of the bipolar forceps. It is cauterized with
for bipolar cauterization (Fig. 4). coagulation current in short period to prevent charring of
the tissue. If minimum of current and high voltage is used
DISCUSSION maximum effect of coagulation is achieved by cogulative
necrosis of tissue and fluids. The further heat spread to
The instrument can be used with single hand very easily. The
surrounding tissue can be prevented by irrigation of the
surgeon should have proper knowledge of principles of
electrodes by glycine or weak electrolyte solution. Thus
electrosurgical dynamics to achieve maximum effect of lateral tissue damage is mininmal.
coagulation and minimum side effects. 1,7,9 If properly used
with irrigation a vessel up to 5 mm can be coagulated. 3,11, Method of Cutting
12,14
There are better coagulating systems like harmonic, Once the tissue is optimally coagulated the tissue is relased
13
ligasure available but they are costly and the operating handles and the scissor is protruted by pressing the thumb knob.Now
have to be changed after 5 to 6 sittings. There are other the tissue is cut under vision with presision by the scissors
limitations like Ligasure can not be used as dissector and its with movement of the ring. One can guarded cutting under
cutting of tissue with monopoler current/sliding blade is blind. vision, as if there is incomplete hemostasis immediately
It also cannot be used as plain scissors. Harmonic is coagulation can be done.
good dissector, excellent coagulant but it is not useful if a
CONCLUSION
vessel starts bleeding profusely. It can be dangerous if its
oscillating jaw which is in lowerside touches underling The described dual instrument has become very useful in
important structure like vessel, ureter or bowel. 8 laparoscopic surgery in our hands.The bipolar cautery

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