Page 8 - World Journal of Laparoscopic Surgery

Efficacy and Safety of Electrothermal Bipolar Vessel Sealer vs ENSEAL in Total Laparoscopic Hysterectomy for Large Uterus

Fig. 3: ALAN generator
Fig. 1: ENSEAL generator

MAterIAls And Methods
This is a prospective randomized case–control study done at JSS
Hospital, Mysuru, Karnataka including 100 women. Patients with
fibroid uteri of size between 12 weeks and 28 weeks were included
in the study. Patients with other indications for TLH were excluded.
Patients included in the study were subjected to detailed
medical history check-ups and examination including abdominal,
vaginal, and bimanual examination. Institutional Ethics Committee
approval was obtained and after obtaining the informed consent
from the participating patients, the data collected were included
for statistical analysis.
All procedures were performed by a single surgeon. Out of 100
women, 50 women who underwent TLH using ALAN vessel sealer
were considered in group A and the remaining 50 who underwent
TLH using ENSEAL were considered in group B. Protocols for
anesthesia, preoperative, and postoperative management were
the same among all the patients. Patients were followed up once
Fig. 2: ALAN vessel sealer hand instrument 2-, 4-, and 6-week after the surgery to look for any subsequent
complications.
The ENSEAL device is designed for laparoscopic vessel sealing
defined bipolar sealing followed by dissection, thus giving better and tissue transection. The first electrode is integrated into the
hemostasis even in a large uterus. They also have cost-saving static lower jaw of the device and the second one in the movable
properties as a result of decreased operative time, decreased use upper jaw. The impedance of the nano-based material of the upper
of postoperative analgesics, and shorter duration of stay. These electrode depends on the temperature and is based on the tissue
devices have one major drawback that their instruments are temperature; it regulates the energy output, thus not allowing the
disposable and are of economic concern. 3,4 temperature to exceed 100°C. While moving the blade to the front
The ENSEAL device (NSEAL 535RE, Ethicon Endo-Surgery position, the double T-shaped cutting blade located longitudinally
(Europe) GmbH) is used for laparoscopic tissue dissection and vessel in the instrument axis closes the jaws. The coagulation and
sealing. It uses nanometer-sized particles embedded in a bipolar cutting processes occur almost simultaneously, and the clamping
temperature coefficient matrix. The current flow is active only force depends on the blade position in which the two jaws are
when the device jaws are closed. The nanoparticles embedded in substantially parallel in a closed position.
them locally interrupt current flow to tissue when the temperature The ALAN vessel sealer uses a special type of bipolar current for
exceeds 100 °C, enabling sealing and transection to occur in a single tissue dissection. Lower tissue impedance is sensed by the machine
step and also minimizing the thermal spread and tissue damage. following which it delivers a specially designed bipolar current for
A new bipolar vessel sealing device (ALAN vessel sealer, Alan the dissection instrument, plasma bisector. The jaws of the plasma
Electronic Systems Pvt. Ltd., Thane, Maharashtra, India), which is bisector are designed circularly, when the jaws are closed a very
cost-effective as it is a reusable instrument, has been developed. narrow portion of the plasma bisector comes in contact with the
This study aimed to compare the efficacy, safety, and perioperative tissues. This enables the maximum concentration of current and
outcomes of ALAN vessel sealer vs ENSEAL in laparoscopic rapid dissection of the tissues. The microplasma which is generated
hysterectomy for a large uterus of more than 12-week size following the passage of dissection current rapidly vaporizes the
(Figs 1 to 3). tissue held between the jaws of the plasma bisector. Due to the

6 World Journal of Laparoscopic Surgery, Volume 14 Issue 1 (January–April 2021)