Energy-based techniques to ensure hemostasis and limit damage during laparoscopy
An experienced practitioner details the technical aspects of 3 modalities and advises an orderly protocol, rather than reflex alone, to minimize risk.
TABLE 2
Factors likely to cause premature incision with ultrasonic energy
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Summary
The use of electrical and ultrasonic energy during operative laparoscopy poses several challenges, including the reduction of unwanted thermal injury and the elimination of incomplete hemostasis.
Since the depth of penetration during monopolar electrosurgery is proportional to both output voltage and surface area, unwanted thermal change can be reduced by using the smallest electrode surface with “cut” current for tissue cutting, and “coag” current with a broad-surface electrode for contact or noncontact (fulguration) coagulation.
Bipolar electrosurgery is the preferred modality for coaptive desiccation of a vascular pedicle with electricity. Despite the isolation of current to the intervening tissue, surgeons must take steps to reduce the lateral percolation of heat into adjacent tissues.
Ultrasonic energy provides reliable coaptive hemostasis and incision with little tissue damage. However, the surgeon must be mindful of the forces that promulgate premature incision. Knowledge of the biophysical behavior of electrical and ultrasonic energy is a prelude to safety and efficacy during laparoscopic dissection.
Dr. Brill reports no affiliations or financial arrangements with any of the manufacturers of products mentioned in this article.
