ABSTRACT
PURPOSE: Use of bipolar electocoagulation devices becomes popular in the laparoscopic surgical field. However, several studies comparing energy-based devices for use in performance of mechanical sealing and cutting techniques have reported various results. The aim of this study was to evaluate feasibility and efficacy of new commercially available bipolar electocoagulation devices: EnSeal(TM) device (Ethicon Endo-Surgery, Cincinnati, OH, USA) by comparison with LigaSure(TM) atlas 5 mm (COVIDIEN, Boulder, CO, USA), for use in performance of coagulation and cutting techniques during performance of laparoscopic colorectal cancer surgery. METHODS: Between June 2010 and February 2011, 50 consecutive patients who underwent curative laparoscopic surgery for right colon cancer or rectal cancer were enrolled. Time and number of device activations were compared during omentectomy in cases of right colectomy and mesorectal trimming procedure in cases of anterior resection. Pathologic data and short-term clinical outcomes were also compared. RESULTS: No significant differences in terms of clinicopathologic comparison were observed between the EnSeal and LigaSure groups. No significant difference in mean operative time (207.6+/-45.3 vs. 198.9+/-57.2; p=0.558), mean time of omentectomy (11.0+/-4.5 vs. 12.6+/-8.6; p=0.293), mean time of m esorectal trimming (18.6+/-10.0 vs. 16.1+/-6.9; p=0.418), mean number of device activations during omentectomy (43.5+/-10.2 vs. 51.6+/-39.2; p=0.586), and mean number of device activations during performance of mesorectal trimming (44.8+/-22.3 vs. 49.1+/-23.7; p=0.597) were observed between the two groups. CONCLUSION: Bipolar electocoagulation devices were adapted for use in laparoscopic surgery, resulting in reduced operative time and blood loss. EnSeal(TM) Device and LigaSure(TM) atlas 5 mm were useful during performance of sealing and cutting techniques in laparoscopic colorectal cancer surgery.
Subject(s)
Humans , Colectomy , Colonic Neoplasms , Colorectal Neoplasms , Laparoscopy , Operative Time , Rectal Neoplasms , Surgical InstrumentsABSTRACT
PURPOSE: Ligasure(TM) is a feedback-controlled bipolar diathermy originally devised to seal vessels and developed to weld tissue bundles. The tissue fusion mechanism consists of melting collagen and elastin, and the tissue welding property of Ligasure(TM) can be used in a hemorrhoidectomy. To confirm the efficacy of Ligasure(TM) in hemorrhoidectomies, I compared it with the conventional semi-open method. METHODS: One hundred patients with grade III or IV hemorrhoids were randomly assigned to the Ligasure(TM) (n=50) or the conventional semi-open (n=50) hemorrhoidectomy group. The operation time, the postoperative analgesic requirement, the hospital stay, the time to return to normal life, and complications were prospectively recorded and analyzed. RESULTS: There was no difference in sex and age between the two groups. The operation time was markedly shorter in the Ligasure(TM) group than semi-open group (10.8+/-4.0 versus 23.7+/-5.2 min; P<0.001). Although the hospital stay was not statistically different, the time to return to the normal life was shorter in the Ligasure(TM) group (9.5+/-3.8 versus 12.7+/-4.0 days; P<0.05). The requirement for postoperative analgesics within 48 hours (nalbuphine, 5mg) was not significantly different. In each group, an urinary retention was noted and treated with urinary catheterization. In Ligasure(TM) group, an anal stenosis was developed and was successfully treated with advancement flap surgery. In each group a secondary bleeding and a skin tag were noted. There was no wound infection or incontinence. CONCLUSIONS: Ligasure(TM) hemorrhoidectomy reduces the operation time and the time to return to the normal life. If anal stenosis is to be prevented, careful attention is required to preserve the anal skin and mucosa. Ligasure(TM) is simple to use and is useful in the treatment of patients with grade III or IV hemorrhoids.