Comparison of coagulation modalities in surgery

The increase in laparoscopic surgery has resulted in an increased need for a safe and reliable method of obtaining minimally invasive operative hemost asis. Because the traditional "open" methods of controlling bleeding (press ure, tying, and suture ligating) are not as easily applied in the laparosco pic arena, a heavy reliance on forms of tissue and vessel coagulation is ne cessary. To better assess these forms, we compare monopolar, bipolar, and u ltrasound energy, in addition to laser energy used in a novel application. In the first part, 20 rabbit mesenteric arteries that measured 1 to 1.5 mm in diameter were coagulated using each of the technologies. We measured the time to coagulation, the efficacy of hemostasis, lateral tissue damage, an d local tissue temperature of the vessels when exposed. Part 2 consisted of a survival study using 12 New Zealand white rabbits. In each of these two groups splenectomies were performed. A laser-heated forceps was compared to a monopolar electrosurgery device for the speed of the operation, blood lo ss, and adhesion grade at necrosectomy. In addition, the speed to cauteriza tion of the iliac vessels and the amount of tissue damage was measured. The se vessels were also examined for the extent of microscopic damage. Bipolar electrosurgery was much slower than the other modalities, while monopolar electrosurgery caused significantly more tissue damage and elevation in lat eral tissue temperature. The ultrasound technology and the laser-heated for ceps were equally safe and efficacious instruments. There was no significan t difference in the ability of the laser-heated forceps or the monopolar ca utery to perform the splenectomy safely. However, the forceps cauterized th e iliac vessels faster and with less lateral thermal injury than the ultras ound device. Although each instrument has its place in the surgical armamen tarium, the ultrasound technology appears to be the safest and most efficac ious commercially available device for obtaining hemostasis. The laser, as it is applied in this setting, was also highly effective, but still a proto type device.