Purpose: To evaluate the postoperative adhesion formation caused by instruments used in gynecologic
laparoscopic surgery and to determine the optimal instruments to use to reduce adhesions.
Materials and Methods: Seventeen juvenile pigs underwent laparoscopic bilateral resection of the
uterine horns under general anesthesia and pneumoperitoneum. The laparoscopic procedures were
carried out using monopolar electrocautery (ME) (n = 8), an electrothermal bipolar vessel sealer
(EBVS) (n = 6), an ultrasonically activated scalpel (UAS) (n = 6), a loop-type ligature (LTL) with
a steel scalpel for severing the tissues (n = 6), and an automatic stapling device (ASD) (n = 8). Second-
look laparotomy was performed 14 days postoperatively, and the degree of postoperative adhesions
was scored from 0 to 6.
Results: The mean and range of adhesion scores were 0.00 with EBVS, 0.13 (range, 0–1) with
ASD, 0.33 (range, 0–2) with LTL, 1.17 (range, 0–3) with UAS, and 3.13 (range, 2–6) with ME. We
found a statistically significant difference in the extent of postoperative adhesion formation associated
with these 5 instruments (P < 0.001, Kruskal-Wallis test).
Conclusion: Adhesion formation increased in the order EBVS < ASD < LTL < UAS < ME. Our
study strongly suggests that surgical instruments can be selected to reduce postoperative adhesion
formation, a particular concern in women of reproductive age.
