Evaluation of Ultrasonically Activated Scalpel Performance in Pediatric Laparoscopic Surgery

Abstract

ABSTRACT

Background and Purpose:

Electrosurgery is the predominant form of energy used in open and laparoscopic surgery despite its well-recognized risks. In 1992, an ultrasonically activated scalpel—Harmonic Scalpel (laparoscopic coagulating shears; LCS)—a device that achieves effective coagulation and safe cutting of tissue, avoiding the risks of electrosurgery, was introduced. The aim of this study was to evaluate the effectiveness of the LCSs in pediatric laparoscopic surgery.

Patients and Methods:

To test the advantages of the LCS in pediatric laparoscopic surgery, we selected six different laparoscopic procedures: primary pull-through for Hirschsprung's disease, Toupet fundoplication, nephrectomy, splenectomy, salpingooophorectomy, and appendectomy. Patients were assigned to two groups prospectively and randomly for each procedure: Lap-LCS (using LCS) or Lap-electro (using conventional electrosurgery). These two groups were compared according to the various laparoscopic procedures with regard to operating time, number of hemoclips used, and the extent of histologic thermal injury.

Results:

The average operating time for the Lap-LCS group was significantly shorter than for the Lap-electro group for each of the six procedures (P < 0.01). The LCS were able to securely transect and coagulate mesenteric vessels of various sizes, short gastric vessels, gonadal vessels, and appendiceal vessels without a need for hemoclips to achieve hemostasis. Hemoclips were required only for splenic and renal vessels in the Lap-LCS group. In contrast, conventional bipolar or monopolar diathermy was insufficient for coagulating short gastric vessels and gonadal vessels in the Lap-electro group, and hemoclips were required. Lateral thermal injury using the LCS was significantly less than that produced the ordinary electrosurgery. Conclusion: These data suggest that the LCS, which do not directly transmit electrical energy to the surrounding tissues, is the safest and most useful of the modern thermal instruments and is therefore beneficial for use in pediatric laparoscopic surgery.