[Ultrasonically activated scalpel in laparoscopic surgery advantages and limits].

UNLABELLED

The disadvantage of monopolar coagulation, the limits of the bipolar coagulation and the frequent changes of instruments during laparoscopic procedures, are three elements that make the harmonic dissectors very useful in laparoscopic surgery.

MATERIAL AND METHOD

In Surgery Clinic were operated with anatomic scalpel (HS), in the last month: 50 cholecystectomies, 25 appendectomies, 12 partial ovarectomies, 10 anexectomies and 2 splenectomies. We used 5 and 10 mm instruments, especially the ETICON scissors.

RESULTS AND CONCLUSIONS

After our short experience with HS and in concordance with literature, we consider that: The advantages are: the features to coagulate nearest delicate anatomic structures (biliary tree, large bowel, blood vessels) the absence of the smog and the slag; the scissors is a versatile device which allow the dissection and the coagulation without changes the instruments. The limits are: hemorrhages after insufficient coagulation or prehension, the necessity of the learning curve, high costs of the disposable materials. The HS device represent a real progress, especially for that laparoscopic surgery which requires the coagulation of blood vessels placed in thick and fat structures.