Power sources in endoscopic surgery.

The power sources used in endoscopic surgery are varied and numerous, and will continue to improve as technology progresses. Early attempts at operative laparoscopy were crude, limited by the available instrumentation, and tended to be frustrating: scissors that had to be frequently sharpened and endocoagulators that took a seemingly interminable time to achieve their tissue effect. New developements in ultrasonic energy and different wavelengths of laser energy are used alongside increasingly sophisticated electrosurgical tools, employing both monopolar and bipolar systems, and innovative delivery systems such as the argon beam coagulator and the Helica Thermal Coagulator. All of these systems have their advocates and their detractors, but in the end the choice of power source is determined by the type of equipment that the operator feels most comfortable with. The surgeon must have a detailed knowledge of the physical concepts required to generate the power source, and be able to understand the complications that can be created by the energy, how to avoid them, how and to deal with them if they occur. Although there are subtle differences in the reaction of the different energy sources with human tissue, the clinical outcome appears to be much the same, and depends more on the skill of the individual surgeon than the power source employed.