Principles and initial experience of a new device for dissection and hemostasis

Electrosurgery is a commonly used technology in laparoscopy. Electrosurgical devices are being used in many medical subdisciplines in order to coagulate, cut, and ablate tissue and to produce hemostasis. The latest advance in electrosurgery is the introduction of novel simultaneous hemostatic sealing and cutting bipolar devices that minimize force by delivering energy as high current and low voltage output. One of these systems is the Gyrus Plasma Trissector (GPT), (Gyrus Group PLC, Gyrus International, Ltd.UK), a novel radiofrequency (RF) system based on bipolar technology, which consists of a proprietary PlasmaKinetic (PK) generator and specific instruments, designed as a system. The instrument consists of a 17 mm long gold‐coated curved jaw with a ceramic insulated cutting element. The PK system uses high‐powered pulsed bipolar energy to produce a plasmakinetic field around the working elements and is designed to operate at temperatures that allow effective tissue dissection but result in minimal collateral damage and adherence to tissue. The GPT was used with the Gyrus G400 WorkStation generator in laparoscopic radical prostatectomies (LRP). Our initial experience with this novel bipolar device demonstrates it to be safe and effective in dissection and hemostasis. The GPT permits us to act quickly when bloody fields are present, improves coagulation, reduces or eliminates sticking, seals large vessels such as dorsal vein complex (DVC) and allows secure grasping and dissecting of tissue. The urologist is familiar with electrosurgery, as we have become comfortable using GPT to dissect, cut, and coagulate tissue. We feel that the GPT can be used in a variety of laparoscopic procedures in urology.

[1]  J. Kübler,et al.  Laparoscopic Nephroureterectomy in Children: A Prospective Study on Ligasure™ versus Clip/Ligation , 2006 .

[2]  V E Weldon,et al.  Continence, potency and morbidity after radical perineal prostatectomy. , 1997, The Journal of urology.

[3]  W. Winer,et al.  An Innovative Bipolar Instrument for Laparoscopic Surgery , 2005, JSLS : Journal of the Society of Laparoendoscopic Surgeons.

[4]  T. El-toukhy,et al.  One hundred cases of laparoscopic subtotal hysterectomy using the PK and Lap Loop systems. , 2005, Journal of minimally invasive gynecology.

[5]  E. Targarona,et al.  Energy Sources for Laparoscopic Colectomy: A Prospective Randomized Comparison of Conventional Electrosurgery, Bipolar Computer-Controlled Electrosurgery and Ultrasonic Dissection. Operative Outcome and Costs Analysis , 2005, Surgical innovation.

[6]  L. Rombauts,et al.  Ignorance of electrosurgery among obstetricians and gynaecologists , 2004, BJOG: an International Journal of Obstetrics and Gynaecology.

[7]  P. Sibbons,et al.  Comparison of wound-healing and tissue effects using the Gyrus PlasmaKnife with monopolar, Coblation, and Harmonic Scalpel methodologies , 2006, Comparative Clinical Pathology.

[8]  J. M. Lee,et al.  Neuroprotection due to irrigation during bipolar cautery. , 2000, Archives of otolaryngology--head & neck surgery.

[9]  B. Todd Heniford,et al.  Energy Sources in Laparoscopy , 2004 .

[10]  D. Morris,et al.  Artery weld strength after bipolar electrocoagulation is affected by electrolyte solutions around the artery. , 1993, Gastrointestinal endoscopy.

[11]  T Frede,et al.  Transperitoneal laparoscopic radical prostatectomy: ascending technique. , 2004, Journal of endourology.

[12]  A. Patriciu,et al.  Nerve sparing radical prostatectomy: effects of hemostatic energy sources on the recovery of cavernous nerve function in a canine model. , 2004, The Journal of urology.

[13]  G. Preminger,et al.  Use of bipolar laparoscopic forceps to occlude and transect the retroperitoneal vasculature: a porcine model. , 2003, Journal of endourology.

[14]  R. Holubkov,et al.  Vascular pedicle ligation techniques during laparoscopic colectomy , 2006, Surgical Endoscopy And Other Interventional Techniques.

[15]  V C Wright Contemporary electrosurgery: physics for physicians. , 1994, The Journal of family practice.

[16]  T. Viset,et al.  Frequency of Lymphoceles after Open and Laparoscopic Pelvic Lymph Node Dissection in Patients with Prostate Cancer , 2003, Scandinavian journal of urology and nephrology.

[17]  Douglas Skarecky,et al.  Impact of cautery versus cautery-free preservation of neurovascular bundles on early return of potency. , 2006, Journal of endourology.

[18]  L. Malis Electrosurgery and bipolar technology. , 2006, Neurosurgery.

[19]  D. Albala,et al.  PlasmaKinetic bipolar vessel sealing: burst pressures and thermal spread in an animal model. , 2005, Journal of endourology.

[20]  S. Lindström,et al.  Comparison of experimental nerve injury caused by ultrasonically activated scalpel and electrosurgery , 2005, The British journal of surgery.

[21]  M. Rosen,et al.  Evaluation of the Efficacy of the Electrosurgical Bipolar Vessel Sealer (LigaSure) Devices in Sealing Lymphatic Vessels , 2005, Surgical innovation.

[22]  D. Terris,et al.  A Comparison of Mucosal Incisions Made by Scalpel, CO2 Laser, Electrocautery, and Constant-Voltage Electrocautery , 1997, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[23]  C. Ou,et al.  Total laparoscopic hysterectomy using multifunction grasping, coagulating, and cutting forceps. , 2004, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[24]  K. Harold,et al.  Comparison of ultrasonic energy, bipolar thermal energy, and vascular clips for the hemostasis of small-, medium-, and large-sized arteries , 2003, Surgical Endoscopy And Other Interventional Techniques.

[25]  Chin-Jung Wang,et al.  Comparison of the efficacy of the pulsed bipolar system and conventional bipolar electrosurgery in laparoscopically assisted vaginal hysterectomy. , 2005, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[26]  J. Kübler,et al.  Laparoscopic nephroureterectomy in children: a prospective study on Ligasure versus Clip/Ligation. , 2007, European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie.

[27]  G Vallancien,et al.  Robotic assisted, laparoscopic pelvic lymph node dissection in humans. , 2001, The Journal of urology.

[28]  F. Greene,et al.  Initial results with an electrothermal bipolar vessel sealer , 2001, Surgical Endoscopy.

[29]  B. Heniford,et al.  A comparison of laparoscopic bipolar vessel sealing devices in the hemostasis of small-, medium-, and large-sized arteries. , 2003, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[30]  A. Harrell,et al.  Energy sources in laparoscopy. , 2004, Seminars in laparoscopic surgery.

[31]  A. Wittgrove,et al.  Laparoscopic Gastric Bypass, Roux en-Y: Experience of 27 Cases, with 3-18 Months Follow-Up , 1996, Obesity surgery.

[32]  A. Crisci,et al.  Role of bladder neck preservation in urinary continence following radical retropubic prostatectomy , 2004, Scandinavian journal of urology and nephrology.

[33]  Wright Vc Contemporary electrosurgery: physics for physicians. , 1994 .

[34]  L. Emery,et al.  Randomized Trial of Suture Versus Electrosurgical Bipolar Vessel Sealing in Vaginal Hysterectomy , 2003, Obstetrics and gynecology.

[35]  J. Colliver,et al.  Hot Versus Cold Tonsillectomy: A Systematic Review of the Literature , 2003, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[36]  J. Rassweiler,et al.  Oncological safety of laparoscopic surgery for urological malignancy: experience with more than 1,000 operations. , 2003, The Journal of urology.

[37]  S. L. Chen,et al.  Complications and recommended practices for electrosurgery in laparoscopy. , 2000, American journal of surgery.

[38]  Chandru Sundaram,et al.  Evaluation of a vessel sealing system, bipolar electrosurgery, harmonic scalpel, titanium clips, endoscopic gastrointestinal anastomosis vascular staples and sutures for arterial and venous ligation in a porcine model. , 2003, The Journal of urology.

[39]  D. Webb,et al.  Use of a computer‐controlled bipolar diathermy system in radical prostatectomies and other open urological surgery , 2001, ANZ journal of surgery.

[40]  Timothy L. Smith,et al.  Electrosurgery in Otolaryngology–Head and Neck Surgery: Principles, Advances, and Complications , 2001, The Laryngoscope.

[41]  S. Nakano,et al.  The ultrasonic coagulating and cutting system injures nerve function. , 2002, Endoscopy.

[42]  J. Kaouk,et al.  Lateral pedicle control during laparoscopic radical prostatectomy: refined technique. , 2005, Urology.

[43]  K. Isaacson New developments in radiofrequency technology for laparoscopic surgery , 2002 .