Harmonic ACE^™ Pistol Grip

A member of the Reviews in Obstetrics & Gynecology editorial board reviewed the following devices. The views of the author are personal opinions and do not necessarily represent the views of Reviews in Obstetrics & Gynecology or MedReviews®, LLC.

Companies can submit a product for review by e-mailing molson@medreviews.com.

• Design/Functionality Scale

  • 1 = Poor design; many deficits
  • 2 = Solid design; many deficits
  • 3 = Good design; few flaws
  • 4 = Excellent design; few flaws
  • 5 = Excellent design; flaws not apparent
• Innovation Scale

  • 1 = Nothing new
  • 2 = Small twist of standard technology
  • 3 = Major twist on standard technology
  • 4 = Significant new technology
  • 5 = Game changer
• Value Scale

  • 1 = Added cost with limited benefit
  • 2 = Added cost with some benefit
  • 3 = Added cost but significant benefit
  • 4 = Marginal added cost but significant benefit
  • 5 = Significant cost savings
• Overall Scale

  • 1 = Don’t bother
  • 2 = Niche product
  • 3 = Worth a try
  • 4 = Must try
  • 5 = Must have

Evaluation

Design/Functionality: 4.0

Innovation: 1.5

Value: 3.0

Overall Score: 4.5

Background

Although hot shears and Kleppinger bipolar forceps can see most surgeons through today’s advanced laparoscopic procedures, few—except operating room purchasing agents and hospital Chief Financial Officers—would argue against the advances in laparoscopic coagulation and cutting technologies. Whether radiofrequency (RF), laser, or ultrasound energy, these devices provide laparoscopic surgeons greater safety and confidence than older, simpler monopolar and bipolar technologies. Are these disposables expensive? Yes. However, injured ureters, bleeding complications, and longer hospital stays and recovery times are not cheap either.

Design/Functionality

The Harmonic Scalpel® (Ethicon Endo-Surgery, Inc., Cincinnati, OH) has been on the market for several years and it is fairly well known. With respect to the core producte, the Harmonic Scalpel takes some getting used to; it really does not like tension. This characteristic can create difficulties for new users, who are used to pulling tissue as far from other structures as possible when coagulating and cutting. For experienced Harmonic users, this is rarely an issue and the super-small thermal footprint easily counterbalances this concern and adds a degree of confidence when operating in tight spaces. The lower cutting and coagulating temperatures (50°C–150°C, as compared with the RF range of 150°C–400°C) make operating near vital structures less anxiety provoking. Unfortunately, the Harmonic ACE™ Pistol Grip (Ethicon Endo-Surgery) is only rated to seal vessels up to 5 mm, whereas its RF cousins typically rate up to 7 mm. With its curved shear design, the Harmonic ACE Pistol Grip is nicely versatile and is an excellent blunt dissection instrument. It does grasp tissue, but the smooth surface of both the blade and anvil are not ideal for this purpose.

The recent change in the device—and the reason for this review—is the new handle. In the previous version, the awkward location of the control buttons forced most surgeons to assume an unnatural pistol grip to most efficiently activate the device. For surgeons with smaller hands, the distance to the buttons frequently required that both hands be used to make the scalpel work. The new handle design addresses and solves these problems by moving the controls to the lower front of the instrument, where they are easily accessible. Other modifications to the lower portion of the handle make the grip feel more natural and comfortable, and the addition of “soft touch” material gives the whole device a better feel.

Design/Functionality Score: 4.0

Innovation

For the purpose of this review, the new handle is the focus. With that in mind, the new design, although important, does not represent a major technological breakthrough. Ergonomics and comfort are important, but moving buttons and changing handle materials are not innovation.

Innovation Scale: 1.5

Value

Determining value for laparoscopic coagulation and cutting devices is difficult. If a surgeon can safely and efficiently perform surgery without disposable devices—and some can—then they provide little value. If a surgeon’s skill set limits the performance of the same minimally invasive procedure without the disposable devices, then the devices represent good value. The Harmonic ACE Pistol Grip is competitively priced compared with other devices. Ethicon did not raise the price with the new design, so the changes represent pure added value. Because the Harmonic ACE offers coagulation, cutting, dissecting, and grasping functionality, there is little need for additional disposable devices.

Value Score: 3.0

Summary

When energy sources are used and compared, minimally invasive surgeons tend to gravitate toward either ultrasound or RF. If you are a committed RF surgeon, the new Harmonic ACE is unlikely to change your mind. If you’re a Harmonic aficionado (and I am), then this new design should make you happy.

Overall Score: 4.5