LigaSure Advance™ Instrument

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 on 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: 2.5

Innovation: 1.5

Value: 1.5

Overall Score: 1.5

Background

Laparoscopic surgery involving the ligation of blood vessels requires surgeons to choose their weapons. In today’s operating rooms, the armamentarium for hemostatic dissecting devices more or less consists of bipolar forceps and scissors, Ethicon’s Harmonic Scalpel™, SurgRx’s (now Ethicon) EnSeal™, Gyrus’ PKS™ Cutting Forceps, and Covidien’s LigaSure™ line of vessel sealing laparoscopic instruments. This review will focus on the newest addition to the LigaSure line, the LigaSure Advance™ (Covidien, Mansfield, MA) 5-mm laparoscopic instrument.

Design/Functionality

Medical device engineers are constantly being asked by their product managers to add features. This drive for added value is distinctly apparent in this new tool. ValleyLab’s (a subsidiary of Covidien) patented vessel sealing technology has been on the market for many years, and has consistently proven itself in the operating room as a reliable means of achieving hemostasis while minimizing lateral thermal spread. The technology is rated to seal vessels up to 7 mm in diameter while keeping its footprint to less than 2 mm.¹ Pretty good, but not good enough. In addition to sealing vessels and then dividing them, surgeons wanted a better tissue dissector and asked for monopolar capabilities to broaden the instrument’s versatility (eg, enabling the device to amputate the cervix in a laparoscopic hysterectomy or open the cuff in the total laparoscopic hysterectomy). To this end, the engineers gave us the LigaSure Advance.

With its newly ergonomically designed handle and sleeker curved jaws fashioned with a dissecting electrode, the LigaSure Advance is meant to be used exclusively with the ForceTriad™ energy platform controlled by TissueFect™ sensing technology for enhanced monopolar, bipolar, and tissue fusion energy. It seals vessels, cuts tissue, and dissects tissue planes. The device is designed to be the only tool any surgeon will ever need.

In theory, the LigaSure Advance has the capability to do all these things. However, in testing, the device was a bit of a disappointment. First, the new handle, “designed for a wide range of hand sizes,” was not particularly comfortable to use. In fairness, this may simply be a reflection of the fact that the newer design moves away from the more traditional pistol grip to which most surgeons are accustomed, but none of the surgeons who tried it liked it better than the older style. Second, jaws retain the same low friction platform common in all the LigaSure laparoscopic devices. This allows tissue to slip out of the jaws too frequently. Finally, and most troublingly, the cramming in of so much technology at the tip creates some problems. In particular, after several uses to seal vessels, the coagulum buildup on the tip can prevent the jaws from opening and closing completely; this in turn disables a safety mechanism on the cutting blades. Without a functioning cutting blade, the entire raison d’être of the device is negated.

Design/Functionality Score: 2.5

Innovation

Although the core vessel sealing technology in the LigaSure Advance is as solid as ever, the refashioning of older devices with as many bells and whistles as could be found felt more regressive than progressive.

Innovation Score: 1.5

Value

As stated in a prior review on the Harmonic Ace™,² determining value for the whole family of laparoscopic coagulation and cutting devices is a difficult task. If a surgeon can safely and efficiently perform surgeries without the disposable devices—and some can—then they are all poor value. If a surgeon’s skill set limits him/her from performing the same minimally invasive procedure without the disposable devices—probably the majority—then they all represent good value. At a retail price of $925, the LigaSure Advance is expensive relative to its competitors. If a given surgeon is able to get everything out of the device that it is supposed to deliver (coagulation, cutting, dissecting, and grasping) there may be some added value, but at that retail price, even that is a stretch. On the whole for the space it’s in, this device is not a great value.

Value Score: 1.5

Summary

In the highly competitive space that is the laparoscopic coagulating and cutting device market, the LigaSure Advance does not seem to add much except cost. For those surgeons who are accustomed to and comfortable with the older LigaSure laparoscopic devices, this newer option is unlikely to offer enough to make them switch.

Overall Score: 1.5