Instrument Review
LigaSure™ 5-mm Blunt Tip laparoscopic instrument is the latest sealer/divider from Medtronic (Dublin, Ireland). LigaSure™ technology has been used since 1998 and there are a variety of instruments for use in both laparoscopic and open procedures. I have been using this instrument along with the Harmonic Scalpel (Ethicon Endosurgery, Somerville, NJ) for many years now.
LigaSure™ uses a combination of pressure and continuous bipolar energy to create vessel fusion. LigaSure™ seals vessels by applying high, uniform mechanical compression while monitoring and adjusting energy delivery to the tissue. Collagen and elastin fibers in the compressed vessel walls are denatured; during the cool-down phase, crosslinking reoccurs, effectively creating a new, solid wall of collagen and elastin tissue. An algorithm in the generator determines optimal time and energy delivery to achieve consistent seals for vessels as large as 7 mm in diameter.
The energy source is the ForceTriad™ energy platform (Fig. 1A), designed to precisely manage energy delivery, creating a range of options for desired tissue effect. There is a feedback-controlled response system (TissueFect™ sensing technology), which automatically discontinues energy delivery when the seal cycle is complete, eliminating the guesswork. TissueFect™ sensing technology monitors changes in tissue impedance 3333 times a second, and adjusts energy output accordingly to deliver the appropriate amount of energy for the desired tissue effect.
Fig. 1.
A The ForceTriad™ Energy Platform is the energy source that is used. B The LigaSure™ 5-mm Blunt Tip laparoscopic instrument with detailed view of the base (B1), handle (B2) and the jaw (B3)
LigaSure™ works quickly with an average seal cycle of 2–4 s. LigaSure™ vessel sealing technology has a 95 % probability of a burst pressure greater than three times normal systolic blood pressure. This means there is increased vessel-sealing reliability and consistency in the operating room. This can be useful when operating on vascular pedicles as seen during myomectomy or hysterectomy [1].
Other sealing systems currently available include [2]:
The Gyrus PK tissue management system™ (Gyrus ACMI, Southborough, MA) which uses bipolar energy that is pulsed.
Harmonic Scalpel™ (Ethicon Endosurgery, Somerville, NJ) which uses a high-frequency ultrasonic transducer (55,000 cycles/s) to create mechanical vibration of one of the two jaws. A microprocessor-controlled generator detects changes in the feedback acoustic pattern. Applying pressure and then sealing with a denatured protein coagulum while applying ultrasonic vibration to denature hydrogen bonds perform vessel coagulation. It has the least thermal spread and smoke production of all the devices. The older versions of the device, however, had poor reliability when it came to sealing blood vessels [3]. However, the new Harmonic Ace™+7 shear uses pure ultrasonic energy and has a stronger large vessel-sealing indication. It can coagulate vessels up to 7 mm in diameter with the use of the Advanced Hemostasis hand-controlled button.
EnSeal PTC Tissue Sealing and Hemostasis System™ (SurgRx, Redwood City, CA) also uses bipolar electrical energy but employs a nanotechnology feedback mechanism to control the energy at the electrode–tissue interface. The jaws contain a temperature-sensitive matrix with embedded conductive carbon spherules designed to “sense” tissue characteristics. It uses extremely high jaw compression to create uniform tissue effects. It does not require a dedicated electrosurgical unit for use; an adapter can be purchased that permits use with most generators. The LigaSure™ device has the highest “burst pressure” (pressure required to induce leakage in the vessel) and fastest sealing time compared to the other three devices.
The advantages of the LigaSure™ include (1) highest burst pressure and fastest sealing time compared to the other sealing devices. (2) Reduced blood loss compared to sutures and clips [4]. (3) Reduced procedure time and patient length of stay compared to sutures. (4) Significantly reduced operative blood loss, reduced procedure time, and shorter hospital stay compared to mechanical ligation techniques.
The latest version of the device has been modified for improved blunt dissection and better stability. The handle is ergonomically designed for greater comfort and reduced fatigue (Fig. 1B1, B2). An obvious disadvantage of the LigaSure™ device is the cost as it is a sterile, single-use-disposable instrument.
The LigaSure™ 5-mm Blunt Tip laparoscopic instrument is manufactured by Covidien (Boulder, CO), which was recently acquired by Medtronic (Dublin, Ireland).
Shaft lengths: 23, 37, and 44.
Shaft diameter: 5 mm.
Jaw type: blunt, double-action with contoured tips (Fig. 1B3).
Jaw surface: textured with ceramic stops. Jaw is 9 % wider than its predecessor.
Order information
Ordering codes: LF1623, LF1637, LF1644.
Order quantity: 6 units/case.
The LigaSure™ 5-mm Blunt Tip laparoscopic instrument is used along with the ForceTriad™ energy platform. This is an all-in-one unit compatible with conventional electrosurgical instruments and all current LigaSure™ instruments.
Order information
Ordering codes:
ForceTriad: ForceTriad™ energy platform,
FT900: ForceTriad™ cart,
FT950: ForceTriad™ cart front panel, and
FT990: ForceTriad™ cart drawer.
The contact information for ordering in India is Covidien Healthcare India Private Limited. Building No. 9B, 10th Floor, DLF Cyber City, Phase-III Gurgaon – 122002, Haryana.
Telephone: +91 124 4709 800.
Fax: +91 124 4206 850.
Dr. Vishvanath C. Karande, M.D., F.A.C.O.G.
is the President, Medical Director, and Director of the IVF Program at InVia Fertility Specialists, Chicago, USA. After completing his residency in Obstetrics and Gynecology at the SUNY at Buffalo, NY, he completed a Fellowship in Reproductive Endocrinology and Infertility at the Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, Norfolk, Virginia. He is Board Certified in the specialty of Obstetrics and Gynecology as well as Reproductive Endocrinology and Infertility. He is a Fellow of the American College of Obstetricians and Gynecologists and a Member of the American Society for Reproductive Medicine. He is also an accomplished laparoscopic surgeon and is accredited by the Accreditation Council for Gynecological Endoscopy. Dr. Karande has authored numerous papers extensively for publication in several peer-reviewed journals.
Compliance with Ethical Standards
Conflict of interest
Dr. V. Karande declares that he does not have any conflict of interest.
Footnotes
Dr. Vishvanath C. Karande is the President, Medical Director, and Director of the IVF Program at InVia Fertility Specialists, Chicago, USA.
References
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