Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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OSE_1309_part2_Layout 1 9/6/13 12:24 PM Page 118 M I N I M A L L Y I N V A S I V E S U R G E R Y stop or reduce the current flow when the vessel is sealed and can be cut. On the other hand, ultrasonic devices (harmonic scalpels) vibrate rapidly, creating the mechanical energy needed to cut and coagulate. Which option is best? That depends. "There is no perfect device, so every surgeon needs to develop a toolbox," says Andrew Brill, MD, the director of minimally invasive gynecology at the California Pacific Medical Center in San Francisco. He explains that ultrasonic energy is best suited for surgeries requiring finesse, the ability to dissect soft tissue in an elegant and controlled fashion with an immeasurable amount of hemostasis and limited thermal spread. "On the other hand," says Dr. Brill, "surgical procedures requiring the creation of vascular pedicles that need to be hemostatic and withstand the forces of surgical manipulation would require something with a bigger punch — an advanced bipolar device." During complex procedures, surgeons needs to move quickly through a lot of tissue, says Michael Lewis, MD, the director of minimally invasive gynecologic surgery and associate residency program director at New York Methodist Hospital in Brooklyn. "When it takes 10 to 15 seconds to seal tissue," he adds, "which they do multiple times throughout procedures, the seconds add up to minutes." One of the complexities of bipolar energy is that it desiccates tissue, meaning the temperature at the instruments' tips can get hotter than harmonic scalpels, says Carl F. Giesler, MD, FACOG, director of minimally invasive gynecologic surgery at the University of Texas Health Science Center in Houston. The resulting charring can cause tissue to stick to instruments. "By choice, I primarily use harmonic energy because I don't deal with as much charring, which eliminates most of the sticking problems some docs face," says Dr. Giesler. In the end, any instrument that provides reliable cutting and coagulation will shorten operative times and 1 1 8 O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | S E P T E M B E R 2013