OSE_1309_part2_Layout 1 9/6/13 12:24 PM Page 119
M I N I M A L L Y
I N V A S I V E
S U R G E R Y
become the preferred choice for surgeons.
2. Reliability
On paper, ultrasonic devices are designed to seal 5mm vessels and bipolar tools are intended for 7mm vessels, says Dr. Brill, who also points
out that the actual performance of an instrument is based largely on
surgeon technique.
In very few circumstances are vessels free and dangling so surgeons
can apply a device as ideally intended, he explains. "The on-paper
promises are realized and maximized only when surgeons approach
vessels in a perpendicular approach, but the devices are hindered by
tangential application."
Dr. Giesler says surgeons want devices they can use during surgery
from start to finish, without having to change instruments in the middle
of the field or in the midst of a case. "Any instrument works well during
straightforward cases, but surgeons want instruments qualified for difficult maneuvers," he says. "With some facilities doing up to 90% of cases
minimally invasive, finding reliable and effective laparoscopic instrumentation is critical."
3. Safety
Harmonic devices use mechanical vibration to cut and seal, which can
limit thermal spread when compared with bipolar devices. Dr. Lewis
points out, however, that the tip on one of the latest advanced bipolar
devices is designed to focus energy where the surgeon intends, which
is one of the biggest factors in instrumentation selection.
"We've seen a lot of improvements in the way instruments are
designed to manage thermal spread," says Dr. Giesler. "All of the manufacturers have come closer to the ideal of less than 3mm of spread.
Technology has progressed significantly in bipolar instruments, so there
S E P T E M B E R 2013 | 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
1 1 9
