[Do bipolar scissors increase postoperative adhesions? An experimental double-blind randomized trial].
OBJECTIVE
The use of bipolar scissors (PowerStar) which has been suggested to reduce bleeding during surgical dissection, involves the theoretical risk for increasing intraperitoneal adhesions because of burn damages to the peritoneum secondary to bipolar electrocautery.


METHODS
Thirty-six white new-Zealand rabbits have been included in a double-blind randomised trial to undergo a laparotomy using either a sharp scissors with on-demand monopolar coagulation or a bipolar scissors. Operatives procedures were standardised: midline laparotomy (5 cm), mobilisation of the right colon, incision of the colonic serosa without suture, incision of the colonic serosa with running sutures, incision of the mesentery. All these steps were performed by the same device according to the randomisation. Ten days later, the rabbits were killed. Adhesions were measured and scored according to the Zühlke classification by a surgeon who was not aware of the type of scissors used. Finally a pathological examination of adhesion was randomly performed.


RESULTS
The two groups were similar for weight and sex-ratio. Two rabbits died before the tenth postoperative day (1 unknown aetiology and 1 evisceration). 34 rabbits were available for the study (18 in the "PowerStar" group and 16 in the control group). The results showed no significant difference between the groups for all measured endpoints (length and score of intraperitoneal and parietal adhesions). Nevertheless, pathological examination showed the burn damages to be less pronounced after using PowerStar.


CONCLUSIONS
Bipolar scissors do not increase postoperative adhesions in the rabbit and probably induce less burn damages than monopolar cautery. The additional advantage i.e. the decrease adhesions formation, because of a less intraperitoneal bleeding, has not been observed in this randomised trial.
Forestier
D
D
Service de chirurgie générale et digestive, Hôtel-Dieu, boulevard Léon-Malfreyt, 63058 Clermont-Ferrand, France.
Slim
K
K
Joubert-Zakeyh
J
J
Nini
E
E
Déchelotte
P
P
Chipponi
J
J
D000818:Animals; D004311:Double-Blind Method; D004564:Electrocoagulation / Q000295:instrumentation; D004598:Electrosurgery / Q000295:instrumentation*; D005260:Female; D007813:Laparotomy; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011817:Rabbits; D011897:Random Allocation; D000267:Tissue Adhesions / Q000517:prevention & control