Comparison of monopolar electrocoagulation, bipolar electrocoagulation, Ultracision, and Ligasure.
OBJECTIVE
Hemostasis is a fundamental principle of surgery. We compared the safety and efficacy of monopolar electrocoagulation (ME), bipolar electrocoagulation (BE), Ligasure (LS), a modern bipolar vessel sealing system, and Ultracision (UC), a system of ultrasound energy based shears. We also studied the healing process after their use.


METHODS
We used each of the above methods to coagulate and divide the short gastric vessels of 16 white male New Zealand rabbits. The animals were killed after 3, 7, 14, or 21 days, and the coagulation sites and the adjacent gastric wall were examined histologically.


RESULTS
LS and UC achieved complete hemostasis without any complications. Conversely, ME and BE often resulted in failed coagulation and perforation of the neighboring gastric wall from a side thermal injury. Histologically, LS demonstrated the mildest side thermal injury and the fastest healing process. We noted greater thermal injury and inflammatory response after UC than after LS on days 7 and 14; however, ME and BE caused the most severe lesions.


CONCLUSIONS
LS and UC are clearly the safest and most efficient methods of coagulation, whereas ME and BE could cause serious clinical and histological complications. We found histological evidence that UC causes a slightly greater inflammatory response than LS, and the clinical implications of this warrant further investigation.
Diamantis
Theodore
T
First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Kontos
Michael
M
Arvelakis
Antonios
A
Syroukis
Spiridon
S
Koronarchis
Dimitris
D
Papalois
Apostolos
A
Agapitos
Emmanuel
E
Bastounis
Elias
E
Lazaris
Andreas C
AC
D000818:Animals; D004195:Disease Models, Animal; D004564:Electrocoagulation / Q000379:methods*; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000473:pathology / Q000628:therapy*; D006488:Hemostasis, Surgical / Q000379:methods*; D008026:Ligation / Q000379:methods; D008297:Male; D011817:Rabbits; D013270:Stomach / Q000098:blood supply; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods*; D014945:Wound Healing