A prospective randomized comparison of two instruments for dissection and vessel sealing in laparoscopic colorectal surgery.
BACKGROUND
A newly available, laparoscopic 5-mm bipolar vessel sealing device promises substantial advantages over the 10-mm instrument. This study compared the safety as well as the technical and surgical aspects of these different tools.


METHODS
For this study, 30 consecutive patients undergoing laparoscopic left-sided colectomy were prospectively randomized for the 5-mm LigaSure or The 10-mm LigaSure. The patients' demographics were analyzed together with their intraoperative and postoperative parameters, and the instruments were assessed by the surgeons with a standardized questionnaire.


RESULTS
The two groups were comparable and demonstrated similar mean operation times, blood losses, and hospital stays. The 5-mm LigaSure was applied in more operation steps and resulted in fewer bleeding episodes and less lens cleaning. Monopolar scissors were used less frequently in the 5-mm group, thus minimizing cauteric lesions and their complications (0 in the 5-mm group vs 2 in the 10-mm group). Overall satisfaction with the 5-mm LigaSure was significantly higher (8.4 +/- 0.18 vs 6.9 +/- 0.41 out of 10; p = 0.002), with significant advantages in terms of dissection capacity, visibility, and handling.


CONCLUSIONS
The 5-mm LigaSure is as secure and fast as the larger 10-mm device and compares favorably in terms of finer dissection as well as trocar flexibility and handling. Therefore, it can be used safely in laparoscopic colorectal surgery.
Hübner
M
M
Department of Visceral and Transplantation Surgery, University Hospital of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
Hahnloser
D
D
Hetzer
F
F
Müller
M K
MK
Clavien
P-A
PA
Demartines
N
N
D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003082:Colectomy / Q000295:instrumentation* / Q000379:methods; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008026:Ligation / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016896:Treatment Outcome