Experimental comparison of the ultrasonically-activated scalpel to electrosurgery and laser surgery for laparoscopic use

Energy sources used in laparoscopic surgery are associated with thermal damage to tissues. In this study, we sought to compare the safety and efficacy of the ultrasonically-activated scalpel to electrosurgery and laser surgery in laparoscopic applications using an animal model (cholecystectomy). Variables examined were gall bladder perforation, bile spillage, smoke generation, operative time, tissue injury, bleeding, liver function tests and post-operative adhesion formation following laparoscopic cholecystectomy. Female pigs were randomized to one of three groups: laparoscopic cholecystectomy performed using electrosurgery (ES), laser surgery (LS), or ultrasonically-activated scalpel (UAS). At the termination of the procedure, the animals were either recovered for 7, 14, or 28 days or immediately euthanized with an intracardiac injection of saturated potassium chloride solution for necropsy (0 day). There was no difference in mean operative time between UAS, ES or LS. LS required greater smoke evacuation (67%) than ES (25%) or UAS (0%) (P < 0.001). Gall bladder perforation during dissection with the UAS was 17%, with ES 50% and with LS, 92% (P < 0.001). Post-operative adhesions occurred in 22% of the UAS group, 67% of the ES group and 89% of the LS group (P < 0.001). The ultrasonically-activated scalpel is more ideally suited for laparoscopic cholecystectomy than electrosurgery or laser surgery, and laser surgery is the least desirable of the three modalities.