Use of a computer-controlled bipolar diathermy system in radical prostatectomies and other open urological surgery

Background: Ligasure((R)) is a computer-controlled bipolar diathermy system, designed to optimally seal vessels less than or equal to 7 mm in diameter. The aim of the present study was to evaluate its application to open urological surgery. Methods: The Ligasure((R)) device was used in 32 consecutive open surgical cases, including 25 radical prostatectomies, five radical nephrectomies, one partial nephrectomy and one nephro-ureterectomy. All procedures were performed using standard surgical techniques, with the exception that the Ligasure((R)) device was used for haemostasis. This included pelvic lymphatics and prostatic, adrenal, gonadal and aberrant obturator vessels, as well as vessels associated with the ureter, vasa, seminal vesicles, peri-renal fat, peritoneum and peri-adrenal tissues. Vessels > 7 mm in diameter, such as the renal artery, were ligated. In no patients were haemostatic clips used. Results: In all procedures, vessels and other structures < 7 mm were successfully sealed using the Ligasure((R)) device. For some structures, such as the prostatic pedicles and the seminal vesicles, the Ligasure((R)) device was much easier to apply than haemostatic clips. Use of the Ligasure((R)) device reduced the operating time (mean: 113 min vs 135.5 min; P < 0.001) and blood loss (mean: 529 mL vs 642 mL; P < 0.02) for radical prostatectomies. No intraoperative or postoperative blood transfusions were required. There were no postoperative haemorrhages, lymph leakage or lymphocoeles. Median inpatient hospital stay was 7 days (range: 6-9 days) and no patients required readmission. Conclusion: The Ligasure((R)) device was safe and easy to use in major urological procedures.