MONOPOLAR ELECTROSURGERY AND NDYAG CONTACT-LASER(TM) IN LAPAROSCOPIC INTESTINAL SURGERY

In a prospective randomized study using a canine model, we compared the use of monopolar electrosurgery (EC) (n = 23) and the Nd:YAG Contact Laser(TM) (CL) (n = 21) on intra- and postoperative morbidity in laparoscopic large-bowel resection. In EC, cutting was performed with scissors and coagulation was performed with electrosurgery. In CL, cutting and coagulation were carried out with the Nd: YAG Contact Laser(TM). Laparoscopic oncologic right colectomy with intraperitoneal ileocolic stapled anastomosis was performed in all dogs. Intraoperative smoke development, difficulty of dissection, hemostasis, and postoperative adhesions were judged using a five-point score. Two weeks after surgery, all dogs were sacrificed and zoopsy was carried out. Three dogs died postoperatively from pneumonia and one from an anastomotic leak. There were no other postoperative complications. Operative time was 135 min (range 105-180) in the CL group and 145 min (range 60-210) in the EC group. Intraoperative smoke development, difficulty of dissection, and postoperative amount of adhesions were not different between groups (P > 0.05). Hemostasis in the CL group (median score of 1, range 1-2) was significantly better (P = 0.01) than in the EC group (median score of 2, range 1-5). Scissors and electrosurgery as well as Nd: YAG Contact Laser(TM) can be used successfully in intestinal laparoscopic surgery. Although the use of the Contact Laser(TM) did not cause less postoperative morbidity than the conventional method, there was significantly better hemostasis using the Nd:YAG Contact Laser(TM).