Techniques for dissection and haemostasis
Epublication WebSurg.com, Dec 2014;14(12). URL: http://websurg.com/doi/lt03enmutter013
Not only does surgical tissue dissection require control of main vessels but it also mandates hemostasis of capillaries located in dissection areas. Surgeons can use mechanical means of tissue control, clips, staples, and sutures. They can also use physical means including radiofrequency-induced tissue fusion (electrocautery to achieve division and coagulation) and ultrasound. The principles of these systems rely on an increased temperature of tissues through a molecular agitation or mechanical means conducive to the dessication of tissues, the fusion of proteins, and to a series of coagulations and divisions. The use of such effective systems can be associated with specific complications. Consequently, it is mandatory for surgeons to know the principles and risks related to their use. Indeed, surgeons will be the end-users of such devices and of their effects. They must be able to inform their patients and prevent the occurrence of accidents which may result in intraoperative or postoperative complications for which they can be directly blamed. In this presentation, the principles of tissue control systems, their potential risks, as well as the prevention of any related accidents are outlined. Electrosurgery and ultrasound use will be respectively addressed along with indications and specific risks associated with their use. Techniques and principles of the new applications of electrocautery controlled by electronic systems (e.g., LigaSure™ vessel-sealing device, Covidien-Valleylab, ultrasound fusion devices such as Sonicision™, Covidien-Valleylab) are described, as well as their benefits and limitations. The specificities and privileged indications for the use of such systems will be detailed. Finally, standard instruments indispensable for laparoscopic interventions will be addressed.