Laparoscopic Intracorporeal Bowel Resection with Ultrasound versus Electrosurgical Dissection

BACKGROUND AND OBJECTIVES We assessed resection time and collateral thermal tissue damage of ultrasonically activated surgery (UAS) and high-frequency blade-enhanced bipolar electrosurgery (BE) in laparoscopic bowel surgery. METHODS We compared UAS laparoscopic intracorporeal small bowel mesentery re-section with an equivalent procedure performed with BE in a porcine model. Resection was defined as 12 end-arcade arteries supplying the intended bowel segment. Vessels were divided one cm off the bowel wall. Aside from shaft diameter, jaws gaping pattern, and cutting blade length, UAS and BE devices were well matched for handle ergonomics, jaws gaping extent, power setting, type of use, working shaft axial rotation, and length. A pathologist blind to the method used assessed the collateral thermal damage. Resections were allocated to either method by computer-generated block randomization. The study design was sequential triangular with a 5% significance level and 90% power. RESULTS No significant differences occurred in intraoperative blood pressure and heart rate variations in pigs undergoing UAS or BE. Median operating time (measured after 10, 20, and 30 resections in each study arm) was significantly shorter in UAS than in BS (0.57 vs. 2.01 min P < 0.001). Histology of small bowel wall specimens revealed no collateral thermal damage. CONCLUSIONS UAS laparoscopic bowel surgery offers reduced resection time as com-pared with its BE counterpart in a porcine model.