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sue," he says, and disperses quickly, so there's little risk of thermal injury to the
surrounding tissue. In highly vascularized anatomy, that's a plus.
Choice and capability
Given the available options and innovations, what factors should surgeons con-
sider to best serve their cutting and sealing needs? "In my mind, the choice
depends on the size of the vessels you're dealing with," says Dr. Barrett. "If
they're larger vessels, a bipolar device. If they're smaller, ultrasonic."
But safety is another important consideration, he says, adding, "What kind of
tissue is around the site? The small bowel is a big risk area for thermal spread.
Which device has the best control over energy delivery and temperature regula-
tion?"
"Every technology has its own nuances," says Dr. Cohen, but he notes it's not
easy to compare and differentiate them in terms of their surgical outcomes.
"What outcomes do you want? There are many studies on energy use in hemor-
rhoid surgery, for instance. A literature search on any of these instruments will
show you the feasibility with which it can be done." But a patient's post-op pain
is a subjective measure, no matter which method you use, and there's a wide
range of inter-related factors to consider in assessing a surgery's success.
"It all depends on the value a technology adds to a case. I see value in, how
quickly can I seal the vessel? Does it stand the test of time, which is to say 7 to
10 days?" says Dr. Cohen. A quality seal that can resist post-op bleeding without
S U R G I C A L E N E R G I E S
Exercise caution outside of the surgical site as well as inside it. The hot jaws of recently
used devices should not make contact with thin, combustible surgical drapes, but should
instead be cooled on a damp sponge or gauze.
That type of risk isn't so much a negative reflection on the device as it is on the user,
says Dr. Cohen. All the same, it shows the need to rethink practices when adapting new
techniques. "With any new technology comes challenges," he says. "And we're all look-
ing to do the safest thing."
— David Bernard
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Fax +1-315-735-6235
email info@mail.conmed.com
www. conmed.com
© 2012 ConMed Corporation, 8/2012, Control #MCM2012168
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