Comparison of Ultra-Sonic Dissector with Scissor and Monopolar Diathermy in Complex Laparoscopic Surgeries for Tissue Dissection and Hemostasis

Background: A wide variety of intra-abdominal procedures are performed by laparoscopy with reduced morbidity than open procedures. Dissection and hemostasis specially in complex surgeries is a challenge. The methods available are blunt, scissor, diathermy and ultra-sonic dissections whilst bipolar diathermy can be used to assist hemostasis. Aim: An evaluation was done of the efficacy of ultra-sonic dissector for tissue dissection in comparison with scissor and monopolar diathermy. Material and methods: An analysis was done on the usage of ultra-sonic dissector comparative to scissor and monopolar diathermy. The time of dissection and blood loss were evaluated. The procedures performed were oesophagectomy, Hellers cardomyotomy, Nissen fundoplication, splenectomy, cholecystectomy, distal pancreatectomy, laparoscopy assisted pancreatico-duodenectomy, adrenalectomy, right hemicolectomy, anterior resection and abdomino-perineal resection. Observation: Hundred and ninety five patients underwent cholecystectomy and preferred technique of dissection was monopolar diathermy hook assisted with Merrylands dissector. In hundred and fourteen patients who underwent complex abdominal surgeries dissection on planes which are vascular ultrasonic dissector with bipolar assistance was quicker than bipolar and scissor, whilst providing good hemostasis. Conclusion: Using ultra-sonic dissector with bipolar assist was preferred to use of ultra-sonic dissector alone. The hybrid approach provides better hemostasis whilst reducing the usage time of ultra-sonic dissector allowing longer usage of probes. On less vascular planes monopolar diathermy is adequate. Selective use of ultrasonic dissector will reduce cost of surgery.