Experience on 245 laparoscopic procedures using the combined ultrasonic and bipolar energy device Thunderbeat™

D. C. Steinemann, A. Zerz, S. Lamm

Objective

In modern laparoscopic surgery the use of an energy device for dissection and preparation is indispensable. Advance energy devices may also be used for vessel sealing reducing the need of vessel clips and vascular staplers. Blood loss and time of surgery are reduced. Experience on the first 245 laparoscopic procedures using the combined ultrasonic and bipolar energy device Thunderbeat™ are reported.

Methods

Operative data and outcome of a consecutive series of 245 patients undergoing laparoscopic procedures using the combined ultrasonic and bipolar energy device Thunderbeat™ is analyzed.

Figure 1

Results

In total 245 laparoscopic procedures in all field of visceral surgery and gynecology have been performed. Among 133 colorectal operations were 113 resections. 64 (57%) of those were performed in NOTES technique using a transvaginal (39) or transrectal (25) access. In upper GI-surgery 37 procedures were performed including Roux-en-Y gastric bypass (12), mesh augmented hiatoplasty (9), total gastrectomy (3). Furthermore 2 left pancreatectomies, 2 splenectomies and one liver wedge resection. Thunderbeat was used for adhesiolysis (19), intraperitoneal onlay mesh repair of incisional hernia (4), lymph node dissection (4) and omententectomy (3). In gynecology Thunderbeat™ was used in hysterectomy (20), adnexectomy (15) and colposacropexy (5). In none of those procedures additional vessel clips or vascular staplers and no other energy device have been used. The total conversion rate to open surgery was 4% (9) for following reasons: anatomical (4), big inflammatory tumours (2), severe adhesions (2) and in one splenectomy case with a necrotic spleen after interventional coiling. There were 6% (14) surgical complications: wound infection in two patients (grade I), peranal bleeding in two patients (Dindo-Clavien grade II), ileus (grade II), intraabdominal abscess nececitating drainage (grade IIIa), intraabdominal heamatoma in two patients after reuptake of oral anticoagulation (grade IIIb), colonic perforation (grade IIIb) and anastomotic leakage in four patients (grade IVb).

Table 1: Laparoscopic procedures

Conclusion

In 245 advanced laparoscopic procedures using Thunderbeat™ we observe no device related conversion or surgical complication. There was no need for additional vessel clips or vascular staplers. The use of Thunderbeat™ in laparoscopic surgery seems to be safe.