Abstract
In a prospective randomized study using a canine model, we compared the use of monopolar electrosurgery (EC) (n=23) and the Nd:YAG Contact Laser™ (CL) (n=21) on intra- and postoperative morbidity in laparoscopic large-bowel resection.
In EC, cutting was performed with scissors and coagulation was performed with electrosurgery. In CL, cutting and coagulation were carried out with the Nd:YAG Contact Laser™. Laparoscopic oncologic right colectomy with intraperitoneal ileocolic stapled anastomosis was performed in all dogs. Intraoperative smoke development, difficulty of dissection, hemostasis, and postoperative adhesions were judged using a five-point score. Two weeks after surgery, all dogs were sacrificed and zoopsy was carried out.
Three dogs died postoperatively from pneumonia and one from an anastomotic leak. There were no other postoperative complications. Operative time was 135 min (range 105–180) in the CL group and 145 min (range 60–210) in the EC group. Intraoperative smoke development, difficulty of dissection, and postoperative amount of adhesions were not different between groups (P>0.05). Hemostasis in the CL group (median score of 1, range 1–2) was significantly better (P=0.01) than in the EC group (median score of 2, range 1–5).
Scissors and electrosurgery as well as Nd:YAG Contact Laser™ can be used successfully in intestinal laparoscopic surgery. Although the use of the Contact Laser™ did not cause less postoperative morbidity than the conventional method, there was significantly better hemostasis using the Nd:YAG Contact Laser™.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Böhm B, Milsom JW, Stolfi VW, Kitago K (1993) Laparoscopic intestinal intraperitoneal anastomosis. Surg Endosc 7: 194–196
Brackett KA, Sankar MY, Joffe SN (1986) Effects of Nd:YAG laser photoradiation on intra-abdominal tissues: A histological study of tissue damage versus power density applied. Laser Surg Med 6: 123–130
Corbitt JD (1992) Preliminary experience with laparoscopic-guided colectomy. Surg Laparosc Endosc 2: 79–81
Cuschieri A, Berci G, McSherry CK (1990) Laparoscopic cholecystectomy. Am J Surg 159: 273–278
Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1: 144–150
Davidoff AM, Pappas TN, Murray EA, Hilleren DJ, Johnson RD, Baker ME, Newman GE, Cotton PB, Meyers WC (1992) Mechanisms of major biliary injury during laparoscopic cholecystectomy. Ann Surg 215: 196–202
Dubois F, Berthelot G, Levard H (1990) Coelioscopic cholecystectomy. Ann Surg 211: 60–62
Hukki J, Krogerus L, Castren M, Schroder T (1988) Effects of different Contact Laser scalpels on skin and subcutaneous fat. Laser Surg Med 8: 276–282
Hunter JG (1991) Laser or electrocautery for laparoscopic cholecystectomy? Am J Surg 161: 345–349
Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparos Endosc 1: 144–150
Luciano AA, Maier DB, Koch EI, Nulsen JC, Whitman GF (1989) A comparative study of postoperative adhesions following laser surgery by laparoscopy versus laparotomy in the rabbit model. Obstet Gyn 74: 220–224
Milsom JW, Böhm B, Stolfi VW, Kitago K (1993) The use of cotton tapes in intestinal laparoscopic surgery. Br J Surg 80: 768
Milsom JW, Lavery IC, Böhm B, Fazio VW (1993) Laparoscopically-assisted ileocolectomy in Crohn's disease. Surg Laparosc Endosc 3: 77–80
Moossa AR, Easter DW, Van Sonnenberg E, Casola G, D'Agostino H (1992) Laparoscopic injuries to the bile duct. Ann Surg 215: 203–208
Nezhat FM, Nezhat C, Pennington E, Ambroze W (1992) Laparoscopic segmental resection for infiltrating endometriosis of the rectosigmoid colon: A preliminary report. Surg Laparosc Endosc 2: 212–216
Phillips EH, Franklin M, Carroll BJ, Fallas MJ, Ramos R, Rosenthal D (1992) Laparoscopic colectomy. Ann Surg 216: 703–707
Saye WB, Miller W, Hertzmann P (1991) Electrosurgery thermal injury. Myth or misconception? Surg Laparosc Endosc 1: 223–228
Schomacker KT, Walsh JT, Flotte TJ, Deutsch TF (1990) Thermal damage produced by high-irradiance continuous wave CO2 laser cutting tissue. Laser Surg Med 10: 74–84
Schroder T, Brackett K, Joffe SN (1987) Proximal pancreatectomy: A comparison of electrocautery and contact and noncontact Nd:YAG laser techniques in the dog. Am J Surg 154: 493–498
Schroder T, Brackett K, Joffe SN (1987) An experimental study of the effects of electrocautery and various lasers on gastrointestinal tissue. Surgery 101: 691–697
Shirk GJ, Gimpelson RJ, Krewer K (1991) Comparison of tissue effects with sculptured fiberoptic cables and other Nd:YAG laser and argon laser treatments. Laser Surg Med 11: 563–68
Voyles CR, Tucker RD (1992) Education and engineering solutions for potential problems with laparoscopic monopolar electrocautery. Am J Surg 164: 57–62
Walsh JT, Flotte TJ, Anderson RR, Deutsch TF (1988) Pulsed CO2 laser tissue ablation: effect of tissue type and pulse duration on thermal damage. Laser Surg Med 8: 108–118
Zweig AD, Meierhofer B, Mueller OM, Mischler C, Romano V, Frenz M, Weber HP (1990) Lateral thermal damage along pulsed laser incisions. Laser Surg Med 10: 262–274
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Böhm, B., Milsom, J.W., Kitago, K. et al. Monopolar electrosurgery and Nd:YAG Contact Laser™ in laparoscopic intestinal surgery. Surg Endosc 8, 677–681 (1994). https://doi.org/10.1007/BF00678565
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00678565