Specialities

Specialized Equipments for Laparoscopic Surgery

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Harmonic scalpel- A fabulous surgical tool in laparoscopy

The harmonic scalpel uses ultrasonic technology that allows both cutting and coagulation at the precise point on impact, resulting in minimal lateral thermal damage. It was introduced commercially in 1993 and it is being used by thousands of surgeons worldwide for open surgery and laparoscopic surgery.

Electrosurgical hemostasis is provided by generation of high temperature at probe tip resulting in coagulation necrosis and even charring. Lateral thermal damage and depth of penetration is high in electrocautery. The conversion of electrical signal to ultrasound wave form takes place in handpiece. The ultrasonic wave is transferred to laparoscopic blade. After the ultrasonic wave leaves the laparoscopic blade ,motion is amplified from 25 microns at handpiece mount to 50 to 100 microns at the blade tip. Cutting speed and coagulation is at the hands of the surgeon. Cutting speed and extent of coagulation can be balanced by varying four factors:

• Power

• Blade sharpness

• Tissue tension

• Pressure/Grip force.

The harmonic scalpel has five power levels. Increasing the power increases the cutting speed and decreases coagulation. In contrast less power decreases cutting speed and increases coagulation. The ultrasonic vibration of 55,500 Hz remains the same at all power levels. At level 1 the blade excursion is approximate 30 microns where as in level 5 it is 100 microns.

Advantages over electrocautery Dual action of coagulation and cutting Heat generated is low No lateral tissue damage No smoke is produced so visualization is better No current passes through the patient eliminating the chance of electrical hazard Less tissue damage, so less post operative pain

How does it work?

Vibrating at 55,500 times per second, the HARMONIC blade denatures protein in the tissue to form a sticky coagulum. Pressure exerted on tissue with the blade surface collapses blood vessels and allows the coagulum to form a haemostatic seal. The surgeon controls cutting and coagulation by adjusting the power level, blade edge, tissue tension and blade pressure. By using only mechanical longitudinal vibration at the distal end, no electrical current is passed to or through the patient, and damage to surrounding tissue and nerves is minimized.

Disadvantages

The only disadvantage is the high cost because of the high cost of the generator and hand piece as well as the high cost of the disposable probe that enters the patients abdomen.

A combination of the Ligasure and the Harmonic Ultracision is the best technology available today for performing advanced laparoscopic surgeries like hysterectomies and myomectomies.

Harmonic Ultracision is a product of Ethicon Endosurgery, a subsidiary company of Johnson & Johnson Pvt Ltd.