Application of a New Integrated Bipolar and Ultrasonic Energy Device in Laparoscopic Hysterectomies

Objective. A retrospective study to evaluate the Thunderbeat, a new vessel sealing device in a small group of patients undergoing laparoscopic hysterectomy to test the safety and effectiveness in achieving hemostasis. Method. The Thunderbeat was used in 12 cases of total laparoscopic hysterectomy. Operative performance involving hemostasis, sealing/coagulation, cutting, dissection, and tissue manipulation was evaluated. Results. No complications were encountered intraoperatively and postoperatively. Intraoperative experience involving hemostasis, sealing/coagulation, and cutting was optimal. Tissue handling was acceptable except for fine dissection. Conclusion. The Thunderbeat is an efficient and safe alternative to standard bipolar in laparoscopic hysterectomy. Larger studies are required to evaluate the cost-effectiveness and significant reduction in operating times as compared to conventional bipolar energy. 1. Introduction Hysterectomy is one of the most commonly performed gynaecological surgeries in the world [1]. Although a Cochrane review favours the transvaginal route because of earlier return to normal activities, fewer febrile episodes, and shorter hospital stay [2], about two-thirds of hysterectomies are still performed abdominally due to uterine size and the technical challenge of access. The last two decades have seen an advent in laparoscopic surgeries primarily due to improved capabilities in optics, energy technology, and increasing surgical expertise. This has allowed minimally invasive surgery to confer the same advantages of the vaginal hysterectomy even for the more challenging cases. Similar to vaginal hysterectomy, laparoscopic hysterectomy has less operative bleeding, less postoperative pain, shorter hospital stay, and shorter convalescence time compared to abdominal hysterectomy [3, 4]. Haemostasis is fundamental in all surgical procedures, and even more so in minimally invasive surgery. Traditional methods of staples and clips have gradually been abandoned due to cost, difficulty with repeated applications, and problems of displacement [4]. Suturing is difficult to master, technically challenging, and time-consuming. Standard energy devices—monopolar and bipolar coagulation—are currently widely used due to their inexpensive nature and reusability. However, this involves high instrument traffic, thermal spread, and sticking and charring of tissues. New products in the market include advanced bipolar coagulation (LigAsure, Bicision, and EnSeal) and ultrasonic energy (Harmonic Ace). Advanced bipolar devices possess active feedback