Haemostasis in Minimal Invasive Gynaecological Surgery Energies: Technical Aspects, Safety and Efficacy

摘要

The objective of this article is to examine the options, the effectiveness and the safety of the energies used in gynaecological minimal invasive surgery (MIGS), laparoscopic surgery developed in the end of 20th century. The rapid development of the MIGS in the last 3 decades is partly due to the advances and innovations achieved in the field of electro, sono and laser energy modalities. In general the energy modalities that are used in MIGS today are laser, ultrasound, bipolar - monopolar electrosurgery, high radio frequency and sealing electrosurgery techniques. The various sealing techniques provide an excellent haemostasis option avoiding tissue carbonization and necrosis. The monopolar and simple bipolar diathermies and laser thermal and haemostasis effect, depend solely on the surgeon's arbitrary estimation of the duration and intensity of the energy that has to be applied on the tissue in order to achieve haemostasis. However, once the advanced bipolar and ultrasonic energies are used vascular sealing is achieved automatically since the device calculates the electrical resistance of the tissue thickness and the duration needed for optimum haemostasis results. Hence, in this article we review the various energies used, technical aspects, safety and efficacy in haemostasis during MIGS.