Hemorrhoidectomy using the Ligasure™ vessel sealing system

Abstract

Immediate complications of surgical procedures for the treatment of hemorrhoids are postoperative pain and bleeding [1]. Bleeding after hemorrhoidectomy is rare but often requires a surgical procedure or even administration of blood units. Hemorrhoidectomy according to Milligan-Morgan or Ferguson is nowadays carried out with conventional diathermy to reduce intraoperative and postoperative blood loss. A number of new hemostatic devices have been developed in the past decade, that have also been tested for hemorrhoidectomy [2]. One of them is the Ligasure™ Vessel Sealing System (LS). The system consists of a generator and a choice of nine different instruments [2]. Only two of these instruments are used for hemorrhoidectomy (Ligasure™ Max handset, LigasureTM Precise). Both of them are shaped like a surgical clamp with different angles of deflection and work as a bipolar clamp. The generator produces a highcurrent, low-voltage pulsed output. The current compares to at least four times the current and 5-20% of the voltage produced by a standard electrosurgery generator. Because of a feedback mechanism, changes in the tissue are sensed 200 times per second, and voltage and current are adapted accordingly. The completion of the sealing process is indicated by an acoustic signal. The device effects a permanent seal by melting collagen and elastin in the vessel walls, thereby reforming a permanent, plastic-like seal. Vessel sealing doesn't need to rely on the formation of a proximal thrombus. The devices are suitable for sealing vessels up to 7 mm in diameter. Because of the design of the instruments, lateral thermal spread is diminished (1-2 mm) and tissue temperature does not exceed 100° Celsius. © Springer-Verlag London Limited 2009.