ORIGINAL CONTRIBUTION Electrothermal Bipolar Vessel Sealing System vs. Harmonic Scalpel in Colorectal Laparoscopic Surgery: A Prospective, Randomized Study Roberto Rimonda, M.D. & Alberto Arezzo, M.D. & Corrado Garrone, M.D. Marco Ettore Allaix, M.D. & Giuseppe Giraudo, M.D. & Mario Morino, M.D. Department of Surgery, University of Torino, Torino, Italy PURPOSE: This study was designed to compare the efficacy and safety of laparoscopic colorectal surgery performed with the aid of LigaSure A vessel-sealing system or Ultracision A . METHODS: Patients eligible for elective laparoscopic right or left hemicolectomy or anterior resection of rectum were randomly assigned to either the use of Ligasure A or Ultracision A . The primary end point was intraoperative reduction of blood loss. Secondary end points were intraoperative and postoperative morbidity and operative time. RESULTS: Between April 2005 and December 2006, 140 consecutive patients were included in the study (70 Ligasure A and 70 Ultracision A ). We performed 31 right hemicolectomies, 69 left hemicolectomies, and 40 anterior resections of rectum. Blood loss was 109.6 ml (Ultracision A 107.9 ml vs. Ligasure A 111.2 ml, P value = 0.72). Intraoperative complication rate was 2.8 percent (Ultracision A 1.4 percent vs. Ligasure A 4.2 percent, P value G 0.01). Postoperative mortality was 0.7 percent. The overall conversion rate was 7.8 percent, 6 in the Ligasure A group and 5 in the Ultracision A group (P value = 0.09). Operative time, considered from pneumoperitoneum to minilaparotomy, was 115.7 minutes (Ultracision A 114.8 minutes vs. Ligasure A 116.3 minutes, P value = 0.89). CONCLUSIONS: Results showed that Ligasure A and Ultracision A are both useful instruments for laparoscopic colorectal surgery with no significant difference in terms of intraoperative/postoperative morbidity and operative time. Choice of which technique to perform should be according to the surgeon’s preference. KEY WORDS: Laparoscopic surgery; Colectomy; Dissection; Electrosurgery; Surgical hemostasis. D uring the past two decades, the introduction of laparoscopic techniques had a significant impact on general surgery. Today, laparoscopy is em- ployed also in complex abdominal procedures. The rapid increase in popularity resulted in the development of new techniques and user-friendly instruments. 1 A key issue is represented by technology and the techniques for safe dissection and vessel sealing. The topic of safety and efficacy of tissue dissection and vessel sealing in colorectal surgery is still relevant. Besides the conventional monopolar and bipolar techniques that proved safe and effective, as shown in a previous study from our group, 2 two different technologies are commonly used for this surgery, i.e., ultrasound dissection 3 and electrothermal bipolar vessel sealing. 4,5 The two most popular tools representing these two different technologies are Ultracision A (Johnson & Johnson Medical, Cincinnati, OH) device and Ligasure A (Valleylab, Covidien, Boulder, CO) device. Whereas the Ultracision A principle is based on inducing protein denaturation inside vessels and conse- quently their occlusion, Ligasure A applies electric power to the tissue with high frequency and low voltage, which results in elastin and collagen degeneration that can seal blood vessels up to 7 mm in diameter. 6 Although several studies proved the safety and efficacy of both Ultracision A and Ligasure A devices, only a few compared the two with DISEASES OF THE COLON &RECTUM VOLUME 52: 4 (2009) 657 Address of correspondence: Professor Mario Morino, Department of Surgery, University of Torino, c.so Dogliotti, 14 Y 10126 Torino, Italy. E-mail: mario.morino@unito.it Dis Colon Rectum 2009; 52: 657Y661 DOI: 10.1007/DCR.0b013e3181a0a70a BThe ASCRS 2009 Copyright @ The ASCRS 2009. Unauthorized reproduction of this article is prohibited.