LIGASURE (VESSEL SILLER)

WHAT IS LIGASURE? 

Ligasure is a vessel sealing instruments,  it helps to vessel sealing during the surgery it can fuse or seal upto 7mm, lymphatic and tissue bundles and has an average seal cycle of two to four seconds in most surgical suitation. 

This instruments used in laparoscopic and as well as open surgery. 

        Ligasure for laparoscopic surgery 

Benefits of ligasure :

It has highest burst pressure, fastest sealing time

Reduce blood loss compared to suture and clips 

Reduce procedure time compared to suture. 

Reduce patient length of compared to suture.

forcep for open surgery 

What is the difference between monopolar, bipolar and ligasure? 

In valleylab cautery machine there are two basic electric surgical current one is monopolar another is bipolar 

monopolar is very good because has lots of function it has cut it can blunt it can fulgrate it can desicate so, monopolar is essential but it has big complications remote injury if you hold the big amount of tissue and bunch of tissue at one time it will create remote injury anywhere it may be many centimeter away and also some times inches away. 

for example cauterized uterine artery with monopolar and surgeon  hold the bunch of vascular pedicle uterine artery some where there is a narrow area there will may be injury. 

Ureter may be burn or near by bowel or somewhere touching create remote injury so that why any big pedicles or specially the vascular pedicle we should required monopolar only option is bipolar. 

Bipolar is very good but bipolar has one problem normal bipolar doesn't cut only very high frequency. Bipolar cuts plasma kinetics energy another problem of bipolar coagulation is that  don't have idea that it is over cooked or undercooked and then remaining uncooked cut by the scissors and bleeding gets started sometime if it is overcooked it is burn again cut bleeding is started.

Thats why first we have to understand how to do vessel silling happens. 

Once you press the vessels then the lumen of vessels comes near to each other and after that once you apply the heat then 55°c protein coagulates and coagulate protein shrink the lumen of the vessels shrink at the same time once temperature reach to 80°C there are two chemical inside the tissue that is elastin and collagen gets melt and then melted collagen will come near to each other and it will fused  lumen and lumen can cut with the scissor but when the temperature goes more than 80°c suppose 180°C, 200°C and 300°C then its melted collagen elastin gets burn at that is acting just like burn charcoal and as soon as you cut bleeding started that is the reason over working is one of the big problem in laparoscopic or even in open general surgery, over cooking should must be avoided  

If using simple biploar will avoid by seeing the colour the colour should not be become black there should be bubbling of water and there is not be sticking those are factor which is generate that temperature will be less than 100°c because if water is bubbling and water content of tissue is present when temperature is no go more than 100°c and colour it is good if it is white and yellow than brown so surgeon will stop as soon as when colour is brown or yellow surgeon will never reached colour is black.

Valleylab company has new device called ligasure. Ligasure actually is trade name the technically name is tissue response electro surgical generator means it is technically response from the tissue that is cooked or it is not cooked its set time for cutting and coagulation automatically it is switchoff.Also like this machine available in enseal from Ehicon company. Thunderbeat olympus company 

-Demonstrate front Part of vessel sealing processor:

Front of machine has no any type of switch so we can not set any temperature and time. 

There is a microprocessor inside that microprocessor automatically decide of the timing of the tissue and its works on the impidence technology once you will cooked the tissue water content will evoporate and impidence check in the impidence sense, it will not allow the melted elasticity and collagen elasticity will not burn it is only liquified sealing of vessels lubricated.

So you have the use there own probe after that you will attached the probe will like that and you will  switch on then it will check the machine it will tell you everything is fine after that you will just check it and you can take the tissue.

-Demonstrate different parts of this hand instruments :

In jaw there will glue inside shaft length 37cm behind probe has switch 

When you press it once the coagulation is completed than automatically sound will start. 

When you press probe will lock and will you one more press it will open (then press the blade will cut the tissue )

Which procedure can do by ligasure 

It is used in all procedure of laparoscopic recommended for use ligasure when you use for vessel silling.

Which procedure can we not use

Whenever cut surface we can't use like colopotomy, we can not use serous layer of myoma

Disclaimer :  This content for education purpose only and is not intended as a medical advice while we strive for 100% accuracy, error may occur, technology and protocols can change over time.