Laparoscopic Energy Devices

Energy devices are among the most important tools in laparoscopic surgeries. We will discuss LigaSure, ENSEAL, and Harmonic ACE in the following section. To learn more about Electrosurgical Unit (ESU), and Argon Plasma Coagulation (APC), refer to our Transplant Info Website .

LigaSure

Valleylab LigaSure manufactured by Covidien (Medtronic) is an advanced Bipolar Device which works with Force Triad Energy Platform. It provides a combination of pressure and energy to create Vessel Fusion of vessels up to and including 7 mm and, lymphatics. Tissue Fusion is a new and improved form of Tissue Sealing which is done with Force Triad Energy Platform.

ENSEAL

ENSEAL G2 Tissue Sealer, manufactured by Ethicon (Johnson & Johnson), is an advanced Bipolar Device which works with the Ethicon Generator G11 which supports HARMONIC® Ultrasonic and ENSEAL® Advanced Bipolar Devices. As soon as you connect each of these devices to the Generator, it will automatically start the appropriate function. ENSEAL seals and transects vessels up to 7 mm and lymphatics. There is a Trigger and a Handle. There are 3 Tones. To activate the system, press the Button. Tone One will be heard. Gently squeeze the Handle to advance the I Blade. During sealing cycle Tone Two which has a higher pitch will be heard. It shows coagulation is progressing. When you hear Tone Three which shows sealing of all tissue has been done, release the Button and the Handle. When you seal a large vascular bundle, squeeze handle gently and more slowly. On thin avascular tissue, squeeze faster. You don't need to hear Tones Two and Three. ENSEAL G2 Articulating Tissue Sealer works similarly. However, when squeezing the Handle, there will be 2 Stops. Squeeze the Handle to the First Stop and then squeeze the Button to start the Sealing. Squeeze further beyond First Stop with appropriate speed to advance accordingly.

Harmonic ACE

Harmonic ACE Plus instrument, manufactured by Ethicon (Johnson & Johnson), is used for dissection, sealing, transection and ostomy creation. It can be used for coagulation and transection of vessels up to 5 mm. It also seals lymphatic vessels up to and including 1 mm in diameter. It has Min and Max Buttons. The Trigger has Audible/ Tactile mechanism to indicate full trigger closure. A second click will be heard and/or felt if complete grip closure is lost. You can use it with a 5 mm trocar. HARMONIC ACE +7 has a third Button, Advanced Hemostasis Button. It is used for vessels up to and including 7mm in size. Generator G11 is used with Harmonic ACE Plus instrument. System default power level Min and Max are 3 and 5 respectively. When Min or Max power level is activated, the number on the monitor will flash and there will be an Audio Feedback. Audio Feedback Tone is different in Min vs Max power levels Modes activation. Minimize tissue tension during activation. When the secondary tone is heard, the tissue should be assessed and the intended surgical action should be completed with maneuvers like gradual application of tension. When you turn on the Generator, system will prompt you activate the instrument for 2 seconds to run test until System Ready appears.

For greater coagulation use a lower generator power level. For greater tissue cutting speed use a higher generator power level.