With the rapid advancement of technologies such as microprocessors and sensors, electrosurgical techniques in the medical field have also seen significant improvement. In electrosurgery, large vessel sealing technology is a revolutionary development. Currently, LigaSure-type large vessel sealing devices dominate the market. Among them, ShouLiang-med’s AGISEAL series stands out for its excellent performance and has received widespread acclaim both domestically and internationally. These devices are now widely used in clinical surgical procedures.

 

In thyroid surgery, the use of energy devices has improved both safety and precision. However, the choice of energy device is a critical consideration for surgeons. Different types of energy devices have their own applications, advantages, and limitations at various stages of surgery—for example, ultrasonic energy devices versus large vessel sealing devices.

 

Ultrasonic energy devices convert electrical energy at 55.5 kHz into mechanical energy via piezoelectric ceramics. The mechanical vibration is transmitted to the tissue through the blade, causing high-frequency friction. This results in vaporization of water molecules, breakdown of protein hydrogen bonds, cell disruption, tissue separation, protein denaturation, and vessel coagulation. Approved by the U.S. FDA, ultrasonic scalpels can safely seal vessels with diameters under 5 mm. While these devices feature lightweight, compact, and flexible curved-tip designs and are increasingly used in thyroid surgery, it’s important to note that their higher operating temperatures can lead to significant lateral thermal spread—especially near the recurrent laryngeal nerve—posing a risk of postoperative complications due to nerve damage.

 

Traditional monopolar and bipolar energy devices typically seal vessels by forming an intraluminal coagulum and rely solely on visual cues for energy control. These devices lack a feedback mechanism to monitor output power and impedance, making it difficult to gauge optimal coagulation power and duration.

 

ShouLiang-med’s independently developed AGISEAL series of advanced energy devices addresses these shortcomings by incorporating a negative feedback detection system. Using enhanced bipolar pressure, AGISEAL denatures and fuses the collagen and fibrin in blood vessels, permanently sealing the lumen. AGISEAL can seal vessels with diameters less than 7 mm, and the sealed vessels can withstand arterial pressures up to three times the normal human level. Additionally, it operates at a lower temperature and produces minimal lateral thermal damage, effectively protecting the recurrent laryngeal nerve and reducing the risk of complications.

 

With intelligent feedback that accurately senses tissue coagulation levels and precisely regulates optimal coagulation power and time, AGISEAL maximizes surgical safety and has become the preferred energy device for thyroid surgery.

Total laparoscopic hysterectomy is a widely used clinical procedure to fully explore the pelvic-abdominal cavity through laparoscopy and reduce surgical risk. Anatomically, the anterior wall of the uterus is densely adherent to the bladder, and the posterior wall of the uterus is densely adherent to the rectum, which is used to determine the success of laparoscopic vaginal total hysterectomy, while total laparoscopic hysterectomy avoids this separation, resulting in less trauma to the patient and faster postoperative recovery ^[1-2]. However, total laparoscopic hysterectomy has high requirements for the primary medical instruments. The performance of different instruments can even impact the success of the surgery ^[3], and intraoperative severing of the uterine tubes, round ligaments, aortosacral ligaments,, and uterine vessels,prompt hemostasis is essential to minimize bleeding. Vessel sealer dividers and ultrasonic scalpels are commonly used auxiliary hemostatic instruments and are widely used in clinical practice. 

 

Ultrasonic scalpel is the mechanical energy converted from ultrasound. It can generate high-frequency vibration, break protein hydrogen bonds, andconvert protein into collagen to seal blood vessels.Simultaneously, the heat generated by the high-frequency vibration and friction of the ultrasonic scalpel can safely separate and cut tissues, and can complete the functionsof separation, hemostasis and cutting at one time ^[4].

 

AGISEAL, independently developed by ShouLiang-med, is a novel vessel sealer dividers. It can output high-frequency electrical energy without completely exposing the blood vessels, dissolve and denature the patient's tissue fibrin and collagen, and combine with jaw pressure to form an almost transparent closure band to close the lumen. It also has the advantages of fast closure speed, no smoke, no impact on the surgical field, low local temperature, and little damage to surrounding tissues.

 

Study ^[5] shows that vessel sealing devices result in less intraoperative bleeding and shorter hospital stays compared to ultrasonic scalpels, indicating that vessel sealing devices can effectively reduce bleeding during surgery and promote postoperative recovery. The reason for this, as analyzed, is that ultrasonic scalpels may form eschar, which carries a risk of tissue tearing and postoperative bleeding. In contrast, vessel sealing devices do not form eschar and do not require dissection of surrounding vascular tissues, thereby resulting in less intraoperative bleeding.

 

The ovaries, as female gonads, are not only related to fertility but also affect endocrine function and the menstrual cycle. Research also indicates that vessel sealing devices have a smaller impact on ovarian function. The analysis attributes this to their lesser impact on uterine blood vessels, leading to reduced bleeding. Since blood supply and follicles in the ovarian cortex are key to ovarian function, this results in less impact on the ovaries.

 

In summary, both vessel sealing devices and ultrasonic scalpels are safe and reliable for use in total laparoscopic hysterectomy. However, vessel sealing devices have less impact on postoperative ovarian function.

 

References:

[1] Wu Mian, Li Yuqin, Wu Yanwen, et al. Clinical observation of three different postoperative analgesia methods in total laparoscopic hysterectomy [J]. Journal of Bengbu Medical College, 2022, 47(3): 330-333.

[2] Wang Kun, Wu Xiaoqiong, Zheng Xiaoling, et al. Value of DWI combined with serum miR-375 levels in evaluating long-term lymph node metastasis after total laparoscopic hysterectomy in cervical cancer patients [J]. Oncology Imaging, 2022, 31(3): 316-322.

[3] Muramatsu T, Sugiyama T, Kuriyama Y, et al. A case of uterine cervical adenocarcinoma in which initial total laparoscopic hysterectomy was performed for suspected atypical endometrial hyperplasia [J]. Tokai J Exp Clin Med, 2020, 45(1): 5-9.

[4] Gu Zhanguo, Shi Fumin, Zhai Jian, et al. Protective effect of ultrasonic scalpel combined with cosmetic incision on facial nerve during parotid tumor surgery [J]. Journal of Hebei Medical University, 2020, 41(2): 154-157.

[5] Tong Yajuan, Meng Yinxia, Li Yuanyuan. Comparison of the application effects of ultrasonic scalpel and LigaSure in total laparoscopic hysterectomy [J]. Henan Medical Research, 2024, 33(21): 3916-3919.