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.

Yu Juan and An Yani from Yantai Yuhuangding Hospital in Shandong Province published an article titled "Advantages of double-circuit Return Electrode Plates in High Frequency Generator" in the *Journal of Qilu Nursing*. The article mentioned that high frequency generator heats the tissues when it comes into contact with the body through the high-frequency and high-voltage electric current generated by the tip of the effective electrode, which achieves the separation and coagulation of the tissues of the body and thus serves the purpose of cutting and hemostasis.  Due to the physical properties of electrical currents, the current acting on the human body must return to the high frequency generator via the return electrode plate to form a complete circuit.

 

The return electrode plate (also known as the neutral or dispersed electrode) is a critical component used in electrosurgery in conjunction with the High Frequency Generator. Its primary purpose is to establish a safe circuit for the electric current, to ensure that the high-frequency current from the monopolar electrode through the patient's body can be safely returned to the generator, to avoid accidental burns. Its core functions include the most basic to provide a low-impedance path for high-frequency current to form a closed circuit, preventing the current from spreading in the body in an uncontrolled manner; secondly, reducing current density by increasing contact area, thereby minimizing localized temperature rises and lowering the risk of thermal tissue damage.  

 

The Disposable Patient Return Electrod provided by ShouLiang-med is professionally designed with key performance advantages to ensure surgical safety:

 

1.Excellent flexibility and strong adhesion ensure a stable and effective contact area between the patient and the electrode during surgery.

2.The conductive foil in the center is evenly divided into two sections. Once applied to the skin, the return electrode monitoring system in the high-frequency surgical device continuously evaluates the contact status. If any abnormality is detected, the system will trigger an audio-visual alarm and automatically stop output, ensuring real-time monitoring of effective patient connection.

3.With nearly zero resistance and low thermal effect, the electrode features a rounded rectangular shape that promotes even heat distribution, significantly reducing the risk of burns.

4.Designed for single use, it prevents cross-contamination between surgical patients and greatly enhances procedural safety.

In modern clinical surgery, advancements in tissue dissection and hemostatic technologies are key to improving safety and efficiency. The application of large vessel sealing systems, combined with dedicated surgical instruments, has significantly enhanced procedural outcomes and represents a major technological breakthrough in the field.

 

Large vessel sealing systems use real-time feedback and intelligent energy platforms to deliver high-frequency current with consistent pressure at the jaws. This causes collagen and elastin in vessel walls to denature and fuse, forming a clear, permanent seal. The system can seal vessels up to 7mm in diameter, requires minimal dissection, offers fast activation, produces no surgical smoke, and minimizes thermal spread to surrounding tissues.

 

Due to high technical barriers, few companies have achieved true innovation in this domain. ShouLiang-med’s SL100M large vessel sealing system is a leading example. Equipped with proprietary tissue-sensing technology, it continuously monitors tissue impedance to precisely adjust energy output, ensuring safe, efficient, and complete sealing of vessels under 7mm.

 

Relevant literature indicates that Wu Zeyu et al.^[1] applied large vessel sealing system in radical gastrectomy and found that major gastric vessels, including the left gastric artery and gastroduodenal artery, could be transected using the sealing system without suture ligation. Wu Baoqiang et al.^[2] found that large vessel sealing system applied in surgery for benign thyroid diseases could simplify the surgical procedure, reduce operative time, and decrease intraoperative blood loss. A systematic review was performed on seven randomized controlled trials by Janssen et al.^[3], its results show that large vessel sealing system is more effective than other electrosurgical or ultrasonic devices in reducing intraoperative bleeding and shortening operative time.

 

In conventional partial small intestine resection, mesenteric vessels must be dissected and ligated. The mesentery contains a dense vessel network with numerous delicate branches that are prone to bleeding. Both ends of the intestine must be clamped before transection. Directly transecting mesentery with large vessel sealing system avoids repeated dissection and ligation of vessels, simplifying the surgical procedure. Furthermore, using large vessel sealing system to directly transect the intestine prevents intestinal leakage, which helps to shorten the operative time.

 

In conclusion, using large vessel sealing system in partial small intestine resection could simplify the procedure, shorten operative time, and reduce bleeding.

 

References：

［1］Wu Zeyu, Yao Yuan, Wan Jin, et al. Application of LigasureTM vessel sealing system in radical D2 surgery for gastric cancer[J]. Chinese Journal of Gastrointestinal Surgery,2008,11 ( 2 ) :184 － 185.

［2］Wu Baoqiang, Chen Weibo, Jiang Yong, et al. Application of LigaSure vessel sealing system in surgery for benign thyroid diseases [J]. Chinese Journal of General Surgery, 2016, 25 ( 11) :1585 － 1589.

［3］ JANSSEN P F，BＲLMANN H A，HUIＲNE J A． Effectiveness of electrothermal bipolar vessel － sealing devices versus other electrothermal and ultrasonic devices for abdominal surgical hemostasis: a systematic review［J］． Surg Endosc，2012，26( 10) : 2892 － 2901．

In recent years, by virtue of its significant advantages, electrosurgical vessel sealer and divider instruments have played a key role in surgery and have been deeply integrated into a rang of specialized surgical procedures. The following outlines its specific applications and advantages in different surgical disciplines:

 

General Surgery: Rapid Sealing, Reduced Trauma
In cholecystectomy, where complex blood vessel network around gallbladder, the instruments can ensure rapid sealing and dividing of vessels, reducing bleeding, minimizing risks and improving visibility.

In herniorrhaphy, where the operative space is limited, the instruments’ precise control allows for safe tissue dissection in narrow spaces, minimizing damage to surrounding nerves and vessels and and supporting postoperative recovery.

 

Gynecologic Surgery: Precision operation for Reproductive Function Preservation

In hysterectomy, where the vessels surrounding uterus are intricate and densely distributed, electrosurgical vessel sealer and divider ensures accurate vessel sealing and dividing while minimizing thermal injury to surrounding organs.
In myomectomy, its adjustable energy output allows for precise fibroid removal while preserving as much healthy uterine tissue as possible, helping preserve future fertility.

 

Cardiothoracic Surgery: A Reliable Choice for High-Risk Areas
Cardiothoracic surgery demands high precision. With its accurate performance, the instruments can safely handle medium and small vessels in the hilum, ensuring sufficient sealing force to withstand intra-thoracic pressure changes.
In cardiac surgery, its pulsed energy release feature minimizes thermal conduction effect to myocardial tissue, enhancing surgical safety.

 

Urologic Surgery: Supporting Recovery, Reducing Risks
In prostatectomy, instruments’ precise seal performance helps preserve sexual nerve function and decrease risk of postoperative complications.
In nephrectomy, its rapid vessel handling properties shorten operative time and reduces renal thermal ischemic injury while combining with minimally invasive techniques.

 

With technology iteration, new generation instruments integrates intelligent feedback system which can monitor tissue status in real-time and adjust energy output automatically, further enhancing seal reliability. Clinical applications shows this technology effectively shortens surgery time, reduces complication rates, and accelerates patient recovery. In the future, through deep integration with digital technologies, the instruments will play a key role in more complex surgical scenarios.

In recent years, electrosurgical vessel sealers/dividers have gained widespread recognition in the field of surgery due to their unique benefits. But what makes them so compelling? Let’s explore the five key clinical advantages that set them apart.

 

1. Minimally Invasive and Tissue-Sparing

One of the most notable advantages of electrosurgical vessel sealers/dividers is their ability to facilitate minimally invasive procedures through small incisions. This not only reduces patient pain and minimizes scarring but also significantly shortens recovery time. Moreover, smaller incisions lower the risk of infections and other postoperative complications, enhancing overall surgical outcomes.

 

2.Easy to Use

The electrosurgical vessel sealer/divider is designed with user-friendliness in mind, ensuring that even less experienced surgeons can operate it with ease. With minimal training requirements, it seamlessly integrates into various surgical workflows without disruption. 

 

3. High Efficiency & Time-Saving

Compared to conventional surgical techniques, the electrosurgical vessel sealer/divider significantly reduces procedure time. By simultaneously sealing and dividing vessels, it enables surgeons to perform operations more efficiently, alleviating stress for both patients and surgical teams, minimizing the risk of complications, and shortening hospital stays.

 

4.Precise Treatment

Electrosurgical Vessel Sealer/ Divider demonstrate exceptional maneuverability, accuracy, and precision during surgery. They are capable of sealing blood vessels with minimal damage to surrounding tissues, effectively reducing the risk of bleeding, bruising, and other complications.

 

5.Cost-Effective

    Although the initial investment in Electrosurgical Vessel Sealer/ Divider instruments may be higher compared to traditional surgical techniques, they are more cost-effective in the long run. The reduction in surgery time and shorter hospital stays significantly lowers overall costs for both patients and healthcare institutions.