Clinical Utility Of A New Articulating Tissue Sealer In Laparoscopic Colorectal Surgery

Background: The fixed location of ports, complex anatomy, and deep/tight spaces limit exposure and continue to be a challenge with current energy devices in laparoscopic surgery. We describe the initial experience with an articulating advanced bipolar energy device. Methods: We performed a prospective, single-arm, multicenter, observational study of laparoscopic colon resections with the ENSEAL G2 Articulating Tissue Sealer. This study was undertaken and financed in its entirety by the manufacturer of the ENSEAL G2 Articulating Tissue Sealer, Ethicon (Cincinnati, OH). Assessments included frequency of articulation and perpendicular transections, surgeons’ experience (via questionnaire) and perceived workload of device use (via NASA Task Load Index). Results: Twenty-nine consecutive procedures, ranked high, medium, and low in complexity (52%, 38%, and 10%, respectively) were included. Average procedure time was 164.9 ± 53.3 min and device implementation time was 40.7 ± 29.6 min. Estimated blood loss was 109±111 cc. Of 4,153 device activations, 59% were articulated. Of 167 isolated vessel transections, 48% used articulation and 83 % were perpendicular. Compared to use of non-articulating devices, ability to get 1) around corners/behind structures, 2) into deep/tight spaces, and 3) straight across vessels were rated as “better” in 93%, 79%, and 72% of the cases, respectively. The device was considered to reduce the need to pass the vessel sealing device to assistants and to reduce instrument exchanges 69% and 55% of the time, respectively. Raw NASA-TLX score was 34.8±16.5. Conclusion: High frequency use of the tissue sealer in articulated mode, minimal blood loss, and usefulness ratings were reported. Usefulness ratings, particularly enabling better angles of transection in tight spaces, and getting around corners to mobilize flexures, underscore the value of articulating energy devices in laparoscopic surgery. The perceived workload of using articulating features was low.