Bipolar Electrosurgery and Hemostasis

When performing operative laparoscopy and using bipolar current to achieve hemostasis or desiccate vessels, there are a couple of simple techniques that can make the task easier for the surgeon. The first trick alleviates the frustration when one is attempting to desiccate either vessels or tissue with a bipolar instrument, and the instrument keeps sticking to the tissue and the char. Inevitably then when the surgeon attempts to remove the instrument or pull it from contact with the tissue, the seal is broken and the vessel or tissue begins bleeding again. In spite of repeated attempts, often the surgeon is unable to keep the instrument from sticking to the tissue. The problem lies in that the tissue is heated and melted while the current is flowing, and when the current is stopped the tissue begins to cool immediately. This cooling results in adherence or sticking of the instrument to the tissue. If the instrument is opened and removed just before the current is stopped (just before the foot pedal is released), it is removed before the tissue cools and sticks to the instrument. And, then there is no break in the desiccation or seal of the tissue in order to remove the instrument. This is a simple trick to prevent frustrating moments in the operating room while achieving adequate hemostasis.The second technique is when one has a superficial bleeding vessel, such as on the pelvic sidewall or on the ovary. The tendency is to grab the tissue between the jaws of the bipolar instrument to desiccate it, but this may result in deeper tissue damage that is necessary with a superficial bleeder. And it may be unsafe; for instance, if the bleeder is on the lateral pelvic wall overlying the ureter or large vessels. A simple technique is to open the blades of the bipolar instrument slightly and then gently touch the tissue on either side of the vessel with the tips or corners of the instrument. When the current is applied, it then will run superficially across the peritoneum between the blades and desiccate the vessel, and with very little tissue damage underneath the surface. Many surgeons feel the tissue actually has to be between the blades to be effective, but this actually is not necessary with superficial bleeding vessels. It is a simple trick to avoid tissue damage to underlying structures when achieving hemostasis.