[Hemostasis and technology. Energy. Development of new technologies]

The hemostasis systems applied in surgery are based on endothermic heat production resulting from the interaction between energy and tissue. The most frequently used energy source is electrocoagulation, applied through two systems: monopolar and bipolar. More sophisticated electrocoagulation systems have progressively been developed such as the Argon beam, in which coagulation is superficial and does not injure the deep tissues, or LigaSure, based on the use of a bipolar system with an inbuilt feedback system allowing vessels to be sealed without excessive heat and a consequent reduction of collateral lesions. Another system that has been developed in the last few years is the ultrasonic scalpel, based on the ability of the cell membrane proteins to denature as a result of ultrasonic vibration. This system avoids some of the risks involved in the use of electrical energy such as accidental burns due to stray electrical current or faulty insulation of an instrument. Moreover, the harmonic scalpel reaches a temperature of no more than 100 degrees and the effect of lateral tissue destruction is much lower than with electrosurgery, although this reduction is negligible when compared with the electrosurgical methods developed in the last few years such as LigaSure. Another system that is also used is laser energy, consisting of a photon beam containing a specific wavelength; each photon moves in step with the others in both time and space. This system has not become widely used due to its high cost, the difficulty of controlling this type of energy, and the lack of objective advantages over conventional electrosurgery.