Using 5-mm bipolar cutting forceps: a new multifunctional instrument

The most technically challenging step in performance of esophagogastric fundoplication is division of the short gastric vessels that connect the splenic hilum to the gastric fundus. Consistent dependable coagulation and division of these vessels would be a significant advance that would make the procedure more widely available to patients, since it would provide surgeons with a safe technique for providing a reliable loose "wrap." Such an instrument has now become available and is called the "bipolar cutting forceps." One of the authors has recently used the tool (5-mm version) for the laparoscopic completion of five Toupet fundoplications and two gastrojejunostomies. The instrument functioned in both the locked and manual mode and provided effective bipolar coagulation and scalpel division of thick lesser curve and greater omental tissue. No bleeding was noted, and all procedures were completed without conversion to laparotomy. The notion that such a multifunctional instrument will lead to cost reductions is possible but yet unproven.