Obtaining reliable hemostasis is crucial as part of laparoscopically assisted vaginal hysterectomies, and over the past 20 years, various methods to do so have been advocated. For instance, in 1989, Harry Reich recommended using sutures to control the uterine vessels, as monopolar, bipolar, and laser instruments available at that time were inherently risky to use along the pelvic sidewall.
Ethicon Endo-Surgery has recently released the ENSEAL G2 Super Jaw, which uses I-Blade bipolar technology to deliver high uniform compression for sealing vessels consistently along the length of the 40 mm curved jaw; it was designed to be used in such open surgical procedures as colorectal, gynecological, and general surgeries. Instead of relying solely on the force of initial jaw closure to provide compression, the Super Jaw closes the upper and lower jaws to a predetermined height as the I-Blade advances to the distal tip. This is a benefit, as the jaw closures of the other bipolar devices can result in a fall-off in force from the proximal to the distal end of the jaws, which may lead to bleeding at the tip of the jaw.
According to its specifications, the single patient-use sealer can be used for coagulating and transecting vessels up to and including 7 mm in diameter as well as tissue bundles. It has a 360-degree rotating shaft and atraumatic teeth for grasping and holding targeted tissues when clamped. It can provide a seal strength that can withstand pressure up to 7 times normal systolic. The Super Jaw has a polymer compound within the jaw that uses Positive Temperature Coefficient technology to modulate energy flow, which allows it to maintain a constant temperature of approximately 100°C. This in turn prevents sticking, charring, and smoking. The Super Jaw also has an offset electrode design that allows it to focus and contain energy within the jaws and minimizes lateral thermal spread (approximately 1 mm).
Dr Rosanne M. Kho, assistant professor of obstetrics-gynecology at the Mayo Clinic in Arizona and consultant for Ethicon Endo-Surgery, has used the Super Jaw in several vaginal hysterectomies; she noted that the learning curve for its use was minimal.
Dr Kho especially finds vessel sealing devices to be helpful in patients with narrower vaginal access as well as those patients with larger uteri. Kho explained, “In my practice it is not as much its ability in decrease operative time, but the ability to gain better access, particularly in difficult cases with the large uterus and also the narrowed vaginal access [that make the Super Jaw a useful device]…. I can say that the seal is excellent.”
First advanced bipolar energy innovation that offers surgeons strong seals, while remaining gentle on tissue. PRNewswire press release. June 15, 2011.
ENSEAL® G2 Super Jaw Tissue Sealer.
Product information. Accessed July 18, 2011.