How a surgeon chooses to cut, ligate and seal blood vessels can be, without exaggeration, a life-or-death decision.

• The method matters. The first decision is the type of surgical energy: monopolar, bipolar, harmonic, thermal fusion or plasma. Balance the speed at which a device can stop bleeding with its potential for collateral damage. While bipolar energy produces less thermal spread, it's more time-consuming and can't cover a large surface area. Monopolar technology is quite fast, but the heat it generates can have a charring effect on tissue. Harmonic technology doesn't generate the same amount of heat as the 2 electrosurgery devices, but it can still harm tissue. Newer technologies combine bipolar and harmonic energies, employ direct thermal energy and pressure, or electrically excite inert gas into a plasma state to cut and coagulate. Adaptive feedback in several products precisely controls energy delivery and sends warning signals to head off thermal injury.
• Instruments on hand. Surgeons need technology that works without requiring any additional steps to ensure hemostasis. Why should they have to use a vessel sealer in addition to a suture ligation? Larger jaw sizes have been developed to accommodate larger vessels, and the fatigued hands of laparoscopic surgeons benefit from grips that fit their hands and don't require crushing pressure to work. Not every blood vessel can be grasped on end, so the ability to articulate or rotate the working channel can make a big difference in reach and how quickly you can bring bleeding under control.
• Plug and play. If you're coordinating a product trial, the first thing you should find out is how many parts are necessary to make it work. Many new devices have a significant capital expense secondary to the non-sterile unit that runs it, and many come with proprietary energy systems that won't properly function with other companies' machines.

Aesculap
Caiman Vessel Sealers
caimansurgery.com
(800) 282-9000
Pricing: not disclosed
FYI: Designed to improve surgical efficiency, Aesculap's Caiman Vessel Sealers allow for quick tissue transection. The radiofrequency devices, available with 5mm and 12mm shafts, feature 26.5mm and 50mm jaws respectively. The Caiman also includes a patented, tip-first jaw-closure mechanism, which enables uniform tissue compression for clean and consistent seals. The 12mm vessel sealers have 80 degrees for articulation for improved maneuverability in challenging anatomy.

ConMed
Altrus Thermal Tissue Fusion System
altrusthermal.com
(800) 448-6506
Pricing: not disclosed
FYI: The Altrus Thermal Tissue Fusion System from ConMed uses direct thermal energy and pressure to effectively seal, transect, dissect and coagulate tissue. A hybrid technology, Altrus combines the vessel-sealing capabilities of an advanced bipolar system with dissection capabilities for a consolidated and streamlined surgical experience that delivers a range of clinical benefits.

Domain Surgical
FMwand Ferromagnetic Surgical System
domainsurgical.com
(801) 924-4950
Pricing: generator, $50,000; disposable, $565
FYI:: Domain Surgical's FMwand Ferromagnetic Surgical System uses pure thermal energy to cut and coagulate tissue without passing any electrical current through the patient. It enables precise dissection near such delicate anatomy as nerve structures and blood vessels with a fraction of the thermal injury that traditional electrocautery causes to tissue. According to the company, surgeons using the FMwand report no electrical interference with intra-operative monitoring equipment or implantable cardiovascular electronics.

Emcision
Habib VesCoag
emcision.com
(888) 492-8168
Pricing: $650
FYI: Easily introduced with a 0.014-inch guidewire under ultrasound, fluoroscopy or angiography guidance, Emcision's Habib VesCoag provides quick reach and treatment of a target vessel in a few simple steps. The single-use, 110cm catheter is designed for precise vascular occlusion to arrest hemorrhage following biopsy or trauma or control blood supply to a target tumor prior to surgical intervention. Compatible with several standard generators, it can be introduced to practice without significant capital investment.

Elliquence
Surgi-Max Plus
elliquence.com
(516) 277-9000
Pricing: not disclosed
FYI: The Surgi-Max Plus energy source marshals high-frequency, low-temperature radio waves for a cell-specific tissue effect that affords unparalleled surgical precision, versatility and safety in treating pathologies, while sparing healthy tissue. The low temperature and non-stick bipolar operation minimize tissue trauma and reduce the need for frequent tip cleaning and irrigation.

Encision
Advanced AEM Monopolar Energy System
encision.com
(303) 444-2600
Pricing: instruments, about $130 per procedure, depending on combination of disposable and reusable elements
FYI: Encision's Advanced AEM instruments, available in a wide variety of styles, including e-Edge Scissors, enTouch graspers and handles, and electrodes, offer the clinical benefits of monopolar energy in cutting and sealing vessels, while also guaranteeing the elimination of stray energy burns to patients.

Ethicon
Harmonic Ace+7 Shears
ethicon.com
(877) 384-4266
Pricing: not disclosed
FYI: Ethicon's Harmonic Ace+7 Shears, the latest offering in the company's line of ultrasonic devices, combines the precise tissue dissection of harmonic instruments with the ability to reliably seal vessels up to 7mm in diameter. The system's advanced hemostasis and intelligent modulation of energy deliver improved performance and efficiency.

Plasma Surgical
PlasmaJet Surgery System
plasmasurgical.com
(678) 578-4390
Pricing: generator, $59,000; handpiece, $500
FYI: The use of pure plasma energy to cut, vaporize, coagulate and dissect tissue has a number of benefits, says Plasma Surgical. Among the advantages of its PlasmaJet system are focused energy with minimal diffusion, which reduces the risk of thermal injury complications, a tip that always remains cool to the touch and the absence of electrical current passed through tissue.