Advancement and benefit of energy sealing in minimally invasive surgery.

Energy sealing has advanced rapidly in the last decade with many new devices becoming available. The rate and variety of advances in technology facilitate new and existing techniques, with ultrasonic shears and electrothermal bipolar graspers forming a vital but changing part of the modern surgeon's armamentarium. Advances including the combination of ultrasonic and bipolar systems, the addition of cutting blades, tissue impedance sensors, and electrode configurations with reduced lateral thermal spread have heralded new opportunities in laparoscopic and minimally invasive surgery. Reduced operating times, lower postoperative pain scores, and shorter length of stay are offset by the additional cost of such instruments. Reduced instrument exchange, improved smoke evacuation, and shorter surgeries by trainees with some devices are benefits that set the scene for further innovation in this vibrant sector.