Finally, and most troublingly, the cramming in of so much technology at the tip creates some problems. In particular, after several uses Belinostat to seal vessels, the coagulum buildup on the tip can prevent the jaws from opening and closing completely; this in turn disables a safety mechanism on the cutting blades. Without a functioning cutting blade, the entire raison d����tre of the device is negated. Design/Functionality Score: 2.5 Innovation Although the core vessel sealing technology in the LigaSure Advance is as solid as ever, the refashioning of older devices with as many bells and whistles as could be found felt more regressive than progressive. Innovation Score: 1.5 Value As stated in a prior review on the Harmonic Ace?,2 determining value for the whole family of laparoscopic coagulation and cutting devices is a difficult task.

If a surgeon can safely and efficiently perform surgeries without the disposable devices��and some can��then they are all poor value. If a surgeon��s skill set limits him/her from performing the same minimally invasive procedure without the disposable devices��probably the majority��then they all represent good value. At a retail price of $925, the LigaSure Advance is expensive relative to its competitors. If a given surgeon is able to get everything out of the device that it is supposed to deliver (coagulation, cutting, dissecting, and grasping) there may be some added value, but at that retail price, even that is a stretch. On the whole for the space it��s in, this device is not a great value. Value Score: 1.

5 Summary In the highly competitive space that is the laparoscopic coagulating and cutting device market, the LigaSure Advance does not seem to add much except cost. For those surgeons who are accustomed to and comfortable with the older LigaSure laparoscopic devices, this newer option is unlikely to offer enough to make them switch. Overall Score: 1.5 Footnotes Dr. Greenberg reports no personal financial relationships with any of the companies whose products he reviews in this column.
Despite the declining death rate of cervical carcinoma, the American Cancer Society estimated almost 4000 deaths and more than 11,000 new diagnoses in 2008.1 Cervical carcinoma is clinically staged according to the International Federation of Gynecology and Obstetrics (FIGO) system; however, this staging system is frequently inaccurate, particularly with advancing stage.

Clinical staging correlates poorly with the true extent of disease. Inaccuracies in staging occur in as many as 25% of patients categorized as FIGO stages I and II and in up to 65% to 90% in FIGO stage III.2 Cervical carcinoma metastasizes predominantly by the lymphatic system in an orderly Carfilzomib fashion: initially to the pelvic lymph nodes then to the para-aortic lymph nodes. Previous studies have demonstrated a strong correlation between the incidence of nodal metastasis with tumor volume and clinical stage.