Human tissue review finds insufficient evidence to compare surgical energy devices

A systematic review published in Surgical Endoscopy examined vessel sealing and lateral thermal spread with advanced surgical energy devices in human tissues. Researchers searched three databases through October 2025 and included 28 studies in a descriptive analysis. Twelve studies reported vessel burst-pressure data, representing 320 patients and 939 samples; 20 assessed lateral thermal spread, with four contributing to both outcomes.

Most vessel seals created by bipolar and ultrasonic devices exceeded physiological burst pressures, although seal failures occurred unpredictably. Reported lateral thermal spread ranged from 0 to 7.64 mm and varied with device, tissue type, testing methodology and definitions of thermal injury. Ligasure was the most frequently investigated vessel-sealing device, appearing in seven studies with 493 samples.

Substantial methodological heterogeneity prevented meta-analysis and reliable comparisons between devices. Risk-of-bias assessments classified 17 studies as low risk, five as moderate risk or having some concerns, five as high or serious risk, and one as critical risk. These tissue-level measurements do not establish comparative clinical complication rates or a universal safe distance from adjacent structures. The findings underscore the need for standardized human-tissue testing rather than supporting selection of one device over another.