## 4 Discussion  
The use of electrosurgical instruments in laparoscopic surgeries facilitates the reliable and rapid sealing of blood vessels and tissues [7]. Previously, laparoscopic energy-based devices with various sealing mechanisms, including bipolar electric current (e.g., LigaSureTM), ultrasonic energy (e.g., Harmonic ScalpelTM), and nanotechnology (e.g., EnSeal PTCTTM) have been studied. It has been reported that devices using bipolar electric current have the highest burst pressure and shortest sealing time [6]. Bipolar electrical energy melts collagen and elastin within the tissue bundles, forming a durable seal. Unlike the circuits of a monopolar surgical system, the advantage of the bipolar energy system is a more controlled spread of energy since it is only transmitted between the jaws of an instrument [8]. However, current technologies still present limitations, such as collateral tissue damage and surgical smoke generation [3; 4; 9]. A previous report of the application of a QMR energy generator into monopolar surgical devices demonstrated favorable tissue effects in both short-term and long-term animal studies [5]. The studies suggested that when using QMR, specific wave forms at high-frequencies (4-64 MHz) transmitted to the tissue into the quanta, which disrupts the molecular bonds of the tissue without causing damage to the surrounding tissue [10; 11]. Further research in molecular cell biological effects of QMR has been conducted in more recent studies as well. Researchers reported the upregulation of vascular endothelial growth factor expression in chronic wounds treated by QMR technology [12]. Another \begin{table}
\begin{tabular}{l c c c} \hline \hline  & **LigaSureTM** & **QMR Energy Source** & \(p\) \\ \hline Vessel width (mm) & 3.08 \(\pm\) 0.20 & 2.90 \(\pm\) 0.37 & 0.657 \\ Time to seal (s) & 4.00 \(\pm\) 0.45 & 5.00 \(\pm\) 0.00 & 0.076 \\ Sealing success rate & 66.7\% (4/6) & 100.0\% (5/5) & 0.455 \\ Temperature (°C) & 73.68 \(\pm\) 1.28 & 79.30 \(\pm\) 3.92 & 0.174 \\ Burst pressure (mmHg) & 802.00 \(\pm\) 0.00 & 963.00 \(\pm\) 3.00 & - \\ Seal width (mm) & 1.92 \(\pm\) 0.07 & 1.98 \(\pm\) 0.25 & 0.593 \\ Collagen denaturation (mm) & 1.60 \(\pm\) 0.47 & 1.36 \(\pm\) 0.16 & 0.264 \\ Wall layer cleavage (\%) & 30.00 \(\pm\) 22.80 & 20.00 \(\pm\) 15.49 & 0.395 \\ Wall injury (\%) & 73.87 \(\pm\) 16.93 & 54.98 \(\pm\) 16.16 & 0.076 \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Evaluated parameters and histological analysis for ligated aortas. \begin{table}
\begin{tabular}{l c c c c c c c c} \hline \hline  & \multicolumn{3}{c}{**Peritoneum**} & \multicolumn{3}{c}{**Vessel**} & \multicolumn{3}{c}{**Ureter**} \\ \cline{2-10}  &
\begin{tabular}{c} **LigaSureTM** \\ _(\(\mathbf{\mathbf{\mathbf{\mathbf{\mathbf{\mathbf{\mathbf{\mathbf{\mathbf{\mathbf{\mathbf{\mathbf{\mathbf{\mathbf{\mathbf{\mathbf{\mathbf{\mathbf{\mathbf{\  
study suggested that the QMR stimulation could trigger the angiogenesis and tissue regeneration of human mesenchymal stromal cells [13]. In this present study, we combined the QMR energy generator with the bipolar laparoscopic instrument and developed a novel laparoscopic sealing energy generator using a frequency of 4 MHz, which is 10 times higher than that of conventional instruments. As for the relationship between the output power and impedance of our QMR energy generator, the estimated impedance to the bipolar electrode before applying energy was approximately 100 ohm, and as the application of energy increased, the impedance increased to 200 to 300 ohm. Impedance appears different depending on the type of tissue, and the degree of coagulation appears different even when the same energy is applied. It was difficult to access the degree of coagulation based on the impedance value alone, therefore, experiments in various tissues were required.