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Purpose: LigasureTM is a feedback-controlled bipolar diathermy originally devised to seal vessels and developed to weld tissue bundles. The tissue fusion mechanism consists of melting collagen and elastin, and the tissue welding property of LigasureTM can be used in a hemorrhoidectomy. To confirm the efficacy of LigasureTM in hemorrhoidectomies, I compared it with the conventional semi-open method. Methods: One hundred patients with grade III or IV hemorrhoids were randomly assigned to the LigasureTM (n=50) or the conventional semi-open (n=50) hemorrhoidectomy group. The operation time, the postoperative analgesic requirement, the hospital stay, the time to return to normal life, and complications were prospectively recorded and analyzed. Results: There was no difference in sex and age between the two groups. The operation time was markedly shorter in the LigasureTM group than semi-open group (10.8±4.0 versus 23.7±5.2 min; P<0.001). Although the hospital stay was not statistically different, the time to return to the normal life was shorter in the LigasureTM group (9.5±3.8 versus 12.7±4.0 days; P<0.05). The requirement for postoperative analgesics within 48 hours (nalbuphine, 5mg) was not significantly different. In each group, an urinary retention was noted and treated with urinary catheterization. In LigasureTM group, an anal stenosis was developed and was successfully treated with advancement flap surgery. In each group a secondary bleeding and a skin tag were noted. There was no wound infection or incontinence. Conclusions: LigasureTM hemorrhoidectomy reduces the operation time and the time to return to the normal life. If anal stenosis is to be prevented, careful attention is required to preserve the anal skin and mucosa. LigasureTM is simple to use and is useful in the treatment of patients with grade III or IV hemorrhoids.