Premium
Lateral temperature spread of monopolar, bipolar and ultrasonic instruments for robot‐assisted laparoscopic surgery
Author(s) -
Hefermehl Lukas J.,
Largo Remo A.,
Hermanns Thomas,
Poyet Cédric,
Sulser Tullio,
Eberli Daniel
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12498
Subject(s) - forceps , clamp , heat sink , thermography , biomedical engineering , materials science , ultrasonic sensor , surgery , medicine , infrared , computer science , radiology , electrical engineering , optics , physics , clamping , computer vision , engineering
Objective To assess critical heat spread of cautery instruments used in robot‐assisted laparoscopic ( RAL ) surgery.Materials and Methods Thermal spread along bovine musculofascial tissues was examined by infrared camera, histology and enzyme assay. Currently used monopolar, bipolar and ultrasonic laparoscopic instruments were investigated at various power settings and application times. The efficacy of using an additional M aryland clamp as a heat sink was evaluated. A temperature of 45 °C was considered the threshold temperature for possible nerve damage.Results Monopolar instruments exhibited a mean ( sem ) critical thermal spread of 3.5 (2.3) mm when applied at 60 W for 1 s. After 2 s, the spread was >20 mm. For adjustable bipolar instruments the mean ( sem ) critical thermal spread was 2.2 (0.6) mm at 60 W and 1 s, and 3.6 (1.3) mm at 2 s. The PK and L iga S ure forceps had mean ( sem ) critical thermal spreads of 3.9 (0.8) and 2.8 (0.6) mm respectively, whereas the ultrasonic instrument reached 2.9 (0.8) mm. Application of an additional M aryland clamp as a heat sink, significantly reduced the thermal spread. Histomorphometric analyses and enzyme assay supported these findings.Conclusions All coagulation devices used in RAL surgery have distinct thermal spreads depending on power setting and application time. Cautery may be of concern due to lateral temperature spread, causing potential damage to sensitive structures including nerves. Our results provide surgeons with a resource for educated decision‐making when using coagulation devices during robotic procedures.