Comparison of lateral thermal damage of the human peritoneum using monopolar diathermy, Harmonic scalpel and LigaSure

Abstract

Background: New hemostatic technologies are often employed in open and laparoscopic surgery to reduce duration of surgery and complications. Monopolar diathermy, Harmonic scalpel and LigaSure are routinely used in open and laparoscopic surgery for tissue cutting and hemostasis. We compared lateral thermal damage following in vivo application of 3 commonly used instruments. Methods:We used monopolar diathermy, Harmonic scalpel and LigaSure to coagulate and divide the peritoneum of patients who underwent median laparotomy. After anesthesia, median supraumbilical laparotomy was performed, and the peritoneum of each patient was coagulated using different devices. Using light microscopy and morphometric imaging analysis, the width of tissue lateral thermal damage was measured from the point of the peritoneal incision. Results:We included 100 patients in our study. After a peritoneal incision, the mean lateral thermal damage of monopolar diathermy, Harmonic scalpel (output power 3), Harmonic scalpel (output power 5) and LigaSure were 215.79 μm, 90.42 µm, 127.48 µm and 144.18 μm, respectively. Conclusion:The degree of lateral thermal spread varied by instrument type, power setting and application time. LigaSure and Harmonic scalpel were the safest and most efficient methods of tissue coagulation. Monopolar diathermy resulted in the greatest degree of thermal damage in tissues. Contexte :On utilise souvent les nouvelles technologies hémostatiques lors de chirurgies ouvertes et laparoscopiques afin d'abréger l'intervention et de prévenir les complications. La diathermie monopolaire, le scalpel Harmonic et le système LigaSure servent couramment lors des chirurgies ouvertes et laparoscopiques pour inciser et cautériser les tissus. Nous avons comparé les lésions thermiques latérales consécutives à l'application in vivo de ces 3 instruments d'usage courant.Méthodes : Nous avons utilisé la diathermie monopolaire, le scalpel Harmonic et le système LigaSure pour cautériser et séparer le péritoine de patients soumis à une laparotomie médiane. Une fois les patients anesthésiés, la laparotomie supraombilicale médiane a été effectuée et le péritoine de chaque patient a été cautérisé à l'aide de différents instruments. Par microscopie optique et analyse morphométrique, nous avons mesuré la largeur des lésions thermiques latérales des tissus à partir du point d'incision du péritoine. Résultats :Nous avons inclus 100 patients dans notre étude. Après l'incision du péri-toine, les atteintes thermiques latérales moyennes associées à la diathermie monopolaire, au scalpel Harmonic (puissance 3), au scalpel Harmonic (puissance 5) et au système Liga Sure ont été respectivement de 215,79 μm; 90,42 μm; 127,48 μm; et 144,18 The Harmonic scalpel incorporates piezoelectric transducers that induce a vibration frequency at the functional tip and transduces a lower amount of energy to the tissue than high-frequency current or laser techniques, resulting in reduced lateral thermal damage and penetration depth owing to lower temperatures. 4,5 Ultras...

Safety and feasibility of a novel non-thermal device for tissue dissection: A preliminary study of the DD1 differential dissector

“…Harmonic and LigaSure) perform coagulation hemostasis by generating heat at the tip of the device. However, unexpected secondary organ damage can occur by thermal injury (12)(13)(14)(15)(16)(17)(18). Therefore, it is necessary to maintain a safety margin such that heat does not directly spread into surrounding tissues during coagulation.…”

“…Energy dissectors, however, have significant limitations due to the large amounts of heat they produce. These limitations lead to several intraoperative complications, such as accidental thermal trauma to blood vessels, nerves, ureters, and bowels (12)(13)(14)(15)(16)(17)(18). Furthermore, thermal instruments can unintentionally fuse adjacent layers, leading to misinterpretation of tissue layers and, subsequently, dissection into the wrong plane.…”

Surgical Efficacy Among Laparoscopic Ultrasonic Dissectors: Are We Advancing Safely? A Review of Literature

“…LigaSure and Harmonic scalpel were the safest and most efficient methods of tissue coagulation. Monopolar diathermy resulted in the greatest degree of thermal damage in tissues [30].…”

“…Its lateral thermal spread is reported to be less than 1 mm [18]. After recruiting 100 patients for a comparative study of Monopolar diathermy, Harmonic scalpel and LigaSure at the department of surgery in Croatia, Družijanić [30] and team with the help of light microscopy and morphometric imaging analysis measured the width of tissue lateral thermal damage from the point of the peritoneal incision. After a peritoneal incision, the mean lateral thermal damages of monopolar diathermy, Harmonic scalpel (output power 3), Harmonic scalpel (output power 5), and LigaSure were 215.79, 90.42, 127.48, and 144.18 lm, respectively as shown in Table 2.…”

Evaluation of Robust Classifier Algorithm for Tissue Classification under Various Noise Levels

“…Previous research showed that thermal tissue damage increased on average 1.41 times, from 90.42 µm to 127.48 µm, when the power level was increased from 3 to 5 in an ultrasonic surgical device that could control the output power level on a scale of 1 to 5 [12]. Furthermore, the position at which the inside of the blade makes contact with the tissue is not incised, forcing the surgeon to increase the output power level of the ultrasonic surgical device.…”