Lateral temperature spread of monopolar, bipolar and ultrasonic instruments for robot‐assisted laparoscopic surgery

Abstract

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 Maryland clamp as a heat sink was evaluated.• A temperature of 45°C was considered the threshold temperature for possible nerve damage.

Vaginal Cuff Thermal Injury by Mode of Colpotomy at Total Laparoscopic Hysterectomy: A Randomized Clinical Trial

“…These clinical findings and the properties of the cut waveform, which have decreased the spread of thermal energy compared with the coag waveform, suggest that the cut mode may be the best mode of electrothermal energy for colpotomy incision, and this is applicable to all LH approaches, including robotic surgery. The depth of thermal injury is affected by not only the mode of electrocautery but also the power setting and the amount of time electrocautery is applied to the tissue [24,25]. In our study, all monopolar power settings were 35 to 40 W, which is similar to the power settings in other studies [24].…”

“…The depth of thermal injury is affected by not only the mode of electrocautery but also the power setting and the amount of time electrocautery is applied to the tissue [24,25]. In our study, all monopolar power settings were 35 to 40 W, which is similar to the power settings in other studies [24]. The length of time electrocautery was applied was not collected in our study, but it likely varied because both experienced minimally invasive surgeons as well as trainees were performing the colpotomy incision.…”

In silico evaluation of geometry variations with respect to the thermal spread during coagulation of egg white using bipolar vessel sealing instruments

“…Several studies compared different electrothermal vessel sealing methods and instruments, using both ex vivo  [10, 11] and in vivo models [12–15], and investigated the thermal spread. The thermal damage to the tissue is generally investigated using histomorphological analysis at the end of the thermofusion process.…”

Comparison between bipolar vessel sealer (LigaSure vessel sealer) and harmonic scalpel in total laparoscopic hysterectomy

“…For ultrasound the thermal spread was 2.9 mm. 4 The harmonic scalpel is a high frequency ultrasonic transducer. The active titanium blade vibrates at 55000 cycles per second.…”