Neuroprotection Due to Irrigation During Bipolar Cautery

Abstract

Simultaneous irrigation and bipolar cautery enhance temperature recovery to basal levels and protect the peripheral nerve from the effects of cautery.

Impact of Cautery versus Cautery-Free Preservation of Neurovascular Bundles on Early Return of Potency

“…Electrocautery, monopolar or bipolar, is known to cause primarily thermal injury to neural tissue in near proximity. 12 Most studies evaluating neural injury have used a myelinated nerve such as the rat's sciatic nerve. The cavernosal nerve is an unmyelinated autonomic nerve that may be more susceptible to damage than thicker myelinated nerves.…”

“…The cavernosal nerve is an unmyelinated autonomic nerve that may be more susceptible to damage than thicker myelinated nerves. Donzelli and associates 12 have shown that temperatures as low as 41°C can cause injury to neural tissue. Alternative sources such as ultrasonic energy have been introduced in an attempt to reduce tissue injury.…”

Real Time Monitoring of Temperature Changes in Neurovascular Bundles During Robotic Radical Prostatectomy: Thermal Map for Nerve-Sparing Radical Prostatectomy

“…9 Furthermore, the study demonstrated that a temperature rise using bipolar cautery was observed, irrespective of irrigation use, but irrigation resulted in a more rapid reversal of the temperature rise. 10 Slight temperature elevations (41-45°C) of relatively short duration may damage cells but are generally repairable and considered non-lethal. 4,5 In this range, heat-mediated physiologic effects include acceleration of metabolism or cellular activity, inactivation of enzymes, rupture of cell membranes, and the delayed onset of increasing blood flow and vessel permeability.…”

“…Although the effect of heat on the myelinated nerves has been described in many animal studies there is little data on the effect of heat on unmyelinated cavernosal nerves. 10,13,14 In a study by Ong AM et al 8 of open radical prostatectomy in the canine animal model, monopolar, bipolar and harmonic energy sources were used to separate the neurovascular bundle from the prostate. Intra-cavernosal pressure measured immediately and at 2-weeks post op showed significant decrease in intracorporeal pressure with nerve stimulation following the use of all three types of energy.…”

The Application of Regional Hypothermia Using Transrectal Cooling During Radical Prostatectomy: Mitigation of Surgical Inflammatory Damage to Preserve Continence

“…Controlled hypothermia impacts a range of biochemical, histologic, and physiologic effects that include a temperature dependent reduction in cellular metabolism leading to reduced energy demands, decreased free radical production, interruption of the apoptotic cascade, and decreased inflammation. 1,[10][11][12][13][14][15][16][17] The protective effects of hypothermia have been demonstrated in the nervous system, cardiac system, shock, transplantation, and partial nephrectomy. 9,13,18,19 We have previously reported our results in applying this technique to radical prostatectomy to prevent inflammatory damage allowing improved preservation of continence and potency.…”