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

Abstract

The specialty of laparoscopy has evolved with the advent of new technologies over the last few years. Energy-based devices and Ultrasonic dissectors are used with a lot of factors in play-including ergonomics and economics during surgery. Here an attempt is based to review the surgical efficacy and safety of these dissectors with importance to plume production and lateral thermal damage. The factors contributing to adversities to the dissectors are also to be noted. The strategy adopted was aimed at finding relevant studies from PubMed from 1995 to 2014. The basic principle of plume production and thermal damage are studied in this review. Factors contributing to the same that can lead to adversities during laparoscopic surgeries are identified. Summarizing key points that increase lateral thermal damage and plume production amongst different ultrasonic shears and suggesting a technique to identify the right balance between the existing dissectors was possible. The RF Device and USS are both useful and widely used and are more safer than monopolar devices. RF Device is considerably slower than USS, as it cannot achieve coagulation and cutting at the same time. Although USS definitely improvises dissection and has less thermal injury than RF Device, the clinical implications in balancing dissection efficacy with hemostasis need to be investigated further. The ideal haemostatic energy-based shear device would be one with excellent hemostatic results and visual acuity while allowing none or minimal thermal energy escape at the point of application. In our current setting, a combined use of both RF and USS device usage as applied in the particular situations has potential.

Laparoscopic Surgery and the debate on its safety during COVID-19 pandemic: A systematic review of recommendations

“…During laparoscopy the creation of a surgical plume is harmful when it persists and decreases visualization, often obliging the surgeon to remove the scope from the surgical field and eliminate the obstructing aerosol particles. 33 Compromised visualization can be dangerous with serious impact of the composition of surgical smoke and its effects on the operating theater workers. Explicitly, the use of e.g.…”

Energy based surgical instruments : With particular focus on collateral thermal injury

“…With greater pressure, there is more cutting but less tissue coagulation. Ultrasonic devices produce less heat than electrosurgery [16,17,38,48,49], and can be used to coagulate tissue, and are documented to divide blood vessels up to 5mm [39]. e mechanism of tissue temperature rise is di erent to electrosurgery.…”

Performance of Harmonic devices in surgical oncology: an umbrella review of the evidence

“…The Harmonic scalpel (HS) is a device that uses ultrasonic energy for cutting of the tissues, tissue dissection, and coagulation [ 6 ]. Numerous studies have described the advantages of ultrasonic sealing and cutting devices over conventional electrosurgery including better hemostasis with minimal thermal damage, reduced risk of nerve damage, fewer instrument changes due to the combined vessel-sealing, tissue cutting and dissecting functionality, and lower visual obstruction from mist or smoke [ 3 , 4 , 7 , 8 ]. Hemostasis is achieved by coaptation of the vessels and sealing with a denatured protein coagulum as well as mechanically breaking tertiary hydrogen bounds in protein molecules by transducing the mechanical energy to tissue.…”