Study of laparoscopic monopolar devices and its thermal effects

Objective: Energy devices are frequently used in minimally invasive surgeries (MIS). For MIS involving gynecologic malignancies, energy devices should be used cautiously to prevent thermal injuries to nearby organs. We evaluated monopolar electrosurgery devices and measured increases in temperature in the tissue and device. Methods: Briefly, the surface of a porcine tissue was incised using short and long activation times. Subsequently, the maximum temperature at the tip of the monopolar device, the cooling time required to reach a temperature of 60 ${\circ }^{}$C, and the maximum tissue temperature were recorded. Results: Longer activation time was correlated with a higher tip temperature. With all activation times, there was an increase in the tip temperature that exceeded 100 ${\circ }^{}$C. The cooling time to reach 60 ${\circ }^{}$C was faster with the short activation times than with the long activation times. Even with the same output, the temperature decreased faster in the coagulation mode, suggesting that the cooling times were shorter with lower outputs. The tissue temperature dropped to 60 ${\circ }^{}$C or less within 1 s in the cut mode but required approximately 2 s in the coagulation mode at 40 W. The temperature of the dissected tissue increased to 60 ${\circ }^{}$C or higher; the cooling time was longer with high output and in the coagulation mode. Conclusions: We revealed that the activation of the monopolar device under routine use conditions exceeded a temperature of 100 ${\circ }^{}$C. Additionally, the temperatures of the tip and tissue were significantly higher in proportion to the output and time. For MIS involving gynecologic malignancies, careful attention is necessary to avoid thermal injury.

Minimally invasive surgery; Monopolar device; Thermal injury

[1] Nduka CC, Super PA, Monson JR, Darzi AW. Cause and prevention of electrosurgical injuries in laparoscopy. Journal of the American College of Surgeons. 1994; 179: 161-170.

[2] Hulka JF, Levy BS, Parker WH, Phillips JM. Laparoscopic-assisted vaginal hysterectomy: American Association of Gynecologic Laparoscopists’ 1995 Membership Survey. Journal of the American Association of Gynecologic Laparoscopists. 1997; 4: 167-171.

[3] Govekar HR, Robinson TN, Stiegmann GV, McGreevy FT. Residual heat of laparoscopic energy devices: how long must the surgeon wait to touch additional tissue? Surgical Endoscopy. 2011; 25: 3499-3502.

[4] Taniguchi F, Wada-Hiraike O, Hirata T, Tajima H, Masuda H, Kitade M, et al. A nationwide survey on gynecologic endoscopic surgery in Japan, 2014-2016. Journal of Obstetrics and Gynaecology Research. 2019; 44: 2067-2076.

[5] Hwang JH, Kim BW. Laparoscopic radical hysterectomy has higher risk of perioperative urologic complication than abdominal radical hysterectomy: a meta-analysis of 38 studies. Surgical Endoscopy. 2020; 34: 1509-1521.

[6] Vetere PF, Apostolis C. Ureteral injury due to a harmonic scalpel during laparoscopic salpingo-oophorectomy. Journal of the Society of Laparoendoscopic Surgeons. 2010; 14: 115-119.

[7] Lin Y, Dionigi G, Randolph GW, Lu I, Chang P, Tsai S, et al. Electrophysiologic monitoring correlates of recurrent laryngeal nerve heat thermal injury in a porcine model. The Laryngoscope. 2015; 125: E283-E290.

[8] Eto K, Omura N, Haruki K, Uno Y, Ohkuma M, Nakajima S, et al. A comparison of laparoscopic energy devices on charges in thermal power after application to porcine mesentery. Surgical Laparoscopy, Endoscopy and Percutaneous Techniques. 2015; 25: e37-41.

[9] Kisch T, Liodaki E, Kraemer R, Mailaender P, Brandenburger M, Hellwig V, et al. Electrocautery devices with feedback mode and tefloncoated blades create less surgical smoke for a quality improvement in the operating theater. Medicine. 2015; 94: e1104.

[10] Krones CJ, Conze J, Hoelzl F, Stumpf M, Klinge U, Möller M, et al. Chemical composition of surgical smoke produced by electrocautery, harmonic scalpel and argon beaminga short study. European Surgery. 2007; 39: 118-121.