Complications of electrosurgery in laparoscopy

A new knotless parametrial tissue ligation technique for safe total laparoscopic hysterectomy

OBJECTIVE

Parametrial tissue ligation during total laparoscopic hysterectomy (TLH) is important in large uteri with large vessels.

METHODS

A retrospective study was performed at Asan Medical Center for comparing TLH performed with a new knotless parametrial tissue ligation method and conventional laparoscopic-assisted vaginal hysterectomy (LAVH) from March 2019 to August 2021. For TLH, after anterior colpotomy, the parametrial tissue was ligated by anchoring the suture and making a loop in one direction three times using 1-0 V-LocTM 180 (Covidien, Mansfield, MA, USA) suture. Subsequently, the cranial part of the loop was cut using an endoscopic device.

RESULTS

A total of 119 and 178 patients were included in the TLH and LAVH groups, respectively. The maximal diameter of the uterus was larger in the TLH group (106.29±27.16 cm) than in the LAVH group (99.00±18.92 cm, P=0.01). The change in hemoglobin (Hb) level was greater in the LAVH group than in the TLH group (P<0.001). The weight of the removed uterus was greater in the TLH group than in the LAVH group (431.95±394.97 vs. 354.94±209.52 g; P=0.03). However, when the uterine weight was >1,000 g, the operative times and change in Hb levels were similar between the two groups. In both groups, no ureteral complications occurred during or after surgery.

CONCLUSION

Knotless parametrial tissue ligation using 1-0 V-LocTM 180 suture in TLH can be safely applied, even in cases with large uteri, without increased risks of ureteral injury or uterine bleeding.

Total laparoscopic hysterectomy (TLH) with endosuturing compared with conventional technique using energy sources

Background

The aim of the study was to demonstrate the technique of total laparoscopic hysterectomy (TLH) with intra-corporeal endosuturing using simple sutures and basic surgical instruments and compare with TLH using electric coagulation equipment i.e. energy sources with regard to operative time, blood loss, postoperative stay and pain scores.

Methods

A retrospective study was undertaken, in Max Super Specialty Hospital Saket, from June 2015 to May 2018, which included 586 cases of TLH (for benign gynecological conditions), of which 287 were performed using intra-corporeal endosuturing (Group 1) and 299 were performed using energy sources (Group 2). To avoid bias, baseline matching was done for body mass index (BMI), indications for surgery, size of uterus, previous abdominal surgeries and comorbidities like diabetes and hypertension after which there were 172 patients in each group.

Results

The mean age of patients was 48.24 ± 6.76 years. All operative outcomes including operative time (104.1 ± 22.6 vs 107.6 ± 32.6 mins, p=0.25), blood loss (78.9 ± 101.6 vs 99.7 ± 177.6 ml, p=0.19), pain score (2.5 ± 1.3 vs 2.7 ± 1.2, p=0.13) and post-operative stay (2.05 ± 0.2 vs 2.07 ± 0.3 days, p=0.36) were similar between the two groups. Uterine size was the major determinant of operative time and operative blood loss.

Conclusion

TLH with intracorporeal endosuturing can be performed safely and gives results comparable with TLH performed using energy sources. Advancement in suturing devices can decrease operative time further and potentially make it easier and more acceptable.

Closing peritoneal tear during laparoscopic inguinal hernia repair: simple and effective technique

PURPOSE

Peritoneal tears occurring during TAPP and TEP are common, and can cause difficulty in continuing surgery, or, if left open can cause postoperative complications. A number of techniques to close the tear in the peritoneum have been described. These techniques are difficult and add to the operating time, and may not be successful in closing the opening in the peritoneum. We describe a simple, effective, fast technique of repairing these tears using the bipolar diathermy.

METHOD

We have used bipolar diathermy to seal inadvertent peritoneal tears occurring during TAPP/TEP repairs. This method of sealing the peritoneum has been used by us since 2015. We decided to review our results of sealing the tears in the peritoneum at TAPP/TEP from 01 Jan 2017 to 31 Dec 2019.

RESULTS

A total of 152 laparoscopic inguinal hernia repair (TAPP/TEP) procedures were done by the authors from 01 January 2017 to 31 December 2019, and of these, 101 cases had some degree of peritoneal tear. All peritoneal tears were very simply sealed using bipolar diathermy.

CONCLUSIONS

Peritoneal tears occurring inadvertently during Laparoscopic TAPP/TEP procedure for repair inguinal hernia can be effectively sealed with simple bipolar diathermy.

Dynamic Impedance Monitoring for Large Diameter Vessel Sealing Using Bipolar Electrosurgery

Vessel sealing using bipolar electrosurgery is becoming a common practice in modern operating rooms. Despite all the advantages such as faster operation, less bleeding, and shorter postsurgery recovery time, side effects including sticking, charring, and rebleeding still occur, leading to increased surgery time and sometimes fatal complications. Tissue impedance during the electrosurgical process has been used to determine the electrical power of the process. However, little has been done to understand the dynamic tissue impedance and its effectiveness in monitoring the vessel sealing process. Moreover, the samples used in previous studies all had small diameters of 2–5 mm. In this study, an experimental setup was developed to perform vessel sealing tests using large-diameter blood vessel samples with mimicking blood flow. The tissue impedance during the heating process was obtained. Burst pressures after sealing were measured. A finite element simulation model was developed to understand the dynamic impedance behavior. It is seen that the tissue impedance increases rapidly in the beginning of the heating process and remains at a level that is several orders of magnitude higher than the initial value. This rapid impedance increase indicates protein denaturing, thus can be used to monitor the electrosurgical vessel sealing process. An impedance-based monitoring algorithm was developed, with which a burst pressure at least twice the normal human systolic blood pressure was achieved.

Heat conduction in porcine muscle and blood: experiments and time-fractional telegraph equation model

This paper presents experimental evidence for the damped-hyperbolic nature of transient heat conduction in porcine muscle tissue and blood. An examination of integer order and Maxwell-Cattaneo heat conduction models indicates that the latter, in effect resulting in a time-fractional telegraph (TFT) equation, provides the best fit to transient heat phenomena in such materials. The numerical method is verified on Dirichlet and Neumann initial boundary value problems using existing analytical results. Overall, the TFT equation captures the wave-like nature of heat conduction and temperature profiles obtained in experiments, while reducing the need for further tunable parameters.

Novel Neovaginoplasty Using Rudimentary Uterine Horn Serosa and Pelvic Peritoneum as a Graft in Müllerian Anomalies with Vaginal Agenesis

STUDY OBJECTIVE

To study the outcome of a novel method of laparoscopic neovaginal reconstruction using rudimentary uterine horn serosa and the pelvic peritoneum as a graft.

DESIGN

Canadian Task Force classification II-1.

SETTING

A university hospital.

PATIENTS

A retrospective study of 14 patients from 2000 to 2014 of patients with vaginal agenesis who underwent laparoscopic neovagina reconstruction using rudimentary uterine horn serosa and the pelvic peritoneum as a graft.

INTERVENTION

Patients with vaginal agenesis associated with müllerian agenesis who requested surgery. Tertiary referral center and laparoscopic unit. The creation of a neovagina using rudimentary uterine horn serosa and the pelvic peritoneum as a graft via a combined laparoscopic and vaginal route.

MEASUREMENTS AND MAIN RESULTS

Data were collected retrospectively including postoperative vaginal length and width, complications, stenosis or reoperations, dyspareunia, and sexual satisfaction. There were no major complications from the surgery with no rectal perforation or bladder or ureteric injury. The postoperative mean (±SD) vaginal length was 6.0±0.7 cm and a width of 2 fingerbreadths. The mean operation time was 142.7±45.9 min. Median blood loss was 100 ml (range: 10 to 300 mL). The mean duration of the hospital stay was 6.6±1.6 days. The follow-up period ranged from 3 to 84 months with a median follow-up of 11 months.

CONCLUSION

Lee's method of neovaginoplasty using rudimentary uterine horn serosa and the pelvic peritoneum as a graft is a good method for neovagina creation with minimal morbidity, fast recovery, and minimal complications. This method results in good anatomic and functional outcome and can be a method that is widely used.

"Energy devices in gynecological laparoscopy - Archaic to modern era"

The introduction of newer vessel sealing systems has revolutionized techniques of hemostasis during laparoscopic surgery. These devices allow for rapid sequential tissue and vessel sealing, coagulation, and transection. Despite of widespread use of newer advanced bipolar and ultrasonic devices, monopolar and conventional bipolar electro-surgery still carry weightage due to wider range of tissue effect, dissection capabilities, cost effectiveness, and ease of availability. Here in we discussed different types of commonly available energy sources in terms of mechanism, efficacy and safety as thorough knowledge is utmost important for surgeon to choose appropriate instrument for surgical procedure.