Effect of argon-beam coagulation on the integrity of suture material

Can bipolar electrosurgery be performed over suture sites without compromising tensile strength of suture material during laparoscopic myomectomy?

STUDY OBJECTIVE

To estimate whether additional bleeding control can be safely achieved during laparoscopic myomectomy using bipolar electrosurgery over the suture sites in patients with blood oozing despite sufficient myometrial sutures.

DESIGN

Retrospective case control study (Canadian Task Force classification II-1).

SETTING

University teaching hospital.

PATIENTS

One hundred twenty-six women who underwent laparoscopic myomectomy performed by one surgeon.

INTERVENTIONS

Changes in maximum tensile strength of various suture materials were measured at tensinometry after bipolar electrosurgery or diathermy. Bipolar electrosurgery was performed over suture sites during laparoscopic myomectomy after adequate suturing (bipolar group, n = 64). Clinical outcomes were compared with those in matched controls (control group, n = 62].

MEASUREMENTS AND MAIN RESULTS

Polyglactin 910 (Vicryl) and glycolide-lactide copolymer (Polysorb) sutures exhibited no substantial changes in maximum tensile strength after 2 seconds of bipolar electrosurgery. However, both sutures demonstrated a decrease in maximum tensile strength of 43.5% and 17.4%, respectively, after 4 seconds of bipolar electrosurgery at 40 W. Compared with the control group, in the bipolar group mean (SD) postoperative hemoglobin concentration was higher (11.1 [1.3] g/dL vs 10.5 [1.3] g/dL), total drainage volume was less (244.6 [133.7] mL vs 380.2 [196.0] mL), a drain was required for a shorter time (2.0 [0.7] days vs 2.8 [0.7] days), and hospital stay was shorter (4.3 [1.6] days vs 5.3 [1.7] days) (p <.05).

CONCLUSIONS

During laparoscopic myomectomy, additional bleeding control can be achieved by using careful short duration bipolar electrosurgery over the suture site. However, application of excessive bipolar electrosurgery (>40 W and ≥ 4 seconds) tends to weaken suture material.

Radiofrequency and its effect on suture strength

The use of radiofrequency-based electrocautery for hemostasis and ablation within the subacromial space and glenohumeral joint can cause damage to suture material. Prior studies have focused on the mechanical properties of sutures including their ability to withstand abrasion. The purpose of this study was to determine the effect of electrical energy on the mechanical properties of 5 different brands of #2 suture used for arthroscopic shoulder repair: FiberWire (Arthrex Inc, Naples, Florida); Orthocord (DePuy Mitek, Norwood, Massachusetts); Hi-Fi (formally Herculine; Linvatec Corp, Largo, Florida); MaxBraid (Teleflex Medical, Research Triangle Park, North Carolina); and Ethibond (Ethicon, Inc, Somerville, New Jersey). A matched pair of human deltoid muscle submerged in buffered saline solution (pH 7.4) was used as a test medium. The suture strengths were tested in 3 different scenarios. The 3 groups were as follows: control group without electrical current, coagulation group with direct introduction of electrical current on a coagulate setting for 2 seconds, and a cutting group with direct introduction of electrical current on a cut setting for 2 seconds. Hi-Fi suture seemed to be the least susceptible to damage by direct electrocautery application. Orthocord suffered the greatest loss of strength of all materials tested. This study demonstrates that exposure to electrocautery damages and weakens suture. Great care should be taken when electrocautery is used during arthroscopic repairs to prevent suture failure and preserve repair integrity.