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Shapira SS, Ehrlich Z, Koren P, Sroka G. Comparing a novel wide field of view laparoscope with conventional laparoscope while performing laparoscopic cholecystectomy. Surg Endosc 2023; 37:8910-8918. [PMID: 37735219 DOI: 10.1007/s00464-023-10393-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/13/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The limited 70° field of view (FoV) used in standard laparoscopy necessitates maneuvering the laparoscope to view the ports, follow the surgical tools, and search for a target region. Complications related to events that take place outside the FoV are underreported. Recently, a novel laparoscopic system (SurroundScope, 270Surgical) was reported to dramatically expand the FoV from 70 to 270°. This study focuses on differences in performing laparoscopic cholecystectomy using the SurroundScope compared to the standard laparoscope. METHODS Forty-four laparoscopic surgeries were performed and video recorded. A subanalysis of 21 Cholecystectomies was performed and compared to 21 Cholecystectomies, performed with the standard laparoscope during the study period by the same surgeon. RESULTS No accidental or intraoperative adverse events occurred when using the SurroundScope. Subanalysis of 21 Cholecystectomies revealed shorter fog/smoke cleaning times using the SurroundScope compared to the standard scope (1.45 ± 5.08 sec vs. 54.95 ± 137.77 sec, p = 0.0454). Furthermore, operations performed with the SurroundScope had a shorter trocar placement duration (85.0 ± 40.9 sec vs. 111.3 ± 70.5 sec; p = 0.077), shorter time to achieve critical view of safety (9.5 ± 4.14 min vs. 15.8 ± 11.87 min; p = 0.015), and shorter procedure duration (31.9 ± 10.4 min vs. 42.9 ± 22 min; p = 0.025). In post-operative evaluations, the surgeon noted that tools could be continuously followed and ports were visible without camera manipulation. Also, the surgeon agreed that the procedure could be better planned due to the wide FoV and that surgical workflow was improved. Furthermore, the surgeon agreed that the procedure was safer using the SurroundScope. CONCLUSIONS Initial results demonstrate the advantages of the SurroundScope over standard laparoscopy. By expanding the FoV, visualization is improved, the procedure is more efficient, significantly shorter and most important, patient safety, per surgeons' testimonials is improved. Further investigation to quantify these benefits in a larger group of patients and among various surgical procedures should be considered.
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Affiliation(s)
| | - Zvi Ehrlich
- Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel
| | - Pazit Koren
- Department of Surgery, Bnai Zion Medical Center, Haifa, Israel
| | - Gideon Sroka
- Department of Surgery, Bnai Zion Medical Center, Haifa, Israel.
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Vyacheslavovich NT, Mikhailovich LK, Romanovich CE, Evgenievich TA, Vyacheslavovich SA. Surgeons know that they don't know about the safe use of surgical energy: an international study reveals that the knowledge gap persists. Surg Endosc 2023:10.1007/s00464-023-09936-5. [PMID: 36879166 DOI: 10.1007/s00464-023-09936-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/05/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION The rate of electrosurgery complications is 0.1-2.1%. More than 10 years ago, SAGES pioneered a well-structured educational program (FUSE) aimed to teach about the safe use of electrosurgery. This inspired the development of similar training programs around the globe. Still, the knowledge gap persists among surgeons, possibly due to the lack of judgment. AIM To investigate factors affecting the level of expertise in electrosurgical safety and their correlation with self-assessment scores among surgeons and surgical residents. MATERIALS AND METHODS We conducted an online survey consisting of 15 questions that could be thematically broken down into 5 blocks. We analyzed how the objective scores were correlated with the self-assessment scores, professional experience, past participation in training programs, and work at a teaching hospital. RESULTS A total of 145 specialists took part in the survey, including 111 general surgeons and 34 s-year surgical residents from Russia, Belarus, Ukraine, and Kirgizia. Only 9 (8.1%) surgeons scored "excellent," 32 (28.8%) scored "good," and 56 (50.4%) scored "fair." Of all surgical residents participating in the study, only 1 (2.9%) scored "excellent," 9 (26.5%) scored "good," and 11 (32.4%) scored "fair." The test was failed by 14 surgeons (12.6%) and 13 (38.2%) residents. The difference between the trainees and the surgeons was statistically significant. Our multivariate logistic model identified 3 significant factors predisposing to successful performance on the test: past training in the safe use of electrosurgery, professional experience, and work at a teaching hospital. Of all study participants, those with no past training in the safe use of electrosurgery, and non-teaching surgeons were the most realistic about their competencies. CONCLUSION We have identified alarming gaps in the knowledge of electrosurgical safety among surgeons. Faculty staff and experienced surgeons scored higher, but past training was the most influential factor in improving knowledge of electrosurgical safety.
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Wikiel KJ, Powlan FJ, Jones TS, Robinson TN, Jones EL. Robotic stray energy with constant-voltage versus constant-power regulating electrosurgical generators. Surg Endosc 2023; 37:580-586. [PMID: 35612638 DOI: 10.1007/s00464-022-09316-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 04/27/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Stray energy from surgical energy instruments can cause unintended thermal injuries. There are no published data regarding electrosurgical generators and their influence on stray energy transfer during robotic surgery. There are two approved generators for the DaVinci Xi robotic platform: a constant-voltage regulating generator (cVRG) and a constant-power regulating generator (cPRG). The purpose of this study was to quantify and compare stray energy transfer in the robotic Xi platform using a cVRG versus a cPRG. METHODS An ex vivo bovine model was used to simulate a standard multiport robotic surgery. The DaVinci Xi (Intuitive Surgical, Sunnyvale, CA) robotic platform was attached to a trainer box using robotic ports. A 5 s, open-air activation of the monopolar scissors was done with commonly used electrosurgical settings using a cPRG (ForceTriad, Covidien-Medtronic, Boulder, CO) or cVRG (ERBE VIO 300 dV 2.0, ERBE USA, Marietta, GA). Stray energy transfer was quantified as the change in tissue temperature (°C) nearest the tip of the assistance grasper (which was not in direct contact with the active monopolar scissors). RESULTS Stray energy transfer occurred with both generators. Utilizing common, comparable settings for standard coagulation, significantly less stray energy was transferred with the cVRG versus cPRG (4.4 ± 1.6 °C vs. 41.1 ± 13.0 °C, p < 0.001). Similarly, less stray energy was transferred using cut modes with the cVRG compared to the cPRG (5.61 ± 1.79 °C vs. 33.9 ± 18.4 °C, p < 0.001). CONCLUSION Stray energy transfer increases tissue temperatures more than 45C in the DaVinci Xi robotic platform. Low voltage modalities, such as cut or blend; as well as a cVRG generator, significantly reduces stray energy. Robotic surgeons can minimize the risk of stray energy injuries by using these low risk modes and/or generator.
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Affiliation(s)
- Krzysztof J Wikiel
- Department of Surgery, The University of Colorado School of Medicine, Aurora, CO, USA. .,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA.
| | - Franklin J Powlan
- Department of Surgery, The University of Colorado School of Medicine, Aurora, CO, USA
| | - Teresa S Jones
- Department of Surgery, The University of Colorado School of Medicine, Aurora, CO, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Thomas N Robinson
- Department of Surgery, The University of Colorado School of Medicine, Aurora, CO, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Edward L Jones
- Department of Surgery, The University of Colorado School of Medicine, Aurora, CO, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
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Sazhin AV, Nechay TV, Tyagunov AE, Yuldashev AG, Zhulina YS, Loban KM, Chechin ER, Ilichev AA, Elgina NY. [Safety in electrosurgery: results of the All-Russian survey]. Khirurgiia (Mosk) 2023:5-12. [PMID: 36583488 DOI: 10.17116/hirurgia20230115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To assess the level of knowledge in electrosurgical safety among specialists in the Russian Federation. MATERIAL AND METHODS An Internet survey was devoted to the issues of electrosurgical safety. The questionnaire consisted of 15 questions in 5 items. Data were collected for 2 months. Data analysis included final assessment of respondents, correlation of results with their own assessment of knowledge and parameters of surgical experience, the fact of training and belonging to the department. Question design, survey and presentation of results were performed in accordance with the CHERRIES (Check list of Reporting Results of Internet E-Surveys) criteria for Internet surveys. RESULTS Survey enrolled 231 specialists. Excellent rating was given to 13 (5.6%) respondents, good - 66 (28.3%), satisfactory - 105 (45.1%) respondents. Forty-nine (21.03%) respondents did not overcome the passing score (7) and showed unsatisfactory knowledge of electrosurgical safety. Mean score among all participants was 8.6±2.6 (median 8 points, interquartile range [7-11]) or 53.3% of maximum value (15). In multivariate logistic model, significant factors were the completed course in electrosurgical safety (OR 2.26, 95% CI 1.30-3.97; p=0.004), experience of work (OR 1.03, 95% CI 1.01-1.05; p=0.011) and work in the department (OR 1.74, 95% CI 1.03-2.95; p=0.038). Respondents who did not take the course (positive significant correlation r=0.1629, p=0.02674) and non-departmental employees (r=0.1655, p=0.031) assess the level of knowledge more adequately with respect to real results. Respondents with completed course (r=0.1078, p=0.4659) and departmental staff (r=0.1411, p=0.2699) are prone to overestimate self-assessment (positive insignificant correlation of their own assessment and received points). CONCLUSION We found significant knowledge gaps in electrosurgical safety among various practitioners. The main causes are no mandatory specialized courses on electrosurgical safety and insufficient motivation of specialists for self-education due to false ideas about their own level of knowledge.
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Affiliation(s)
- A V Sazhin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - T V Nechay
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A E Tyagunov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A G Yuldashev
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Yu S Zhulina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - K M Loban
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E R Chechin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A A Ilichev
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - N Yu Elgina
- Pirogov Russian National Research Medical University, Moscow, Russia
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Link T. Guidelines in Practice: Electrosurgical Safety. AORN J 2021; 114:60-72. [PMID: 34181252 DOI: 10.1002/aorn.13421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/05/2022]
Abstract
Surgeons routinely use electrosurgical devices to cut and coagulate tissue during surgical procedures. However, hazards associated with electrosurgery (eg, burns, electrical shock, fire) can place patients or personnel at risk. Perioperative nurses should standardize processes, preoperatively assess the risks for electrosurgical injuries, and participate in education activities on electrosurgical safety to help prevent injuries from occurring. The AORN "Guideline for electrosurgical safety" provides guidance to perioperative personnel for safe use of electrosurgical units, electrocautery devices, and argon-enhanced coagulators. This article discusses prevention of electrosurgical unit injuries, including those that can be caused by electrosurgical accessories. A scenario describes how a team investigating two incidents related to use of electrosurgery uses an assessment tool to identify risks for injury and includes a report of these risks in the surgical briefing. Perioperative RNs should review the entire guideline for additional information when creating and updating policies and procedures for electrosurgical safety.
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An Accessible Laparoscope for Surgery in Low- and Middle- Income Countries. Ann Biomed Eng 2021; 49:1657-1669. [PMID: 33686617 DOI: 10.1007/s10439-020-02707-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/04/2020] [Indexed: 01/11/2023]
Abstract
Laparoscopic surgery is the standard of care in high-income countries for many procedures in the chest and abdomen. It avoids large incisions by using a tiny camera and fine instruments manipulated through keyhole incisions, but it is generally unavailable in low- and middle-income countries (LMICs) due to the high cost of installment, lack of qualified maintenance personnel, unreliable electricity, and shortage of consumable items. Patients in LMICs would benefit from laparoscopic surgery, as advantages include decreased pain, improved recovery time, fewer wound infections, and shorter hospital stays. To address this need, we developed an accessible laparoscopic system, called the ReadyView laparoscope for use in LMICs. The device includes an integrated camera and LED light source that can be displayed on any monitor. The ReadyView laparoscope was evaluated with standard optical imaging targets to determine its performance against a state-of-the-art commercial laparoscope. The ReadyView laparoscope has a comparable resolving power, lens distortion, field of view, depth of field, and color reproduction accuracy to a commercially available endoscope, particularly at shorter, commonly-used working distances (3-5 cm). Additionally, the ReadyView has a cooler temperature profile, decreasing the risk for tissue injury and operating room fires. The ReadyView features a waterproof design, enabling sterilization by submersion, as commonly performed in LMICs. A custom desktop software was developed to view the video on a laptop computer with a frame rate greater than 30 frames per second and to white balance the image, which is critical for clinical use. The ReadyView laparoscope is capable of providing the image quality and overall performance needed for laparoscopic surgery. This portable low-cost system is well suited to increase access to laparoscopic surgery in LMICs.
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Beyersdorffer P, Kunert W, Jansen K, Miller J, Wilhelm P, Burgert O, Kirschniak A, Rolinger J. Detection of adverse events leading to inadvertent injury during laparoscopic cholecystectomy using convolutional neural networks. ACTA ACUST UNITED AC 2021; 66:413-421. [PMID: 33655738 DOI: 10.1515/bmt-2020-0106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 02/16/2021] [Indexed: 01/17/2023]
Abstract
Uncontrolled movements of laparoscopic instruments can lead to inadvertent injury of adjacent structures. The risk becomes evident when the dissecting instrument is located outside the field of view of the laparoscopic camera. Technical solutions to ensure patient safety are appreciated. The present work evaluated the feasibility of an automated binary classification of laparoscopic image data using Convolutional Neural Networks (CNN) to determine whether the dissecting instrument is located within the laparoscopic image section. A unique record of images was generated from six laparoscopic cholecystectomies in a surgical training environment to configure and train the CNN. By using a temporary version of the neural network, the annotation of the training image files could be automated and accelerated. A combination of oversampling and selective data augmentation was used to enlarge the fully labeled image data set and prevent loss of accuracy due to imbalanced class volumes. Subsequently the same approach was applied to the comprehensive, fully annotated Cholec80 database. The described process led to the generation of extensive and balanced training image data sets. The performance of the CNN-based binary classifiers was evaluated on separate test records from both databases. On our recorded data, an accuracy of 0.88 with regard to the safety-relevant classification was achieved. The subsequent evaluation on the Cholec80 data set yielded an accuracy of 0.84. The presented results demonstrate the feasibility of a binary classification of laparoscopic image data for the detection of adverse events in a surgical training environment using a specifically configured CNN architecture.
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Affiliation(s)
| | - Wolfgang Kunert
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Kai Jansen
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Johanna Miller
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Peter Wilhelm
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Oliver Burgert
- Department of Medical Informatics, Reutlingen University, Reutlingen, Germany
| | - Andreas Kirschniak
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Jens Rolinger
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
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Wikiel KJ, Overbey DM, Carmichael H, Chapman BC, Moore JT, Barnett CC, Jones TS, Robinson TN, Jones EL. Stray energy transfer in single-incision robotic surgery. Surg Endosc 2020; 35:2981-2985. [PMID: 32591940 DOI: 10.1007/s00464-020-07742-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/12/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Stray energy transfer from surgical monopolar radiofrequency energy instruments can cause unintended thermal injuries during laparoscopic surgery. Single-incision laparoscopic surgery transfers more stray energy than traditional laparoscopic surgery. There is paucity of published data concerning stray energy during single-incision robotic surgery. The purpose of this study was to quantify stray energy transfer during traditional, multiport robotic surgery (TRS) compared to single-incision robotic surgery (SIRS). METHODS An in vivo porcine model was used to simulate a multiport or single-incision robotic cholecystectomy (DaVinci Si, Intuitive Surgical, Sunnyvale, CA). A 5 s, open air activation of the monopolar scissors was done on 30 W and 60 W coag mode (ForceTriad, Covidien-Medtronic, Boulder, CO) and Swift Coag effect 3, max power 180 W (VIO 300D, ERBE USA, Marietta, GA). Temperature of the tissue (°C) adjacent to the tip of the assistant grasper or the camera was measured with a thermal camera (E95, FLIR Systems, Wilsonville, OR) to quantify stray energy transfer. RESULTS Stray energy transfer was greater in the SIRS setup compared to TRS setup at the assistant grasper (11.6 ± 3.3 °C vs. 8.4 ± 1.6 °C, p = 0.013). Reducing power from 60 to 30 W significantly reduced stray energy transfer in SIRS (15.3 ± 3.4 °C vs. 11.6 ± 3.3 °C, p = 0.023), but not significantly for TRS (9.4 ± 2.5 °C vs. 8.4 ± 1.6 °C, p = 0.278). The use of a constant voltage regulating generator also minimized stray energy transfer for both SIRS (0.7 ± 0.4 °C, p < 0.001) and TRS (0.7 ± 0.4 °C, p < 0.001). CONCLUSIONS More stray energy transfer occurs during single-incision robotic surgery than multiport robotic surgery. Utilizing a constant voltage regulating generator minimized stray energy transfer for both setups. These data can be used to guide robotic surgeons in their use of safe, surgical energy.
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Affiliation(s)
- Krzysztof J Wikiel
- Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA.
- Rocky Mountain Regional Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA.
| | - Douglas M Overbey
- Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA
- Department of Surgery, Duke University, Durham, NC, USA
| | - Heather Carmichael
- Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA
| | - Brandon C Chapman
- Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, TN, USA
| | - John T Moore
- Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Carlton C Barnett
- Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Teresa S Jones
- Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Thomas N Robinson
- Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Edward L Jones
- Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
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Overbey DM, Carmichael H, Wikiel KJ, Hirth DA, Chapman BC, Moore JT, Barnett CC, Jones TS, Robinson TN, Jones EL. Monopolar stray energy in robotic surgery. Surg Endosc 2020; 35:2084-2090. [PMID: 32385708 DOI: 10.1007/s00464-020-07605-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/28/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Stray energy transfer from monopolar radiofrequency energy during laparoscopy can be potentially catastrophic. Robotic surgery is increasing in popularity; however, the risk of stray energy transfer during robotic surgery is unknown. The purpose of this study was to (1) quantify stray energy transfer using robotic instrumentation, (2) determine strategies to minimize the transfer of energy, and (3) compare robotic stray energy transfer to laparoscopy. METHODS In a laparoscopic trainer, a monopolar instrument (L-hook) was activated with DaVinci Si (Intuitive, Sunnyvale, CA) robotic instruments. A camera and assistant grasper were inserted to mimic a minimally invasive cholecystectomy. During activation of the L-hook, the non-electric tips of the camera and grasper were placed adjacent to simulated tissue (saline-soaked sponge). The primary outcome was change in temperature from baseline (°C) measured nearest the tip of the non-electric instrument. RESULTS Simulated tissue nearest the robotic grasper increased an average of 18.3 ± 5.8 °C; p < 0.001 from baseline. Tissue nearest the robotic camera tip increased (9.0 ± 2.1 °C; p < 0.001). Decreasing the power from 30 to 15 W (18.3 ± 5.8 vs. 2.6 ± 2.7 °C, p < 0.001) or using low-voltage cut mode (18.3 ± 5.8 vs. 3.1 ± 2.1 °C, p < 0.001) reduced stray energy transfer to the robotic grasper. Desiccating tissue, in contrast to open air activation, also significantly reduced stray energy transfer for the grasper (18.3 ± 5.8 vs. 0.15 ± 0.21 °C, p < 0.001) and camera (9.0 ± 2.1 vs. 0.24 ± 0.34 °C, p < 0.001). CONCLUSIONS Stray energy transfer occurs during robotic surgery. The assistant grasper carries the highest risk for thermal injury. Similar to laparoscopy, stray energy transfer can be reduced by lowering the power setting, utilizing a low-voltage cut mode instead of coagulation mode and avoiding open air activation. These practical findings can aid surgeons performing robotic surgery to reduce injuries from stray energy.
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Affiliation(s)
| | - Heather Carmichael
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Krzysztof J Wikiel
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Douglas A Hirth
- General Surgeons of Western Colorado, Grand Junction, CO, USA
| | - Brandon C Chapman
- General Surgeons of Western Colorado, Grand Junction, CO, USA
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, TN, USA
| | - John T Moore
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Carlton C Barnett
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Teresa S Jones
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Thomas N Robinson
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Edward L Jones
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA.
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Frountzas M, Pergialiotis V, Stergios K, Doulamis I, Katafygiotis P, Lazaris AC, Schizas D, Perrea DN, Nikiteas N, Toutouzas K. Fibrin sealants as an adequate treatment alternative to traditional suturing for confined bowel lesions: A hypothesis for future experimental research. Med Hypotheses 2019; 136:109514. [PMID: 31812011 DOI: 10.1016/j.mehy.2019.109514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/26/2019] [Accepted: 11/30/2019] [Indexed: 02/07/2023]
Abstract
Bowel perforation is a rare, but serious complication of laparoscopic surgery with a mortality rate that reaches 20%. There are several risk factors that could predispose to bowel perforation, but the surgeon's experience and the difficulty of each case play the most important role. Delayed bowel injuries happen due to conduction of electrical energy through the abdominal cavity, and in the majority of cases require reoperation. Early bowel injuries are caused by thermal injury of an electrosurgical instrument or during the insertion of the laparoscopic instruments inside the peritoneal cavity. Such injuries are recognized during the operation and are usually fixed by placing sutures. TISSEEL™ is a fibrin sealant with various applications in several surgical specialties, that simulates the latter stages of the coagulation cascade, and could be used as an alternative treatment for confined bowel perforations during laparoscopy. The efficacy of fibrin sealants in closing bowel gaps has been tested in some experimental models as well as its adequacy in enhancing bowel anastomoses performed with sutures. In addition, there is scarce evidence that fibrin sealants enhance the healing process after bowel enclosure either combined to suturing or not, which is supported by an experimental pilot study, that was conducted by our study group. The present study tries to combine all the available data in order to propose an effective alternative treatment for confined bowel injuries or controversial cases, that happen during laparoscopic surgery. In that way, every surgeon could face them even without huge expertise, conversions to open surgery would diminish and the disadvantages of suturing would disappear. Future experimental studies should be designed in the terms of extensive comparison of the two methods, with the purpose of this comparison to be tested in humans in the future.
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Affiliation(s)
- Maximos Frountzas
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens Medical School, Athens, Greece.
| | - Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens Medical School, Athens, Greece; First Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
| | - Konstantinos Stergios
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens Medical School, Athens, Greece
| | - Ilias Doulamis
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Patroklos Katafygiotis
- Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas C Lazaris
- Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, Laiko General Hospital, Athens Medical School, Athens, Greece
| | - Despina N Perrea
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens Medical School, Athens, Greece
| | - Nikolaos Nikiteas
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens Medical School, Athens, Greece; Second Department of Propaedeutic Surgery, Laiko General Hospital, School of Medicine, Athens Medical School, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Propaedeutic Surgery, Hippocration Hospital, Athens Medical School, Athens, Greece
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Garnon J, Fuerstner M, Uri IF, Ramamurthy N, Hausegger K. Intramural Hydrodissection of an Adherent Bowel Loop during Renal Tumor Cryoablation: Complication or Thermoprotection? J Vasc Interv Radiol 2018; 29:1294-1296. [PMID: 30146201 DOI: 10.1016/j.jvir.2018.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/20/2018] [Accepted: 04/27/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, Place de l'Hôpital, Strasbourg 67000, France
| | | | - Ishaq Fahmi Uri
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Nitin Ramamurthy
- Department of Radiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
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12
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Hoffman MS, Wenham R, Apte S, Chon HS, Shahzad M. Simulation of Thermal Bowel Injury During Robotic Surgery Utilizing the Porcine Model. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mitchel S. Hoffman
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and University of South Florida Morsani College of Medicine and MCC-GYN Program, Tampa, FL
| | - Robert Wenham
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and University of South Florida Morsani College of Medicine and MCC-GYN Program, Tampa, FL
| | - Sachin Apte
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and University of South Florida Morsani College of Medicine and MCC-GYN Program, Tampa, FL
| | - Hye Sook Chon
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and University of South Florida Morsani College of Medicine and MCC-GYN Program, Tampa, FL
| | - Mian Shahzad
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and University of South Florida Morsani College of Medicine and MCC-GYN Program, Tampa, FL
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13
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van Duren BH, van Boxel GI, Hart A, Newton N. A novel safety mechanism to reduce the risk of inadvertent electrosurgical injury. J Med Eng Technol 2016; 40:239-44. [DOI: 10.3109/03091902.2016.1162214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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14
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[Specific complications of minimally invasive surgery]. Chirurg 2015; 86:1097-104. [PMID: 26541448 DOI: 10.1007/s00104-015-0105-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Minimally invasive surgery (MIS) is fundamentally different from open surgery regarding positioning of the patient, access routes and instrumentation. Each of these aspects is associated with its own specific morbidity, such as positioning-related complications, trocar-induced lesions, hypercapnia-associated phenomena and thermal damage. The growing experience of surgeons and technological progress have increased patient safety to a maximum and have resulted in an impressive spread of MIS in the various fields of surgery including the most common, such as cholecystectomy and hernia repair and special fields, such as bariatric, thoracic and oncological surgery. This narrative review summarizes the current knowledge on the inherent complications of MIS.
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