Electrosurgery in urology: recent advances

Laparoscopic sealing devices on animal models: searching the least harmful for the surrounding tissue

Background and aims

Sealing devices can produce mechanical and thermal damage to collateral tissue, with few studies analyzing these effects. However, the least harmful device for the surrounding tissue will achieve optimal functional results.

Methods

We compared the tissue damage made by different laparoscopic electro-cauterization instruments while using them as hemostatic means on the stomach and epiploon of Wistar rats, respectively on the diaphragm and urinary bladder of a porcine model. Five devices were used based on either radio frequency diathermy or ultrasound energy, with one coagulation cycle for the automatic hemostasis. Infrared thermography tracked thermal injury on the collateral tissue made by each device on the porcine model.

Results

We analyzed the collateral tissue with irreversible thermal damage caused by each sealing device with infrared thermography with ANOVA statistical test. Based on histopathological examination, we calculated the mean value of the area with edema and coagulation necrosis caused by these maneuvers of hemostasis as a pattern of tissue damage around the sealing mark of every hemostatic device.

Conclusions

Compared with bipolar sealing devices, ultrasound-based devices offered better collateral tissue preservation, with the smallest damaging temperature spread, on animal models. Further research on ultrasound vs. bipolar sealing devices used as hemostatic tools could more accurately assess their impact on functional outcomes in real life surgery setting.

A systematic review and network meta-analysis comparing energy devices used in colorectal surgery

BACKGROUND

The aim of this study was to compare energy devices used for intraoperative hemostasis during colorectal surgery.

METHODS

A systematic literature review and Bayesian network meta-analysis performed. MEDLINE, EMBASE, Science Citation Index Expanded, and Cochrane were searched from inception to August 11th 2021. Intraoperative outcomes were operative blood loss, operative time, conversion to open, conversion to another energy source. Postoperative outcomes were mortality, overall complications, minor complications and major complications, wound complications, postoperative ileus, anastomotic leak, time to first defecation, day 1 and 3 drainage volume, duration of hospital stay.

RESULTS

Seven randomized controlled trials (RCTs) were included, reporting on 680 participants, comparing conventional hemostasis, LigaSure™, Thunderbeat® and Harmonic®. Harmonic® had fewer overall complications compared to conventional hemostasis. Operative blood loss was less with LigaSure™ (mean difference [MD] = 24.1 ml; 95% confidence interval [CI] - 46.54 to - 1.58 ml) or Harmonic® (MD = 24.6 ml; 95% CI - 42.4 to - 6.7 ml) compared to conventional techniques. Conventional hemostasis ranked worst for operative blood loss with high probability (p = 0.98). LigaSure™, Harmonic® or Thunderbeat® resulted in a significantly shorter mean operative time by 42.8 min (95% CI - 53.9 to - 31.5 min), 28.3 min (95% CI - 33.6 to - 22.6 min) and 26.1 min (95% CI - 46 to - 6 min), respectively compared to conventional electrosurgery. LigaSure™ resulted in a significantly shorter mean operative time than Harmonic® by 14.5 min (95% CI 1.9-27 min) and ranked first for operative time with high probability (p = 0.97). LigaSure™ and Harmonic® resulted in a significantly shorter mean duration of hospital stay compared to conventional electrosurgery of 1.3 days (95% CI - 2.2 to - 0.4) and 0.5 days (95% CI - 1 to - 0.1), respectively. LigaSure™ ranked as best for hospital stay with high probability (p = 0.97). Conventional hemostasis was associated with more wound complications than Harmonic® (odds ratio [OR] = 0.27; CI 0.08-0.92). Harmonic® ranked best with highest probability (p = 0.99) for wound complications. No significant differences between energy devices were identified for the remaining outcomes.

CONCLUSIONS

LigaSure™, Thunderbeat® and Harmonic® may be advantageous for reducing operative blood loss, operative time, overall complications, wound complications, and duration of hospital stay compared to conventional techniques. The energy devices result in comparable perioperative outcomes and no device is superior overall. However, included RCTs were limited in number and size, and data were not available to compare all energy devices for all outcomes of interest.

Intraoperative burn from a grounding pad of electrosurgical device during breast surgery: A CARE-compliant case report

RATIONAL

Burns at the site of the return electrode (i.e., grounding pad) are possible effects of electrosurgery. Despite this knowledge, however, ignorance or negligence with regards to proper handling of the grounding pads still often occurs. Burn injuries can be easily prevented by taking the necessary precautions; thus, during plastic surgery, careful attention should to be paid.

PATIENT CONCERNS

A 38-year-old female patient was admitted to our ward to be performed augmentation mammoplasty. Before the start of the procedure, the grounding pad was placed on the surgical table and the left calf of the patient was placed on the grounding pad. Before using the endoscope, we found a burn on patient's left calf, where the grounding pad had been placed.

DIAGNOSIS

It was a 3-cm-by-3-cm-sized full thickness burn. The surrounding areas had no painful sensation with noninfectious sign.

INTERVENTION

Debridement and direct closure was performed with elliptical incision of eschar.

OUTCOMES

The patient did not require additional surgical procedure anymore and satisfied with the scar.

LESSONS

Through this case, we present the appropriate management of electrical burns from a grounding pad, and emphasize the understanding of the mechanism of burn because of electrosurgery, and how to use the grounding pad optimally to minimize the patient's risk.