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Lateral thermal spread induced by energy devices: a porcine model to evaluate the influence on the recurrent laryngeal nerve

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Abstract

Background

Recurrent laryngeal nerve (RLN) paralysis is a frequently observed complication after esophagectomy, and thermal injury is considered to be one of the causes. The difference in the lateral thermal spread associated with the grasping range of various energy devices remains unknown.

Methods

Ultrasonic devices (Harmonic® HD1000i and Sonicision™) and a vessel-sealing device (Ligasure™) were studied. We evaluated the temperature of these devices, the activation time required, and the thermal spread on porcine muscle when the devices were used with different grasping ranges (thermal spread study). In addition, we evaluated the influence of thermal spread by short grasping use of the energy devices on the viability of RLN in a live porcine model (NIM study).

Results

In the thermal spread study, the temperature of the ultrasonic devices lowered as grasping range increased, whereas the highest temperature of Ligasure was observed when used with two-thirds grasping. The activation time of ultrasonic devices became longer as grasping range increased, whereas the grasping range did not influence the activation time of Ligasure. Thermal spreads 1 mm from the energy devices were unaffected by the grasping ranges. Although the temperature of the Ligasure was lower than that of the ultrasonic devices, thermal spread by Ligasure was significantly greater than that induced by the ultrasonic devices. In the NIM study, the activation of the Sonicision with one-third grasping range did not cause EMG changes at distances of up to 1 mm from the RLN, whereas applying Ligasure with a one-third grasping range 1 mm away from the RLN led to a critical result.

Conclusions

The grasping range did not influence the thermal spread induced by the energy devices. Ultrasonic devices may be safer in terms of lateral thermal spread to the RLN than Ligasure.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

    Masaru Hayami, Masayuki Watanabe, Shinji Mine, Yu Imamura, Akihiko Okamura, Masami Yuda, Kotaro Yamashita, Tasuku Toihata & Yoshiaki Shoji

  2. Department of Clinical Trial Planning and Management, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

    Naoki Ishizuka

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  1. Masaru Hayami
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  2. Masayuki Watanabe
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  3. Shinji Mine
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  4. Yu Imamura
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Correspondence to Masayuki Watanabe.

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Drs. Masaru Hayami, Masayuki Watanabe, Shinji Mine, Yu Imamura, Akihiko Okamura, Masami Yuda, Kotaro Yamashita, Tasuku Toihata, Yoshiaki Shoji, and Naoki Ishizuka have no conflicts of interest or financial ties to disclose.

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Hayami, M., Watanabe, M., Mine, S. et al. Lateral thermal spread induced by energy devices: a porcine model to evaluate the influence on the recurrent laryngeal nerve. Surg Endosc 33, 4153–4163 (2019). https://doi.org/10.1007/s00464-019-06724-y

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