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Monopolar stray energy in robotic surgery

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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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Funding

This study was funded by a 2016 SAGES Research Grant.

Author information

Authors and Affiliations

  1. Department of Surgery, Duke University, Durham, NC, USA

    Douglas M. Overbey

  2. 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

    Heather Carmichael, Krzysztof J. Wikiel, John T. Moore, Carlton C. Barnett, Teresa S. Jones, Thomas N. Robinson & Edward L. Jones

  3. General Surgeons of Western Colorado, Grand Junction, CO, USA

    Douglas A. Hirth & Brandon C. Chapman

  4. Department of Surgery, University of Tennessee College of Medicine, Chattanooga, TN, USA

    Brandon C. Chapman

Authors
  1. Douglas M. Overbey
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  2. Heather Carmichael
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  3. Krzysztof J. Wikiel
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  4. Douglas A. Hirth
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  5. Brandon C. Chapman
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  6. John T. Moore
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  7. Carlton C. Barnett
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  8. Teresa S. Jones
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  9. Thomas N. Robinson
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  10. Edward L. Jones
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Corresponding author

Correspondence to Edward L. Jones.

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Disclosures

Dr. Overbey received a 2016 SAGES Research Grant for this study. No study number was assigned. Drs. Carmichael, Wikiel, Hirth, Chapman, Moore, Barnett, T. Jones, Robinson, and E. Jones have no conflicts of interest or financial ties to disclose.

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Overbey, D.M., Carmichael, H., Wikiel, K.J. et al. Monopolar stray energy in robotic surgery. Surg Endosc 35, 2084–2090 (2021). https://doi.org/10.1007/s00464-020-07605-5

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  • DOI: https://doi.org/10.1007/s00464-020-07605-5

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