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Stray energy transfer in single-incision robotic surgery

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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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Funding

This study was funded by a 2016 SAGES Research Grant.

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Authors and Affiliations

  1. Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA

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

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

    Douglas M. Overbey

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

    Brandon C. Chapman

  4. Rocky Mountain Regional Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA

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

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  1. Krzysztof J. Wikiel
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  2. Douglas M. Overbey
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  3. Heather Carmichael
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  4. Brandon C. Chapman
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  7. Teresa S. Jones
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Correspondence to Krzysztof J. Wikiel.

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Disclosures

Dr. Krzysztof Wikiel has received travel reimbursement from Intuitive Surgical, Inc., to participate in resident training labs in Sunnyvale, CA and Houston, TX. Drs. Douglas Overbey, Heather Carmichael, Brandon Chapman, John Moore, Carlton Barnett, Teresa Jones, Thomas Robinson, and Edward Jones have nothing to disclose.

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Wikiel, K.J., Overbey, D.M., Carmichael, H. et al. Stray energy transfer in single-incision robotic surgery. Surg Endosc 35, 2981–2985 (2021). https://doi.org/10.1007/s00464-020-07742-x

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