Abstract
Background
Reports of iatrogenic thermal injuries during laparoscopic surgery using new generation vessel-sealing devices, as well as anecdotal reports of hand burn injuries during hand-assisted surgeries, have evoked questions about the temperature safety profile and the cooling properties of these instruments.
Methods
This study involved video recording of temperatures generated by different instruments (Harmonic ACE [ACE], Ligasure V [LV], and plasma trisector [PT]) applied according the manufacturers’ pre-set settings (ACE setting 3; LV 3 bars, and the PT TR2 50W). The video camera used was the infrared Flex Cam Pro directed to three different types of swine tissue: (1) peritoneum (P), (2) mesenteric vessels (MV), and (3) liver (L). Activation and cooling temperature and time were measured for each instrument.
Results
The ACE device produced the highest temperatures (195.9° ± 14.5°C) when applied against the peritoneum, and they were significantly higher than the other instruments (LV = 96.4° ± 4.1°C, and PT = 87° ± 2.2°C). The LV and PT consistently yielded temperatures that were < 100°C independent of type of tissue or “on”/ “off” mode. Conversely, the ACE reached temperatures higher than 200°C, with a surprising surge after the instrument was deactivated. Moreover, temperatures were lower when the ACE was applied against thicker tissue (liver). The LV and PT cooling times were virtually equivalent, but the ACE required almost twice as long to cool.
Conclusions
The ACE increased the peak temperature after deactivation when applied against thick tissue (liver), and the other instruments inconsistently increased peak temperatures after they were turned off, requiring few seconds to cool down. Moreover, the ACE generated very high temperatures (234.5°C) that could harm adjacent tissue or the surgeon’s hand on contact immediately after deactivation. With judicious use, burn injury from these instruments can be prevented during laparoscopic procedures. Because of the high temperatures generated by the ACE device, particular care should be taken when it is used during laparoscopy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Awwad JT, Isaacson K (1996) The Harmonic Scalpel: an intraoperative complication. Obstet Gynecol 88:718–720
Birch DW, Park A, Shuhaibar H (1999) Acute thermal injury to the canine jejunal free flap: electrocautery versus ultrasonic dissection. Am Surg 65:334–337
Campagnacci R, de Sanctis A, Baldarelli M, Rimini M, Lezoche Z, Guerrieri M (2007) Electrothermal bipolar vessel sealing device vs. ultrasonic coagulating shears in laparoscopic colectomies: a comparative study. Surg Endosc 21:1526–1531
Campbell PA, Cresswell AB, Frank TG, Cuschieri A (2003) Real-time thermography during energized vessel sealing and dissection. Surg Endosc 17:1640–1645
Carbonell AM, Joels CS, Kercher KW, Matthews BD, Sing RF, Heinford BT (2003) A comparison of laparoscopic bipolar vessel sealing devices in the hemostasis of small-, medium-, and large-sized arteries. J Laparoendosc Adv Surg Tech A. 13:377–380
Diamantis T, Kontos M, Arvelakis A, Syroukis S, Koronarchis D, Papalois A, Agapitos E, Bastounis E, Lazaris AC (2006) Comparison of monopolar electrocoagulation, bipolar electrocoagulation, Ultracision, and Ligasure. Surg Today 36:908–913
Emam TA, Cuschieri A (2003) How safe is high-power ultrasonic dissection? Ann Surg 237:186–191
Farley DR, Greenlee SM, Larson DR, Harrington JR (2004) Double-blind, prospective, randomized study of warmed, humidified carbon dioxide insufflation vs standard carbon dioxide for patients undergoing laparoscopic cholecystectomy. Arch Surg 139:739–743; discussion 743–734
Kadesky KM, Schopf B, Magee JF Blair GK (1997) Proximity injury by the ultrasonically activated scalpel during dissection. J Pediatr Surg 32:878–879
Kennedy JS, Stranahan PL, Taylor KD Chandler JG (1998) High-burst-strength, feedback-controlled bipolar vessel sealing. Surg Endosc 12:876–878
Koch C, Friedrich T, Metternich F, Tannapfel A, Reimann HP, Eichfeld U (2003) Determination of temperature elevation in tissue during the application of the Harmonic Scalpel. Ultrasound Med Biol 29:301–309
Kunde D, Welch C (2003) Ultracision in gynaecological laparoscopic surgery. J Obstet Gynaecol 23:347–352
Landman J, Kerbl K, Rehman J, Andreoni C, Humphrey PA, Collyer W, Olweny E, Sundaram C, Clayman RV (2003) Evaluation of a vessel sealing system, bipolar electrosurgery, Harmonic Scalpel, titanium clips, endoscopic gastrointestinal anastomosis vascular staples and sutures for arterial and venous ligation in a porcine model. J Urol 169:697–700
Matek W, Reidenbach HD, Wittmann A, Beierlein L, Hermanek P (1989) A comparative study of the tissue-destroying effect of the laser and electrocoagulation. Endoscopy 21:31–36
Ong AM, Su LM, Varkarakis I, Inagaki R, Link S, Bhayani A, Patriciu A, Crain B, Walsh P (2004) Nerve sparing radical prostatectomy: effects of hemostatic energy sources on the recovery of cavernous nerve function in a canine model. J Urol 172:1318–1322
Pietrow PK, Weizer AZ, L’esperance JO, Auge BK, Silverstein A, Cummings T, Preminger GM, Albala DM (2005) PlasmaKinetic bipolar vessel sealing: burst pressures and thermal spread in an animal model. J Endourol 19:107–110
Tulikangas PK, Smith T, Falcone T, et al. (2001) Gross and histologic characteristics of laparoscopic injuries with four different energy sources. Fertil Steril 75:806–810
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kim, F.J., Chammas, M.F., Gewehr, E. et al. Temperature safety profile of laparoscopic devices: Harmonic ACE (ACE), Ligasure V (LV), and plasma trisector (PT). Surg Endosc 22, 1464–1469 (2008). https://doi.org/10.1007/s00464-007-9650-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9650-9