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01-05-2021 | Laparoscopy

Monopolar stray energy in robotic surgery

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

Published in: Surgical Endoscopy | Issue 5/2021

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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Title: Monopolar stray energy in robotic surgery
Authors: Douglas M. Overbey
Heather Carmichael
Krzysztof J. Wikiel
Douglas A. Hirth
Brandon C. Chapman
John T. Moore
Carlton C. Barnett
Teresa S. Jones
Thomas N. Robinson
Edward L. Jones
Publication date: 01-05-2021
Publisher: Springer US
Keywords: Laparoscopy
Cholecystectomy
Published in: Surgical Endoscopy / Issue 5/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07605-5

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Monopolar stray energy in robotic surgery

Abstract

Introduction

Methods

Results

Conclusions

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Abstract

Introduction

Methods

Results

Conclusions

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