Plume Characteristics (Emission Direction, Types and Settlement Time) Affects Visual Field Obstruction Generated by Laparoscopic Ultrasonic Devices (LUD).

Fernando J Kim, MD, David Sehrt, Alexandre Pompeo, MD, Wilson Molina, MD

Denver Health Medical Center

Objective: To characterize laparoscopic ultrasonic device surgical plume emission direction, types (laminar or turbulent) and settlement time affecting visualization.

Materials and Methods: The Harmonic ACE, Covidien Cordless Sonicision, Olympus SonoSurg and Thunderbeat were activated 15 -27 times/study using industry specified settings with dry model (bovine liver in laparoscopic pelvic trainer) and wet model (5 gallon Plexiglas container with water) to evaluate bubbles dispersed by the devices. Image J software quantified and characterized PE direction, types and mean plume settlement time. Histology of bovine liver identified coagulative necrosis at the edges of the wounds confirming devices activation.

Results: Two types of plume emission were identified generating different directions of plume: Laminar flow causes minimal visual obstruction by directing the aerosol downwards while turbulent flow directs aerosol randomly around the blade. Straight and curved blades produced laminar and turbulent flows respectively. Interestingly, laminar flow decays immediately from LUDs activation while turbulent flow reaches maximum field obstruction at 0.9 seconds and dissipates >1.93s. Plume settlement for 30% of visual field obstruction was 0.57s for laminar and >2s for turbulent flow. Wet environment studies showed similar findings from blade geometry. Histology of edges of tissue after activation revealed coagulative necrosis with all devices. Cautery effect was less noticeable with SonoSurg compared to other devices.

Conclusion: Laparoscopic ultrasonic devices with straight blades produced laminar flow and plume dissipated faster than curved blades (ACE). Surgeons may avoid laparoscope smearing from maximum plume generation depending on the laparoscopic ultrasonic device.

Session: Poster Presentation

Program Number: P379

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