Detailed Analysis of Surgical Energy Use in a General Surgical Practice

Andrea Limpuangthip, BA, Gyusung Lee, PhD, Ivan George, Adrian Park, MD. University of Maryland Medical Center

Introduction:
Advancing surgical technology has recently focused research on development of energy-based surgical devices that both minimize patient harm and maximize operating room efficiency. Laparoscopic surgeries commonly and significantly employ energy-based devices to cut, coagulate, or seal tissue with minimal blood loss. Despite the revolutionizing impact of energy devices, few investigations address their usage patterns. This study serves to define and characterize the consumption patterns of energy-based tissue cutting and cauterization/sealing devices used in laparoscopic procedures.

Methods:
In a general operative setting, we studied monopolar and ultrasonic devices, using a time-stamping protocol to record time activation and duration. Energy data was compiled from 46 laparoscopic procedures, performed by 5 highly experienced surgeons. Using perceived energy consumption, laparoscopic procedures were categorized as RYGB, hernia (inguinal, incisional, ventral), cholecystectomy, colectomy, PEH, and other (appendectomy, splenectomy, Heller myotomy). Using one-way ANOVA, we compared the mean total number of activations among surgeons.

Results:
Results derived from comparing activation times within a single category as performed by each experienced surgeon show little variation. Our finding that the total number of activations did not differ among participating surgeons (F(3,6)=0.085, p>0.05) indicates that this descriptive study serves as a reasonable representation of baseline energy use in a general operative setting. Furthermore, results show energy device usage varied depending on procedure. Energy devices were activated from an average low of 46.2 times in hernia procedures to an average high of 139.4 times in PEH repairs. With energy use duration, an average low of 84.3 seconds was found in cholecystectomies while PEH repairs implemented energy devices a total average high of 443.0 seconds. Average activation duration ranged from 1.5 seconds for cholecystectomy to 3.1 seconds for PEH. Amount of energy used compared with procedure length averaged a low of 2.2% per RYGB and a high of 6.9% for PEH.

Conclusion:
As the field of laparoscopic surgery continually advances, there is greater need for improving both application and efficacy of energy devices. The information our data yield serves as a basic, faithful representation of energy used in general surgical procedures. Predictably, energy use was comparable among representative surgeons but varied widely in terms of laparoscopic procedures. Acquiring even rudimentary data—such as which energy-based instruments are most often used and which procedures are most energy consumptive—sets the stage to amass even more valuable data concerning energy usage. Data collecting that concentrates on variance in use of energy devices on a procedure-by-procedure basis provides a foundation useful for studying workflow and ergonomic impacts. A starting point too is developed from which to undertake the crafting of specifications for new device refinements.