Erica Sutton, MD, Kelsey Lewis, BS, Michael Hughes, Jr., MD, Patrick Bone, BS. Hiram C. Polk, Jr. Department of Surgery, University of Louisville School of Medicine, Louisville, KY; Olympus America, Incorporated, Center Valley, PA.
Objective of the Technology
The Thunderbeat™ platform is designed to integrate the benefits of ultrasonic energy and bipolar technology into a single multi-functional instrument. We describe the improvements in OR time, instrument use and exchanges we have observed during our early use of Thunderbeat™ for laparoscopic donor nephrectomy (LDN).
Description of the technology and method of use or application
The Thunderbeat™ uses a center-pivot jaw to distribute closing pressures evenly across tissues independent of tissue thickness or type. This allows the instrument to rapidly cut tissue with ultrasonic energy and to seal vessels 4-7mm in size as seen with bipolar energy. We replaced our standard ultrasonic energy device with Thunderbeat™ for five consecutive cases of LDN (Group B). We then compared our experience with Thunderbeat™ to the three LDN cases immediately prior (Group A).
We observed a significant decrease in the overall operative time between groups A (mean 280 ± 58 min) and B (mean 178 ± 21 min), (p=0.01). Fewer instrument exchanges contributed in part to the time savings. We do not have complete recordings of the cases in Group A; however, anecdotally we observed fewer instrument exchanges in Group B (mean = 39 exchanges per case). As our familiarity with the technology improved, we used fewer clips in the operation until finally the only clips used were on the distal ureter delivered via a reusable clip applier. Thus, we have been able to eliminate the disposable clip applier, use of the hook cautery, and a 12mm port (in favor of a 5 mm port) that previously accommodated a 10mm disposable clip applier. Our initial experience suggests the adrenal vein, lumbrical veins and gonadal vein can all be safely sealed and divided using Thunderbeat™. Not having clips on the adrenal vein or lumbricals allowed us to divide the renal vein more proximally without interference of the clips to the stapler.
Thunderbeat™ has improved our operative efficiency for LDN by providing rapid tissue dissection and reliable vessel sealing of vessels 4-7mm. Future investigation should randomize cases to standard ultrasonic energy devices versus Thunderbeat™ and prospectively measure operative data, instrument exchanges, smoke interference, renal vein length, and equipment costs.