Early results of using Integrated Bipolar and Ultrasonic Energy Devices in Laparoscopic Donor Nephrectomy

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).

 

Preliminary result

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.

 

Conclusion/future direction

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.

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