Douglas M Overbey, Edward L Jones, Brandon C Chapman, Sarah A Hilton, Teresa S Jones, Thomas N Robinson. University of Colorado
Introduction: Stray energy transfer during use of the monopolar “Bovie” is recognized as a cause of potentially catastrophic complications during laparoscopic and single incision surgery. Recent data suggests single incision laparoscopic surgery to carry additional risk in comparison to traditional laparoscopic surgery through capacitive and antennae coupling. While SILS is declining in use, both traditional robotic surgery and single incision robotic surgery are rapidly increasing. This is echoed by the startling increase in the reporting of energy-related adverse events during robotic surgery. The purpose of this study is to compare stray energy transfer with each approach and configuration.
Methods and Procedures: In a laparoscopic trainer box, the monopolar instrument was activated using both robotic instrumentation (da vinci® system) and laparoscopic instrumentation, each in the traditional and single-incision configurations. In all set-ups, energy was delivered through an L-hook using 30 watts of coagulation mode and a five second activation period. During energy activation to the L-hook, each nonelectrical instrument (camera and grasper) tips were placed adjacent to the simulated tissue. The primary outcome variable was an increase in simulated tissue temperature (°C) placed adjacent to the non-electrical grasper and camera tips. Temperature was measured with a thermal camera.
Results: In the traditional configuration, the laparoscopic platform transfers more unintended energy than the robotic platform at the camera telescope (p<0.001) but not at the assistant grasper (p=0.6). In the single-incision configuration, the laparoscopic platform transfers more unintended energy than the robotic platform, both at the camera telescope (p<0.001) and the assistant grasper (p<0.001)(Table 1).
Conclusions: In contrast to single-incision laparoscopic setups, single-incision robotic surgery appears to be protective from thermal injury due to stray energy transfer. This is likely due to the changes in instrumentation with the single-incision robotic platform utilizing semi-rigid instruments. Also in contrast with laparoscopy, the assistant grasper is the highest risk for thermal injury due to stray energy. Surgeons can use this data to help avoid clinical scenarios which promote stray energy transfer.
|Traditional Robotic Surgery||2.3±3.6||18.3±5.8|
|Single-Incision Robotic Surgery||0.1±0.1||0.1±0.1|
|Traditional Laparoscopic Surgery||39±10||20±10|
|Single-Incision Laparoscopic Surgery||41±12||38±9|
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80220
Program Number: P417
Presentation Session: Poster (Non CME)
Presentation Type: Poster