J. Bilello1, T. Robinson1, T. Jones1, K. Wikiel1, E. Jones1 1University Of Colorado Denver, Department Of Surgery, Aurora, CO, USA
Introduction:
Achieving hemostasis through the use of surgical energy is essential in nearly all laparoscopic cases. During laparoscopic surgery, radiofrequency energy can transfer to nearby instruments resulting in patient burns via capacitive coupling. More than one-third of energy instruments have a defect in the insulation which can result in unintentionally burns in patients and have also resulted in patient death. Previous studies have shown that severe tissue damage and necrosis can occur at temperatures as low as 60°C. Active electrode monitoring (AEM) is a new emerging technology that may reduce the risk of stray energy injuries during laparoscopic surgery. These devices consist of a conductive metal tube that acts as a protective shield around a laparoscopic instrument, minimizing the impact of a potential insulation layer defect. Few studies have evaluated the efficacy of active electrode monitoring in reducing stray energy injuries due to laparoscopic insulation defects. This study aims to compare thermal injury in bovine intestine tissue both with and without active electrode monitoring in a benchtop model of laparoscopic insulation failure.
Methods:
Radiofrequency energy (joules) was delivered to a standard, monopolar, L-hook and an active electrode monitoring L-hook at 30W in coagulation mode via the most commonly used electrosurgical generator. An insulation defect was created in the shaft of both instruments and the change in tissue temperature from baseline was recorded with a thermal camera. Statistical significance was set at p < 0.05.
Results:
After an insulation defect had been made, the active electrode monitoring energy device minimally changed tissue temperatures compared to the standard L-hook at 30W in coagulation mode (6.3°C±0.42 vs. 131.6°C±0.39, p<0.0001). Additionally, significantly less energy was transferred with the active electrode monitoring L-hook compared to the standard L-hook despite similar insulation defects (59.7±3.3J vs. 148.19±8.1J, p<0.0001).
Conclusion:
Active electrode monitoring aims to minimize stray energy in laparoscopic instruments, preventing patient burns from energy devices. In this benchtop study of standard, laparoscopic energy instruments with insulation defects, active electrode monitoring eliminated stray energy transfer from the device to tissue. Active electrode monitoring should be considered when performing any laparoscopic surgery that requires monopolar energy to reduce the risk of stray energy burns and patient complications.