Sophisticated Dissection without Monopolar Scissors

Abstract

<h3>Study Objective</h3> To demonstrate how the bipolar method allows for pinpoint dissection with minimal thermal spread in a variety of challenging operative scenarios in gynecology. <h3>Design</h3> Case presentations. <h3>Setting</h3> Urban general hospital in Japan. <h3>Patients or Participants</h3> From December 2018 to April 2021, we performed 485 robotic surgeries using the double bipolar method in a variety of procedures such as hysterectomy for benign pathology, robotic sacro-colpopexy and para-aortic and pelvic lymphadenectomy for cervical and endometrial cancer. <h3>Interventions</h3> Pinpoint dissection in the case of severe Douglas Pouch adhesion or bladder adhesion, transperitoneal lymphadenectomy and extraperitoneal para-aortic and pelvic lymphadenectomy and nerve-sparing radical trachelectomy is a great advantage. These challenging procedures require the elucidation of fine structures and well as accurate separation of adhered organs. The double bipolar method is accurate, powerful and efficient with minimal thermal spread. <h3>Measurements and Main Results</h3> Only one patient who had extensive adhesion due to previous surgery required surgery from postoperative peritonitis. All other patients recovered quickly and without complications. <h3>Conclusion</h3> Monopolar scissors are a standard robotic equipment, used by the majority of surgeons. Although monopolar scissors allow for good quality dissection, thermal spread is always a concern. The thermal spread is known to be source of intraoperative complications and reducing this problem is an important concern. As a result, we implemented the double bipolar method. Not only because of its pinpoint accuracy, but also because the cutting mechanism has minimal thermal spread which is desirable especially when dissection ultra-fine structures.