Bipolar Electrosurgery Research Articles

Comparison of Two Bipolar Systems in Laparoscopic Hysterectomy

To compare the efficacy of 2 bipolar systems during total laparoscopic hysterectomy (TLH): the pulsed bipolar system (PlasmaKinetic; Olympus, Japan) vs. conventional bipolar electrosurgery (Kleppinger bipolar forceps; Richard Wolf Instruments, Vernon Hills, IL). We retrospectively reviewed medical records of 80 women who underwent TLH for benign gynecologic disease between 2009 and 2010. Forty women received TLH using the conventional bipolar system and another 40 using the pulsed bipolar system. The clinical outcomes and complications were compared between the 2 groups. No significant differences between the 2 groups were observed in terms of age, body mass index, and hospital stay. However, the blood loss was greater (515.3 ± 41.2mL vs. 467.9 ± 33.4mL, P < .05) and the operation time was longer (173.4 ± 33.4min vs. 157.3 ± 21.3min, P < .05) in the conventional group. Additionally, the uterine weight was lighter in the conventional group (218.5 ± 23.4g vs. 299.4 ± 41.1g, P < .05). None of the surgeries were required to be converted to laparotomy. No significant differences were found in intraoperative or postoperative complications between the groups. The pulsed bipolar system has some advantages over the conventional system, and therefore, may offer an alternative option for patients undergoing TLH.

Comparison of the Efficacy of the Pulsed Bipolar System and Conventional Bipolar Electrosurgery in Total Laparoscopic Hysterectomy(TLH)

Comparison of the Efficacy of the Pulsed Bipolar System and Conventional Bipolar Electrosurgery in Total Laparoscopic Hysterectomy(TLH)

Can Bipolar Electrosurgery Be Performed Over Suture Sites Without Compromising Tensile Strength of Suture Material During Laparoscopic Myomectomy?

Study Objective To estimate whether additional bleeding control can be safely achieved during laparoscopic myomectomy using bipolar electrosurgery over the suture sites in patients with blood oozing despite sufficient myometrial sutures. Design Retrospective case control study (Canadian Task Force classification II-1). Setting University teaching hospital. Patients One hundred twenty-six women who underwent laparoscopic myomectomy performed by one surgeon. Interventions Changes in maximum tensile strength of various suture materials were measured at tensinometry after bipolar electrosurgery or diathermy. Bipolar electrosurgery was performed over suture sites during laparoscopic myomectomy after adequate suturing (bipolar group, n = 64). Clinical outcomes were compared with those in matched controls (control group, n = 62]. Measurements and Main Results Polyglactin 910 (Vicryl) and glycolide-lactide copolymer (Polysorb) sutures exhibited no substantial changes in maximum tensile strength after 2 seconds of bipolar electrosurgery. However, both sutures demonstrated a decrease in maximum tensile strength of 43.5% and 17.4%, respectively, after 4 seconds of bipolar electrosurgery at 40 W. Compared with the control group, in the bipolar group mean (SD) postoperative hemoglobin concentration was higher (11.1 [1.3] g/dL vs 10.5 [1.3] g/dL), total drainage volume was less (244.6 [133.7] mL vs 380.2 [196.0] mL), a drain was required for a shorter time (2.0 [0.7] days vs 2.8 [0.7] days), and hospital stay was shorter (4.3 [1.6] days vs 5.3 [1.7] days) (p <.05). Conclusions During laparoscopic myomectomy, additional bleeding control can be achieved by using careful short duration bipolar electrosurgery over the suture site. However, application of excessive bipolar electrosurgery (>40 W and ≥4 seconds) tends to weaken suture material.

Terumo Precision-Drive Articulating Instrument To Facilitate Gynecologic Laparoscopy

The Terumo Precision-Drive Articulating Instrument is designed to provide motorized rotation and articulation for endoscopic suture placement, knot tying, dissection and mono and bi-polar electrosurgery. Over the past two years, we applied the Terumo Precision-Drive Articulating Instrument to 6 female pigs of medium weight followed by 4 cadaveric dissections. The new device optimizes dissection, desiccation, suturing and knot tying during common gynecologic procedures. A reduction number of ports and time involved for the more difficult maneuvers was also noted.

Monopolar and Bipolar Hysteroscopic Electrosurgery: New Insights into the Differences between Surgery in Insulating and Conducting Liquid Media

Monopolar and Bipolar Hysteroscopic Electrosurgery: New Insights into the Differences between Surgery in Insulating and Conducting Liquid Media

Particulate Matter Generated During Monopolar and Bipolar Hysteroscopic Human Uterine Tissue Vaporization

Study Objective To characterize the insoluble particulate matter generated during hysteroscopic monopolar and bipolar electrosurgery. Design In vitro comparative study (Canadian Task Force Classification II-1). Setting Teaching hospital. Patients Eight patients undergoing hysterectomy with benign indications. Intervention Tissue blocks were divided, and 1 g of tissue was vaporized using a monopolar and a bipolar vaporizing electrode. Measurements and Main Results The particles were examined at light microscopy to study their morphologic features. Particle analysis was carried out using a laser diffraction particle analyser. Monopolar uterine tissue vaporization generated particles of a smaller median diameter than did bipolar vaporization (0.13 μm and 0.25 μm, respectively). The distribution by particle surface area in both instruments seems to be complex, with peaks at 0.35 and 4.0 μm for monopolar-generated particles and 0.5 and 5.0 μm for bipolar-generated particles. Another smaller peak with larger particles produced by both instruments was identified at 30 μm. During monopolar uterine tissue vaporization, 9.96% of particles generated were smaller than 5 μm, whereas during bipolar vaporization, 3.81% of particles were smaller than 5 μm (p = .01). Conclusion Particulate matter generated during hysteroscopic electrosurgical vaporization using monopolar and bipolar instruments is heterodisperse and complex in shape. Monopolar vaporization results in particles of a smaller median diameter compared with bipolar vaporization. Both instruments generate 2 distinct populations of particles by surface area. The distribution of particles by volume during hysteroscopic electrosurgery is complex.

Thermal spread and heat absorbance differences between open and laparoscopic surgeries during energized dissections by electrosurgical instruments

The reported literature suggests a higher incidence of collateral damage during energized dissections in laparoscopic surgery than in open surgery, probably because the ambient environment of the two approaches causes different heat absorbance and thermal spread during energized dissection. The experimental design involved randomized allocation of the surgical approach (4 open and 4 laparoscopic procedures) for eight adult pigs. A bipolar electrosurgery system (LigaSure) was used to perform 40 standardized regional dissections and procedures (5 per animal in randomized order). During these procedures, both white light and infrared thermographic imaging (3-5 mum) were recorded, and biopsy specimens were procured for histology. The core body temperatures were significantly different between the two approaches. The laparoscopic group had a smaller temperature drop (3.08 +/- 0.98 degrees C vs 1.9 +/- 0.72 degrees C; p = 0.03). Differences also were observed in the thermal spread between the laparoscopic and open groups during portal vein dissection with the Advance (1.7 +/- 0.2 mm vs 2.3 +/- 1.7 mm; p = 0.07). Both thermography and histology confirmed the safety of the LigaSure system in limiting thermal spread and necrosis at the fusion line. Significant degradation of the instruments began after 10 activations. The deterioration was faster and more extensive in laparoscopic surgery. Heat absorbance and thermal spread during bipolar electrosurgery are significantly different between open and laparoscopic surgery. Device performance degradation with repeat activations is more marked in laparoscopic surgery.

Comparison of the Efficacy of the Pulsed Bipolar System and Conventional Bipolar Electrosurgery in Total Laparoroscopic Hysterectomy (TLH)

Comparison of the Efficacy of the Pulsed Bipolar System and Conventional Bipolar Electrosurgery in Total Laparoroscopic Hysterectomy (TLH)

Bipolar Electrosurgery

Bipolar electrosurgery is part of the customary gynecologic surgical armamentarium providing isolated thermal effects and blood vessel occlusion. However, end points are not always predictable as hemostasis may require contiguous applications and thermal damage can significantly expand beyond the ta

Bipolar Electrosurgery: Convention and Innovation

Bipolar electrosurgery is part of the customary gynecologic surgical armamentarium providing isolated thermal effects and blood vessel occlusion. However, end points are not always predictable as hemostasis may require contiguous applications and thermal damage can significantly expand beyond the target zone. Unintentional transection of a patent vessel cannot be entirely reduced. Recent advances in bipolar technology provide more predictable vessel occlusion with less thermal damage. To date, there are 3 novel bipolar platforms, using either impedance feedback from the operative site to moderate output as pulsed current with lower voltage or by local regulation using nanotechnology within the jaws.

Bipolar electrosurgery: A short history

Bipolar electrosurgery: A short history

Comparison of Nd:YAG Surgical Laser and Remorgida Bipolar Electrosurgery Forceps for Canine Laparoscopic Ovariectomy

To investigate and compare technique, surgical time, and complications of canine laparoscopic ovariectomy using Nd:YAG surgical laser and Remorgida bipolar electrosurgery forceps. Randomized, prospective clinical trial. Female dogs (n=40) for elective ovariectomy. Dogs had bilateral ovariectomy with one ovary randomly assigned to removal by use of Nd:YAG surgical laser with a 600 mum optical fiber in contact mode and the other ovary to removal by use of a Remorgida forceps (featuring bipolar electrocoagulation with simultaneous sharp resection). Duration of predetermined surgery intervals and complications were compared between techniques. Additionally, the effects of several intraoperative variables on surgical time were evaluated. Ovariectomy by use of Remorgida forceps required significantly less time than laser ovariectomy but intraoperative hemorrhage was not reduced. Surgical time was significantly increased in obese dogs, depending on the amount of fat in the ovarian ligament. Intraoperative hemorrhage had no significant influence on surgical time. Both ovariectomy techniques were effective but the Remorgida forceps can be used as a relatively inexpensive, stand-alone device that decreases surgical time compared with Nd:YAG laser ovariectomy. Novel techniques, such as laser and combined bipolar electrosurgical and cutting forceps aim to reduce surgery duration, complication rates and recovery time in laparoscopic surgery.

Superiority of Using Bipolar Radiofrequency Energy for Internal Mammary Artery Harvesting

The purpose of this study was to observe the acute effects of harvesting the porcine internal mammary artery using a novel bipolar (BP) radiofrequency energy device. The internal mammary artery from 16 porcine subjects was harvested using monopolar electrosurgery, BP electrosurgery, ultrasonic coagulation, and mechanical dissection with clips. Segments were evaluated with respect to endothelial function and integrity and the strength of side-branch sealing. Adenosine triphosphate-induced relaxation was greatest with internal mammary artery segments harvested by bipolar electrosurgery in comparison with monopolar electrosurgery (p = 0.0271), ultrasonic coagulation in comparison with monopolar electrosurgery (p = 0.0047), and mechanical clipping in comparison with monopolar electrosurgery (p = 0.0381). The standard error of the mean failed to demonstrate any significant difference in epithelial disruption among the four treatment groups. Clips and bipolar electrosurgery exhibited the most secure ligations with burst pressures exceeding 350 mm Hg. Internal mammary artery segments harvested using a novel BP electrosurgery retained a greater degree of endothelial function when compared with monopolar electrosurgery and ultrasonic coagulation. Side-branch sealing with BP electrosurgery was as secure as mechanical clips.

Laparoscopic radical hysterectomy using pulsed bipolar system: Comparison with conventional bipolar electrosurgery

Objective To compare the efficacy, results and complications of using the pulsed bipolar system (PlasmaKinetic; Gyrus Medical, Maple Grove, MN) and conventional bipolar electrosurgery (Kleppinger bipolar forceps; Richard Wolf Instruments, Vernon Hills, IL) in laparoscopic radical hysterectomy and pelvic lymphadenectomy in the management of early invasive cervical carcinoma. Methods This was a retrospective case-control study. We recruited consecutively 38 patients with cervical cancer for laparoscopic radical hysterectomy with pulsed bipolar system. For comparison, we recruited consecutively the latest 38 patients with cervical cancer for laparoscopic radical hysterectomy with conventional bipolar electrosurgery in the same period. From Jan. 2001 to Dec. 2005, total 76 patients with cervical cancer for laparoscopic radical hysterectomy were recruited for statistical analysis. Results No significant difference was found between the two groups in terms of age, body weight, staging, and hospital stay. There were statistically significant difference in blood loss and operative time. The blood loss was more in conventional bipolar electrosurgery group (mean 564 ml, median 500 ml, range 50–2400 ml) compared with pulsed bipolar system group (mean 397 ml, median 350 ml, range 100–1200 ml) ( p < 0.03). But there was no statistically significant difference in blood transfusion between the two groups ( p = 0.454). The operation time for the conventional bipolar electrosurgery group (mean 229 min, median 232 min, range 121–352 min) was longer than that for the pulsed bipolar system group (mean 172 min, median 177 min, range 65–267 min) ( p < 0.001). None of the laparoscopic procedure was required to be converted to laparotomy. There was no significant difference in the intra-operative complication, but there was statistically less postoperative complication in the pulsed bipolar system group ( p < 0.01). There was no significant difference in recurrence rate in both groups. Conclusions Our findings indicate that pulsed bipolar system is more effective in laparoscopic radical hysterectomy when compared with conventional bipolar electrosurgery. Pulsed bipolar system has advantage over conventional bipolar electrosurgery in less blood loss, shorter operative time, less postoperative complication and may offer an alternative option for patients undergoing laparoscopic radical hysterectomy.

Cochlear implant integrity after adenoidectomy with Coblation and monopolar electrosurgery

Purpose Conventional electrosurgical adenoidectomy has been deemed contraindicated in subjects with cochlear implants (CIs) because of risk to the CI and the auditory neurons. No published studies have evaluated the safety of electrosurgical adenoidectomy techniques with CIs. The goal of this study was to compare the impact of monopolar electrosurgery and Coblation radiofrequency bipolar electrosurgery on CI integrity. Methods Twelve fresh, cadaveric pigs received unilateral CIs, then the nasopharynx was treated for 15 to 30 minutes with continuous monopolar electrosurgery or Coblation. CIs were tested by the manufacturer for device integrity before and after treatment. Results Integrity was maintained in all CIs treated with either monopolar or Coblation electrosurgery. Conclusions Although the safety of electrosurgical adenoidectomy after CI placement remains unproven, these observations suggest that judicious use of conventional monopolar and Coblation electrosurgery in adenoidectomy does not convey a serious risk to CI integrity. Theoretical considerations favor the use of Coblation over monopolar electrosurgery in CI recipients.

Energy Sources for Laparoscopic Colectomy: A Prospective Randomized Comparison of Conventional Electrosurgery, Bipolar Computer-Controlled Electrosurgery and Ultrasonic Dissection. Operative Outcome and Costs Analysis

The development of operative laparoscopic surgery is linked to advances in ancillary surgical instrumentation. Ultrasonic energy devices avoid the use of electricity and provide effective control of small- to medium-sized vessels. Bipolar computer-controlled electrosurgical technology eliminates the disadvantages of electrical energy, and a mechanical blade adds a cutting action. This instrument can provide effective hemostasis of large vessels up to 7 mm. Such devices significantly increase the cost of laparoscopic procedures, however, and the amount of evidence-based information on this topic is surprisingly scarce. This study compared the effectiveness of three different energy sources on the laparoscopic performance of a left colectomy. The trial included 38 nonselected patients with a disease of the colon requiring an elective segmental left-sided colon resection. Patients were preoperatively randomized into three groups. Group I had electrosurgery; vascular dissection was performed entirely with an electrosurgery generator, and vessels were controlled with clips. Group II underwent computer-controlled bipolar electrosurgery; vascular and mesocolon section was completed by using the 10-mm Ligasure device alone. In group III, 5-mm ultrasonic shears (Harmonic Scalpel) were used for bowel dissection, vascular pedicle dissection, and mesocolon transection. The mesenteric vessel pedicle was controlled with an endostapler. Demographics (age, sex, body mass index, comorbidity, previous surgery and diagnoses requiring surgery) were recorded, as were surgical details (operative time, conversion, blood loss), additional disposable instruments (number of trocars, EndoGIA charges, and clip appliers), and clinical outcome. Intraoperative economic costs were also evaluated. End points of the trial were operative time and intraoperative blood loss, and an intention-to-treat principle was followed. The three groups were well matched for demographic and pathologic features. Surgical time was significantly longer in patients operated on with conventional electrosurgery vs the Harmonic Scalpel or computed-based bipolar energy devices. This finding correlated with a significant reduction in intraoperative blood loss. Conversion to other endoscopic techniques was more frequent in Group I; however, conversion to open surgery was similar in all three groups. No intraoperative accident related to the use of the specific device was observed in any group. Immediate outcome was similar in the three groups, without differences in morbidity, mortality, or hospital stay. Analysis of operative costs showed no significant differences between the three groups. High-energy power sources specifically adapted for endoscopic surgery reduce operative time and blood loss and may be considered cost-effective when left colectomy is used as a model.

Evaluation of a vessel sealing system, bipolar electrosurgery, harmonic scalpel, titanium clips, endoscopic gastrointestinal anastomosis vascular staples and sutures for arterial and venous ligation in a porcine model.

We assessed the usefulness of the LigaSure (Valleylab, Boulder, Colorado) vessel sealing system for vascular control during laparoscopic surgery and compared it with other available hemostatic modalities. A total of 31 domestic pigs were divided into 5 groups. In groups 1 and 2 the vessel sealing system was compared with titanium clips and Endo-GIA (United States Surgical, Stamford, Connecticut) staples. In group 3 the vessel sealing system was compared with standard Klepinger (Karl Storz, Culver City, California) bipolar forceps. In group 4 the harmonic scalpel and Trimax (United States Surgical) bipolar forceps were compared. In group 5 in vivo laparoscopic application of the vessel sealing system was evaluated. The 5 mm. laparoscopic vessel sealing system sealed arteries up to 6 mm. and veins up to 12 mm. in diameter at supraphysiological bursting pressure. We evaluated 13 arteries with a diameter of 6 mm. or less at a mean bursting pressure of 662 mm. Hg (range 363 to 1,985) and 11 veins with a diameter of 12 mm. or less with a mean bursting pressure of 233 mm. Hg (range 63 to 440). Collateral tissue damage extended 1 to 3 mm. from the application site. Standard bipolar energy with Klepinger and Trimax forceps was less reliable and in some cases vessel sealing could not be accurately assessed before vessel division. Collateral tissue injury was 1 to 6 mm. The harmonic scalpel did not reliably seal vessels larger than 3 mm. but resulted in the least acute collateral tissue injury of 0 to 1 mm. In the porcine model the LigaSure system is a viable option for laparoscopic management of arteries up to 6 mm. and veins up to 12 mm. in diameter.

222: Retrospective Analysis Comparing the New Harmonic “Ace” Scalpel to Bipolar Electrosurgery for LAVH in a Community Setting

To compare the total operative time and blood loss using the Harmonic “Ace” Scalpel and traditional bipolar electrosurgery. A retrospective comparison of the last 50 cases of LAVH using bipolar electrosurgery and the first 50 cases gathered prospectively using the Harmonic “Ace” Scalpel. A group gynecology only private practice at a small physician owned community hospital in southwest USA. One hundred patients (ages 22–76), 50 consecutive patients in the bipolar group and 50 consecutive patients in the Harmonic group undergoing a LAVH. Laparoscopic Assisted Vaginal Hysterectomy. The surgical time and blood loss in the bipolar group was 83 minutes and 285 ml respectively. Surgical time and blood loss in the Harmonic “Ace” group was (preliminary data) 53 minutes and 225ml respectively. Complications were similar in the two groups: 2 small bladder perforations during the vaginal portion in the bipolar group, and none in the Harmonic “Ace” group. The new Harmonic “Ace” Scalpel appears to be a safe and effective instrument for the LAVH, may save significant operating room time, and have less blood loss than bipolar electrosurgery.

Comparison of the Efficacy of the Pulsed Bipolar System and Conventional Bipolar Electrosurgery in Laparoscopically Assisted Vaginal Hysterectomy

We compared the safety and effectiveness of the pulsed bipolar system (PlasmaKinetic; Gyrus Medical, Maple Grove, MN) and conventional electrosurgery (Kleppinger bipolar forceps; Richard Wolf Instruments, Vernon Hills, IL) in laparoscopically assisted vaginal hysterectomy (LAVH). In this prospective, nonrandomized study, 62 women with benign gynecologic diseases scheduled for LAVH were divided into two groups: one group underwent LAVH with the pulsed bipolar system and the second group underwent LAVH with conventional electrosurgery. Outcome measures for both groups were compared in terms of length of operative time, amount of blood loss, requirement of blood transfusion, and length of hospital stay. The mean operative time (87.6+/-28.1 minutes vs. 93.4+/-20.2 minutes, P=0.368), blood loss (196.8+/-143.7 mL vs. 253.2+/-125.8 mL, P=0.105), and blood transfusion rate (3.2% vs. 6.5%, P=1.0) were slightly greater in the conventional electrosurgery group than those in the pulsed bipolar system group, although these differences were not statistically significant. The mean length of hospital stay was similar in both groups (3 days). No patients developed serious complications related either to conventional electrosurgery or to the pulsed bipolar system. Our findings indicate that the pulsed bipolar system is as safe and effective as conventional electrosurgery, and may offer an alternative option for patients undergoing LAVH.

Comparison of experimental nerve injury caused by ultrasonically activated scalpel and electrosurgery

Iatrogenic nerve injury caused by heat from dissection instruments is a significant problem in many areas of surgery. The aim of the present study was to compare the risk of nerve injury for three different dissection instruments: monopolar and bipolar electrosurgery (ES) and an ultrasonically activated (US) instrument. The biceps femoris muscle was cut in a standard manner just adjacent to the sciatic nerve using monopolar ES, bipolar ES or US shears. A total of 73 functional experiments were conducted in which the nerve was isolated, divided proximally, and stimulated supramaximally in 37 anaesthetized rats. The electromyographic (EMG) potential was recorded distally before and after each experiment. Nerve dysfunction was defined as more than 10 per cent loss of the evoked EMG potential. Fifty-nine nerves were examined histologically after dissection with the different instruments. The extent of heat damage was determined in four nerves that were divided with ES bipolar scissors and five that were divided with US shears. Reduction in the EMG potential was significantly more frequent in the monopolar ES group than in the US group. Morphological examination also showed significantly less nerve damage in the US group. US instruments may be safer than ES for dissection close to nerves.