Comparison of surgical plume among laparoscopic ultrasonic dissectors using a real-time digital quantitative technology

Abstract

BackgroundThis study aimed to analyze the effect of surgical plume generation from various ultrasonic dissectors on laparoscopic visibility, including the first cordless ultrasonic dissector, using a novel real-time digital quantification technique.MethodsThe Covidien Cordless Sonicision, the Harmonic ACE, and the Olympus SonoSurg were applied to bovine liver with industry-specified settings. Consecutive activations were digitally captured from a laparoscope positioned to replicate the clinical setting. Plume was recognized by ImageJ software, and the percentage of pixels containing plume in each video frame was calculated. Analysis of variance statistical multi-analysis and Welch’s t test were computed for all p values.ResultsThe average maximum plume produced by the Sonicision, ACE, and SonoSurg with the maximum setting were respectively 8.76 % (range, 4.32–17.41 %), 18.04 % (range, 9.07–55.12 %), and 9.46 % (range, 5.68–22.12 %) (p = 0.026). The deviations between the ACE and the other devices were significant (p < 0.05). The average maximum plumes produced with the coagulation setting were 4.80 % (range, 0.24–19.83 %) for the Sonicision, 26.63 % (range, 8.12–73.50 %) for the ACE, and 0.21 % (range, 0.06–1.05 %) for the SonoSurg (p < 0.001). The differences between all the instruments in the coagulation setting were significant.ConclusionTo the authors’ knowledge, this is the first report on a real-time digital analysis of surgical plume generation using ImageJ software. In the coagulation setting, the SonoSurg generated minimal plume. The Sonicision obstructed approximately 4 %, whereas the ACE generated plume that obstructed 25 % of the laparoscopic field. In the cutting setting, the SonoSurg and Sonicision generated the least obstruction, whereas the ACE caused the most obstruction.

Surgical Efficacy Among Laparoscopic Ultrasonic Dissectors: Are We Advancing Safely? A Review of Literature

“…As an extension of this study, detection and quantification of surgical plume with ultrasonic dissectors using real-time digital quantitative technology ImageJ was pioneered by Kim et al [16]. The investigators reported that plume generation was increased in coagulation rather than in cut mode.…”

“…Deviation of the ACE from the Sonicision and SonoSurg was significant (p\0.05). There was a statistically significant difference in mean dissection speed and production of plume where Sonicision was resultantly shown to be faster in the tested tissue [16] ( Table 1).…”

“…In the comparative study [16] among different ultrasonic dissectors, the SonoSurg produced minimal obstruction during activation. The ACE generated the most plume, with approximately five times more plume than the Sonicision.…”

“…Moreover, they concluded that different instruments generate different amounts of obstruction of plume despite the use of the same ultrasonic technology. The ACE (Ethicon Endo-Surgery Inc, Cincinnati, Ohio) produced 5 times more plume than did Sonicision (Covidien, Mansfield, Massachusetts), while SonoSurg (Olympus USA, Center Valley, Pennsylvania) produced the least amount of plume [16]. SonoSurg generated negligible plume obstruction (0.21 % of operating field), while Sonicision obstructed 4.8 % of operating field and ACE 26.63 % [16].…”

“…The ACE (Ethicon Endo-Surgery Inc, Cincinnati, Ohio) produced 5 times more plume than did Sonicision (Covidien, Mansfield, Massachusetts), while SonoSurg (Olympus USA, Center Valley, Pennsylvania) produced the least amount of plume [16]. SonoSurg generated negligible plume obstruction (0.21 % of operating field), while Sonicision obstructed 4.8 % of operating field and ACE 26.63 % [16]. Kim et al [17] went on to identify two types of plume generations based on the blade geometry as well.…”