Effect of Monopolar Cutting Mode against Bipolar Diathermy on Surgical Dissection of Microvessels

Abstract

Background An ideal vessel dissection will be to maximize bleeding control through coagulation while minimizing vessel damage. Among the diathermy methods, there has been no report comparing the effect on vessels. This study aims to verify the effect of bipolar diathermy against monopolar diathermy cutting mode for vessel dissection. Methods A total of 18 Sprague–Dawley rats were divided into three groups according to the method of pedicle dissection for 6 × 6 cm sized abdominal flap; (group 0) surgical scissors, (group 1) monopolar diathermy cutting mode and (group 2) bipolar diathermy. They were evaluated for the temperature of device tip and the radiating heat to the surrounding tissue, change in vessel diameter, flow velocity, and perfusion to the skin flap during dissection. Final flap survival rate and pathology of the vessels were also evaluated. Results Significantly higher radiating heat was observed using bipolar diathermy (average: 37.5°C) compared with group using monopolar diathermy (average: 34.4°C) (p value 0.045). However, there were no differences in vessel diameter, skin flap perfusion, flow velocity, and flap survival rate among the groups. Conclusions Both monopolar diathermy cutting mode and bipolar diathermy are safe to use to dissect the pedicle vessels when used adequately. Although it has no significant difference in relations to flap survival, vessel spasm, and perfusion/velocity to the flap, the extent of histologic damage may be less in monopolar diathermy cutting mode. Using monopolar diathermy cutting mode may provide efficiency to achieve ligation in small vessels during pedicle dissection but requires finesse technique and a learning curve.

Bipolar or monopolar electrosurgery in blepharoplasty: A comparison of surgical outcomes and patient satisfaction

“…Previous studies compared the application of b‐ and m‐ESUs in different types of surgery 7,14 . However, this is the first study that proved the effectiveness of b‐ESUs based on subjective outcome data in blepharoplasty.…”

“…Tissue water content can increase 19,20 . For this reason, we assume that the minimal thermal damage in the surrounding tissue through lower temperatures and less carbonization is responsible for edema, and it might affect to total satisfaction and inconvenience 7 . Further research seems to be needed to further clarify this correlation.…”

“…Monopolar diathermy with its higher coagulation current tends to induce more tissue necrosis and carbonization than bipolar methods 10 . Compared with monopolar electrosurgery, bipolar electrosurgery is considered a safer surgical tool for tissue coagulation 7 . Furthermore, it appears to be more efficient than monopolar diathermy, especially in minimally invasive settings 11 …”

“…This theoretically does not cause spark gaps in the target tissue, and the resulting temperature of the coagulated tissue is lower than with monopolar coagulation. Furthermore, due to the lower currents used in bipolar diathermy, heat damage to surrounding tissue can be minimized 7 . However, with the relatively low currents used in bipolar units, surgeons may need more time to coagulate an individual bleeding spot 8 .…”

“…Both electrosurgical modes have been studied in different types of surgery 7,8 . In oculoplastic surgery, however, there have been few studies so far.…”