Lateral thermal spread induced by energy devices: a porcine model to evaluate the influence on the recurrent laryngeal nerve

Hayami, Masaru; Watanabe, Masayuki; Mine, Shinji; Imamura, Yu; Okamura, Akihiko; Yuda, Masami; Yamashita, Kotaro; Toihata, Tasuku; Shoji, Yoshiaki; Ishizuka, Naoki

doi:10.1007/s00464-019-06724-y

Cited by 22 publications

(19 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Maximum activation temperatures of ultrasonic EBDs and hybrid devices (e.g. TB) may exceed 200°C, only lower to monopolar electrocautery which have a higher maximum activation temperature (> 350°C) (28,29,33,39). Advanced bipolar EBDs, bipolar electrocautery and FMsealer have maximum activation temperatures ranging from 80 to 100°C (33,41,48).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Improving Voice Outcomes After Thyroid Surgery – Review of Safety Parameters for Using Energy-Based Devices Near the Recurrent Laryngeal Nerve

Wang

Huang

et al. 2021

Front. Endocrinol.

View full text Add to dashboard Cite

Technological advances in thyroid surgery have rapidly increased in recent decades. Specifically, recently developed energy-based devices (EBDs) enable simultaneous dissection and sealing tissue. EBDs have many advantages in thyroid surgery, such as reduced blood loss, lower rate of post-operative hypocalcemia, and shorter operation time. However, the rate of recurrent laryngeal nerve (RLN) injury during EBD use has shown statistically inconsistent. EBDs generate high temperature that can cause iatrogenic thermal injury to the RLN by direct or indirect thermal spread. This article reviews relevant medical literatures of conventional electrocauteries and different mechanisms of current EBDs, and compares two safety parameters: safe distance and cooling time. In general, conventional electrocautery generates higher temperature and wider thermal spread range, but when applying EBDs near the RLN adequate activation distance and cooling time are still required to avoid inadvertent thermal injury. To improve voice outcomes in the quality-of-life era, surgeons should observe safety parameters and follow the standard procedures when using EBDs near the RLN in thyroid surgery

show abstract

Section: Discussionmentioning

confidence: 99%

“…Since the device is available in lengths ranging from 13 to 48 cm, it can be used in either endoscopic or open surgery. According to Hayami et al, Sonicision can be safely used at a distance of 1 mm from the RLN (39).…”

Section: Ultrasonic Ebdsmentioning

confidence: 99%

Improving Voice Outcomes After Thyroid Surgery – Review of Safety Parameters for Using Energy-Based Devices Near the Recurrent Laryngeal Nerve

Wang

Huang

et al. 2021

Front. Endocrinol.

View full text Add to dashboard Cite

show abstract

“…However, it has been reported that the thermal spread during the use of RF and HS devices varied in function of the instruments employed, time of activation, the pressure of jaws on the tissue, and type of tissue sealed [3]. In fact, in a study performed on muscles for the evaluation of lateral thermal spread, RFVS showed a rise of 25 • C at 1 mm from the device and were < 1.0 • C at 5 and 10 mm [38]. In another study performed on artery segments, the RFVS showed lateral thermal spread at 3.8 mm and on vein segments at 3.4 mm [23].…”

Section: Discussionmentioning

confidence: 99%

Swine Small Intestine Sealing Performed by Different Vessel Sealing Devices: Ex-Vivo Test

Lacitignola

Imperante

Trisciuzzi

et al. 2021

Veterinary Sciences

View full text Add to dashboard Cite

This study aimed to evaluate the sealing quality of swine small intestine using different laparoscopic radiofrequency vessel sealing devices (two 5 mm: RFVS-1 and -2; one 10 mm: RFVS-3) and a harmonic scalpel (HS) compared to golden standard closure technique. The study was divided into two arms. In study arm 1: n = 50 swine intestinal loops (10 per group) were transected with each instrument and the loops in which the devices provided complete sealing, at the gross inspection, were tested for maximum burst pressure (BP) and histological evaluation and compared to an automatic linear stapler. After the BP tests, the devices that achieved significantly lower BP values were excluded from the second arm. The RFVS-1 and -3 provided statistically significant results and were used in study arm 2, to obtain full-thickness biopsies along the antimesenteric border of the loop and were compared with hand-sewn intestinal closure (n = 30; 10 per group). The biopsies were histologically evaluated for thermal injury and diagnostic features, and intestinal loops tested for BP. RFVS-3 achieved comparable results (69.78 ± 4.23 mmHg, interquartile range (IQR) 5.8) to stapler closing technique (71.09 ± 4.22 mmHg, IQR 4.38; p > 0.05), while the RFVS-1 resulted in significantly (p < 0.05) lower BP (45.28 ± 15.23 mmHg, IQR 24.95) but over the physiological range, conversely to RFVS-2 (20.16 ± 7.19 mmHg, IQR 12.02) and HS (not measurable). RFVS-3 resulted not significantly different (p > 0.05) (45.09 ± 8.75 mmHg, IQR 10.48) than Suture (35.71 ± 17.51 mmHg, IQR 23.77); RFVS-1 resulted significantly lower values (23.96 ± 10.63 mmHg, IQR 9.62; p < 0.05). All biopsies were judged diagnostic. Data confirmed that RFVS-1 and -3 devices provided suitable intestinal sealing, with BP pressures over the physiological range. Conversely, the HS and RFVS-2 should not be considered for intestinal sealing. RFVS devices could be employed to obtain small intestine stump closure or full-thickness biopsies. However, further studies should be performed in live animals to assess the role of the healing process.

show abstract

“…For example, in neurosurgery, the application of ES is limited, which may cause acute and subacute nerve damage. In thyroid surgery, the thermal damage induced by electrosurgical equipment may cause damage to the recurrent laryngeal nerves, resulting in dysphonia or even potentially life-threatening asphyxia (22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

Comparative healing of swine skin following incisions with different surgical devices

et al. 2021

View full text Add to dashboard Cite

Background: Electrosurgical technology is widely used in surgical dissection and hemostasis, but the generated heat creates thermal injury to adjacent tissues and delays wound healing. The plasma blade (PB) applies pulsed radiofrequency (RF) to generate electrical plasma along the edge of a thin, flat, insulated electrode, minimizing collateral tissue damage. This study aimed to evaluate wound healing in swine skin following incision with a new surgical system that applies low-temperature plasma (NTS-100), a foreign PB, conventional electrosurgery (ES), and a scalpel blade.Methods: In vitro porcine skin and an in vivo porcine skin model were used in this study. Full-thickness skin incisions 3 cm in length were made on the dorsum of each animal for each of the 5 surgical procedures at 0, 21, 28, 35, and 42 days. The timing of the surgical procedures allowed for wound-healing data points at 1, 2, 3, and 6 weeks accordingly. Local operating temperature and blood loss were quantified. Wounds were harvested at designated time points, tested for wound tensile strength, and examined histologically for scar formation and tissue damage. Results: Local operating temperature was reduced significantly with NTS-100 (cut mode 83.12±23.55 ℃; coagulation mode 90.07±10.6 ℃) compared with PB (cut mode 94.46±11.48 ℃; coagulation mode 100.23±6.58 ℃, P<0.05) and ES (cut mode 208.99±34.33 ℃, P<0.01; coagulation mode 233.37±28.69 ℃, P<0.01) in vitro. Acute thermal damage from NTS-100 was significantly less than ES incisions (cut mode: 247.345±42.274 versus 495.295±103.525 μm, P<0.01; coagulation mode: 351.419±127.948 versus 584.516±31.708 μm, P<0.05). Bleeding, histological scoring of injury, and wound strength were equivalent for the NTS-100 and PB incisions. Conclusions:The local operating temperature of NTS-100 was lower than PB, and NTS-100 had similarly reliable safety and efficacy.

show abstract

Lateral thermal spread induced by energy devices: a porcine model to evaluate the influence on the recurrent laryngeal nerve

Cited by 22 publications

References 33 publications

Improving Voice Outcomes After Thyroid Surgery – Review of Safety Parameters for Using Energy-Based Devices Near the Recurrent Laryngeal Nerve

Improving Voice Outcomes After Thyroid Surgery – Review of Safety Parameters for Using Energy-Based Devices Near the Recurrent Laryngeal Nerve

Swine Small Intestine Sealing Performed by Different Vessel Sealing Devices: Ex-Vivo Test

Comparative healing of swine skin following incisions with different surgical devices

Contact Info

Product

Resources

About