Measuring thermal spread during bipolar cauterizing using an experimental pneumoperitoneum and thermal sensors

Abstract

ObjectiveDuring nerve-sparing robot-assisted radical prostatectomy (RARP) bipolar electrocoagulation is often used but its use is controversial for the possible thermal damage of neurovascular bundles. Aim of the study was to evaluate the spatial-temporal thermal distribution in the tissue and the correlation with the electrosurgery-induced tissue damage in a controlled, CO2-rich environment modelling the laparoscopy conditions..MethodsWe manufactured a sealed plexiglass chamber (SPC) equipped with sensors to reproduce experimentally the environmental conditions of pneumoperitoneum during RARP. We evaluated in 64 pig musculofascial tissues (PMTs) of approximately 3 cm3 × 3 cm3 × 2 cm3 the spatial-temporal thermal distribution in the tissue and the correlation with the electrosurgery-induced tissue damage in a controlled CO2-rich environment modeling the laparoscopy conditions. Critical heat spread of bipolar cauterizing during surgical procedure was assessed by the employment of a compact thermal camera (C2) with a small core sensor (60 × 80 microbolometer array in the range 7–14 μm).ResultsBipolar instruments used at 30 W showed a thermal spread area of 18 mm2 when applied for 2 s and 28 mm2 when applied for 4 s. At 60 W, bipolar instruments showed a mean thermal spread and 19 mm2 when applied for 2 s; and 21 mm2 when applied for 4 s. Finally, histopathological analysis showed that thermal damage is distributed predominantly on the surface rather than in depth.ConclusionsThe application of these results is very interesting for the definition of an accurate use of bipolar cautery during nerve-sparing RARP. It demonstrates the feasibility of using miniaturized thermal sensors, thus addressing the potential for next developments regarding the design of thermal endoscopic devices for robotic use.

Electrosurgery for the Gynaecologist: Cutting and Coagulating with One Instrument and One Setting

“…1 sec [9] with a voltage as close as possible to 200 V, and using bipolar instruments with a small tip. The importance of short coagulation was illustrated by the damaged volume [10] and depth being 1.1 and 1.3 mm after a 2 or 4 sec of bipolar coagulation with a setting of coag force three and 30W without mentioning the tip size. Plasma jets or plasma scalpels [11] are unlikely to permit pinpoint coagulation since a spark at a distance is not suited for intermittent or underwater coagulation or for localized coagulation.…”