Ultrasonic thermal damage during robotic hysterectomy

Area of Science:

• Gynecologic surgery
• Minimally invasive procedures
• Surgical technology

Background:

• Energy application in minimally invasive hysterectomy can cause thermal injury.
• Thermal injury may increase the risk of vaginal cuff dehiscence.
• Understanding energy-induced tissue damage is crucial for patient safety.

Purpose of the Study:

• To compare vaginal tissue damage between two ultrasonic energy power settings (Max-Setting 5 and Min-Setting 3) during robotic hysterectomy.
• To evaluate the impact of different ultrasonic energy settings on thermal injury in a swine model.
• To determine if higher power settings increase tissue damage during colpotomy.

Main Methods:

• Prospective, single-blinded study using a swine model (18 animals).
• Robotic ultrasonic energy was used for colpotomy transections, mimicking human surgery.
• 72 vaginal specimens were analyzed by a blinded veterinary pathologist for thermal injury measurement.

Main Results:

• Mean thermal injury (µm) was not statistically different between Max-Setting 5 (1243 ± 544) and Min-Setting 3 (1293 ± 554).
• Transection time was significantly shorter with Max-Setting 5 (13.00 ± 7.75 s) compared to Min-Setting 3 (17.92 ± 9.03 s).
• The rate of injury (µm/s) trended higher with Max-Setting 5 (118.98 ± 72.81) versus Min-Setting 3 (93.03 ± 62.34).

Conclusions:

• Ultrasonic energy settings did not significantly differ in causing vaginal tissue damage in swine models.
• Max-Setting 5 offers a faster transection time with equivalent tissue injury compared to Min-Setting 3.
• Max-Setting 5 may be recommended in human surgery to decrease operative time without increasing tissue damage.