Monopolar stray energy in robotic surgery.

Area of Science:

• Minimally Invasive Surgery
• Surgical Technology
• Patient Safety

Background:

• Stray energy transfer from monopolar radiofrequency energy during laparoscopy presents significant risks.
• The prevalence and characteristics of stray energy transfer in robotic surgery remain largely unquantified.
• Robotic surgery's increasing adoption necessitates understanding its unique energy transfer risks.

Purpose of the Study:

• To quantify stray energy transfer associated with robotic surgical instrumentation.
• To identify and evaluate strategies for minimizing stray energy transfer during robotic procedures.
• To compare the extent of stray energy transfer in robotic surgery versus traditional laparoscopy.

Main Methods:

• Utilized a laparoscopic trainer with DaVinci Si robotic instruments, including a monopolar L-hook.
• Simulated a minimally invasive cholecystectomy by inserting a camera and assistant grasper.
• Measured temperature changes near the non-electric tips of robotic instruments adjacent to simulated tissue (saline-soaked sponge) during energy activation.

Main Results:

• Significant temperature increases were observed in simulated tissue near the robotic grasper (18.3°C) and camera (9.0°C).
• Reducing power to 15W or using low-voltage cut mode substantially decreased temperature increases.
• Activating instruments in contact with desiccated tissue, rather than in open air, significantly minimized stray energy transfer.

Conclusions:

• Stray energy transfer is a quantifiable risk in robotic surgery, with the assistant grasper posing the highest thermal injury risk.
• Strategies to mitigate stray energy transfer in robotic surgery include lowering power settings, employing low-voltage cut mode, and ensuring tissue contact.
• These findings provide practical guidance for surgeons to enhance safety and reduce iatrogenic injuries during robotic procedures.