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Stray energy transfer in single-incision robotic surgery
Krzysztof J Wikiel1,2, Douglas M Overbey3,4, Heather Carmichael3
1Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA. Krzysztof.Wikiel@CUAnschutz.edu.
Surgical Endoscopy
|June 28, 2020
Summary
Single-incision robotic surgery (SIRS) transfers more stray energy than traditional robotic surgery (TRS). Using a constant voltage regulating generator significantly minimizes stray energy transfer in both surgical approaches.
Area of Science:
- Surgical Technology
- Minimally Invasive Surgery
- Biomedical Engineering
Background:
- Stray energy from monopolar radiofrequency instruments can cause unintended thermal injuries during laparoscopic surgery.
- Single-incision laparoscopic surgery (SILS) poses a higher risk of stray energy transfer compared to traditional laparoscopic surgery.
- Limited data exists on stray energy transfer during single-incision robotic surgery (SIRS).
Purpose of the Study:
- To quantify and compare stray energy transfer during traditional multiport robotic surgery (TRS) and single-incision robotic surgery (SIRS).
- To evaluate the impact of power settings and generator type on stray energy transfer in robotic surgery.
Main Methods:
- A porcine model simulating cholecystectomy was used for both TRS and SIRS setups.
- Monopolar scissors were activated at varying power settings (30W and 60W coag mode; Swift Coag effect 3, max 180W).
- Tissue temperature adjacent to surgical instruments was measured using a thermal camera to quantify stray energy transfer.
Main Results:
- SIRS exhibited greater stray energy transfer at the assistant grasper compared to TRS (11.6°C vs. 8.4°C).
- Reducing power from 60W to 30W significantly decreased stray energy transfer in SIRS but not significantly in TRS.
- A constant voltage regulating generator minimized stray energy transfer in both SIRS and TRS (0.7°C).
Conclusions:
- Single-incision robotic surgery involves greater stray energy transfer than multiport robotic surgery.
- Constant voltage regulating generators effectively minimize stray energy transfer in both surgical configurations.
- Findings provide guidance for robotic surgeons to ensure safe surgical energy utilization.
