Repeated partial tissue bite with inadequate cooling time for an energy device may cause thermal injury

Over the past three decades, the use of ultrasonically activated device (USAD) and advanced bipolar device (ABD) has grown in minimally invasive surgeries. However, the thermal profile differences during repeated dissection with different grasping ranges of energy devices, which provide valuable information for preventing thermal injury by energy devices, remain unclear.

We developed an ex vivo benchtop model to examine the temperature profile of the blade and jaws of two USADs (HARMONIC® ACE + and Sonicision™) and a ABD (Ligasure™ Maryland) with different grasping ranges (partial tissue and full tissue bite) in repeated dissection with minimum cooling time. The maximum temperature, time required for completion to dissection of 10 cm of porcine muscle, thermal spread, and cooling time to reach 60 °C were continuously measured using video thermography. In addition, to evaluate one more grasping range "no tissue", we performed a stress test that activated the USAD without tissue intervention to assess the effects of excessive load on the blade and jaw.

Repeated dissection of energy devices with minimal cooling time results in high blade and jaw temperatures proportional to the incision distance. In particular, the USADs with partial tissue bite showed a significantly higher temperatures at the blade and jaw, longer cooling times, and higher lateral thermal spread than those with a full tissue bite and the ABD. The stress test with a USAD showed an extremely high blade temperature exceeding 400 °C, with the tissue pad melting only 13.2 s after activation.

Although USAD with partial tissue bite help ensure precise dissection, repeated long activation with inadequate cooling time may increase the risk of thermal injury during surgery. These results suggest that surgeons should use energy devices properly while understanding the risks of adjacent organ damage that could result from abuse of the device.