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The Protective Shield: A Comparative Analysis of Standard Laparoscopic Techniques versus Active Electrode Monitoring
Josh Bilello1, Jacob Larsen1, Daniel Fu1
1Department of Surgery, University of Colorado, Aurora, Colorado.
Introduction:
Achieving hemostasis through the use of surgical energy is essential in nearly all laparoscopic cases. During laparoscopic surgery, radiofrequency energy can transfer to nearby instruments resulting in patient burns via capacitive coupling. More than one-third of energy instruments have a defect in the insulation, which can result in unintentional burns in patients and has also resulted in patient death. Previous studies have shown that severe tissue damage and necrosis can occur at temperatures as low as 60°C. Active electrode monitoring (AEM) is a new emerging technology that may reduce the risk of stray energy injuries during laparoscopic surgery. These devices consist of a conductive metal tube that acts as a protective shield around a laparoscopic instrument, minimizing the impact of a potential insulation layer defect. Few studies have evaluated the efficacy of AEM in reducing stray energy injuries due to laparoscopic insulation defects. This study aims to compare thermal injury in bovine intestine tissue both with and without AEM in a benchtop model of laparoscopic insulation failure.
Methods:
Radiofrequency energy (Joules) was delivered to a standard, monopolar, L-hook and an AEM L-hook at 30 W in coagulation mode via the most commonly used electrosurgical generator for 3 s. An insulation defect was created in the shaft of both instruments, and the change in tissue temperature from baseline was recorded with a thermal camera. Statistical significance was set at P < 0.05.
Results:
After an insulation defect had been made, the AEM energy device minimally changed tissue temperatures compared to the standard L-hook at 30 W in coagulation mode (23.93°C ± 0.79 versus 148.85°C ± 1.62, P < 0.0001). Additionally, significantly less energy was transferred with the AEM L-hook compared to the standard L-hook despite similar insulation defects (17.31 J ± 0.49 versus 43.66 J ± 1.89, P < 0.0004).
Conclusions:
AEM aims to minimize stray energy in laparoscopic instruments, preventing patient burns from energy devices. In this benchtop study of standard, laparoscopic energy instruments with insulation defects, AEM eliminated stray energy transfer from the device to tissue. AEM should be considered when performing any laparoscopic surgery that requires monopolar energy to reduce the risk of stray energy burns and patient complications.
