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MRCOG Part 2 Core Surgical Skills > Review of advanced energy devices for the minimal access gynaecologist TOG 2021 > Flashcards

Review of advanced energy devices for the minimal access gynaecologist TOG 2021 Flashcards

1
Q

List as many types of advanced energy devices

A

Advanced bipolar device
Ultrasound device
Hybrid Device
Plasma device
Laser device

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2
Q

What is advance bipolar device?

A

Combine bipolar with integral blade to deliver haemostasis and cutting

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3
Q

Examples of advance bipolar device

A

Ligasure
Enseal
PK cutting forceps
Caiman 5

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4
Q

Advantage advance bipolar device

A

Consistent vessel seal
Haemostasis feedback
Seals up to vessels up to 7mm D
Cut with blade only
Independent coagulation

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5
Q

Disadvantage advance bipolar device

A

2 step cut and coagulation
Less suitable for fine dissection
Greater lateral thermal spread (7mm)

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6
Q

What is a key feature of ABDs is that it can detect impedance? What is impedance? What tissues have high/low impendence?

A

Impedance is the opposition to flow of electrical current.

high impedance e.g. skin & adipose tissues, scarred tissues

Low = muscle, tendon, blood

Can measure impedance to know when seal is complete

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7
Q

How to ensure maximum coagulation with ABD?

A

Ensure no tissues stuck to jaws
Ensure tissue not under tension

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8
Q

With ABD what safe margin should be kept from vital tissue?

A

0.5-1cm (thermal spread 7mm)

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9
Q

Table summarising bio thermal effects at different temperature
37
45-50
60-80
100
>100
>300

A
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10
Q

How to ultrasound devices work?

A

Ultrasound seal and cut vessel without integral blade.

Piezoelectircal transducer converter electrical energy unto USS. Mechanical emergency - vibrates causing hydrogen ro break and proteins converted to coagulu - captive coagulation.

Higher energy - small vapour cavities/tissue distractive - cavitation.

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11
Q

Ultrasound devices can seal vessels up to what diameter?

A

UD seal up to 5mm except Harmonic Ace+ 7 shear - 7mm

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12
Q

Given examples of ultrasound devices

A

Harmonic
Sonicision
Sonicbeat
Lotus

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13
Q

Advantage ultrasound device

A

Fine dissection
Haemostasis feedback
No radio frequency energy
Avoid neuromuscular activation
Reduce surgical plume
Reduced lateral thermal spread vs ABD

Better for complex dissection such as deep infiltrating Endo, ureterolysis, lap myomectomy

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14
Q

Disadvantage ultrasound device

A

Less reliable seal for vessels >5mm in D
Residual heat

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15
Q

How to minimise residual heat

A

Minimise activation time
Use minimal energy
Use irrigation to cool tip
Keep device in view or remove it from port
Wait before manipulating tissue

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16
Q

What is an example of a hybrid energy devices?

A

Thunderbolt

17
Q

How do hybrid energy devices function?

A

Combines ultrasound and bipolar energy.

‘Seal and cut’ both USS and bipolar energy active

‘Seal’ only bipolar used

18
Q

Thunderbeat can seal vessel up to what diameter?

A

7mm

19
Q

Advantages hybrid energy device?

A

Consistent vessel seal
Up yo 7mm D
Fine dissection
Reduced intrstument traffic
Improved efficiency
Haemostatsis feedback

Advance lap surgery, excision deep end, myomectomy

20
Q

Disadvatages hybrid energy device

A

Residual heat

21
Q

How to plasma devices work?

A

Utilise radio frequency to create jet capable of causing superficial haemostats and cutting

22
Q

Examples plasma device

A

PlasmaJet SS
Helical TC
BC

23
Q

Advantage plasma device

A

Precise tissue effect
Minimal LTS (<8mm)
No residual heal
No smoke production

Used for superficial Endometritis, may preserve ovarian function to Tx ovarian endometrioma

24
Q

Disadvantage plasma device

A

Small vessels,s only
Raised intra-abdominal pressure (need to evacuate pneumpperitoneum)
Potential for gas emboli
Limited to superficial tissue effect

25
Q

What can be the effect of elevated intra-abdominal pressure during laparoscopy?

A

Reduced ventilatory capacity and reduced cardiac output

26
Q

How do laser devices work

A

Light Amplification by Stimulated Emission of Radiation

Projects highly concentrated beam of light through the stimulated emission of photons.

No touch technique like PD

27
Q

Examples of laser devices

A

Lumens
Acupulse

28
Q

Advantage laser device

A

Extremely precise tissue effect
Minimal LTS
Minimal tissue penetrance

29
Q

Disadvantage laser device

A

Small vessels only
Inefficienct dissection
Staff training
Optical damage
Implementation cost
Maintenance
Fire hazard
Surgical plume

MRCOG Part 2 Core Surgical Skills (27 decks)

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