Review of advanced energy devices for the minimal access gynaecologist TOG 2021 Flashcards
List as many types of advanced energy devices
Advanced bipolar device
Ultrasound device
Hybrid Device
Plasma device
Laser device
What is advance bipolar device?
Combine bipolar with integral blade to deliver haemostasis and cutting
Examples of advance bipolar device
Ligasure
Enseal
PK cutting forceps
Caiman 5
Advantage advance bipolar device
Consistent vessel seal
Haemostasis feedback
Seals up to vessels up to 7mm D
Cut with blade only
Independent coagulation
Disadvantage advance bipolar device
2 step cut and coagulation
Less suitable for fine dissection
Greater lateral thermal spread (7mm)
What is a key feature of ABDs is that it can detect impedance? What is impedance? What tissues have high/low impendence?
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
How to ensure maximum coagulation with ABD?
Ensure no tissues stuck to jaws
Ensure tissue not under tension
With ABD what safe margin should be kept from vital tissue?
0.5-1cm (thermal spread 7mm)
Table summarising bio thermal effects at different temperature
37
45-50
60-80
100
>100
>300
How to ultrasound devices work?
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.
Ultrasound devices can seal vessels up to what diameter?
UD seal up to 5mm except Harmonic Ace+ 7 shear - 7mm
Given examples of ultrasound devices
Harmonic
Sonicision
Sonicbeat
Lotus
Advantage ultrasound device
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
Disadvantage ultrasound device
Less reliable seal for vessels >5mm in D
Residual heat
How to minimise residual heat
Minimise activation time
Use minimal energy
Use irrigation to cool tip
Keep device in view or remove it from port
Wait before manipulating tissue
What is an example of a hybrid energy devices?
Thunderbolt
How do hybrid energy devices function?
Combines ultrasound and bipolar energy.
‘Seal and cut’ both USS and bipolar energy active
‘Seal’ only bipolar used
Thunderbeat can seal vessel up to what diameter?
7mm
Advantages hybrid energy device?
Consistent vessel seal
Up yo 7mm D
Fine dissection
Reduced intrstument traffic
Improved efficiency
Haemostatsis feedback
Advance lap surgery, excision deep end, myomectomy
Disadvatages hybrid energy device
Residual heat
How to plasma devices work?
Utilise radio frequency to create jet capable of causing superficial haemostats and cutting
Examples plasma device
PlasmaJet SS
Helical TC
BC
Advantage plasma device
Precise tissue effect
Minimal LTS (<8mm)
No residual heal
No smoke production
Used for superficial Endometritis, may preserve ovarian function to Tx ovarian endometrioma
Disadvantage plasma device
Small vessels,s only
Raised intra-abdominal pressure (need to evacuate pneumpperitoneum)
Potential for gas emboli
Limited to superficial tissue effect
What can be the effect of elevated intra-abdominal pressure during laparoscopy?
Reduced ventilatory capacity and reduced cardiac output
How do laser devices work
Light Amplification by Stimulated Emission of Radiation
Projects highly concentrated beam of light through the stimulated emission of photons.
No touch technique like PD
Examples of laser devices
Lumens
Acupulse
Advantage laser device
Extremely precise tissue effect
Minimal LTS
Minimal tissue penetrance
Disadvantage laser device
Small vessels only
Inefficienct dissection
Staff training
Optical damage
Implementation cost
Maintenance
Fire hazard
Surgical plume
