Department of Surgery, Duke University, Durham, NC, USA.
Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA.
Surg Endosc. 2021 May;35(5):2084-2090. doi: 10.1007/s00464-020-07605-5. Epub 2020 May 8.
Stray energy transfer from monopolar radiofrequency energy during laparoscopy can be potentially catastrophic. Robotic surgery is increasing in popularity; however, the risk of stray energy transfer during robotic surgery is unknown. The purpose of this study was to (1) quantify stray energy transfer using robotic instrumentation, (2) determine strategies to minimize the transfer of energy, and (3) compare robotic stray energy transfer to laparoscopy.
In a laparoscopic trainer, a monopolar instrument (L-hook) was activated with DaVinci Si (Intuitive, Sunnyvale, CA) robotic instruments. A camera and assistant grasper were inserted to mimic a minimally invasive cholecystectomy. During activation of the L-hook, the non-electric tips of the camera and grasper were placed adjacent to simulated tissue (saline-soaked sponge). The primary outcome was change in temperature from baseline (°C) measured nearest the tip of the non-electric instrument.
Simulated tissue nearest the robotic grasper increased an average of 18.3 ± 5.8 °C; p < 0.001 from baseline. Tissue nearest the robotic camera tip increased (9.0 ± 2.1 °C; p < 0.001). Decreasing the power from 30 to 15 W (18.3 ± 5.8 vs. 2.6 ± 2.7 °C, p < 0.001) or using low-voltage cut mode (18.3 ± 5.8 vs. 3.1 ± 2.1 °C, p < 0.001) reduced stray energy transfer to the robotic grasper. Desiccating tissue, in contrast to open air activation, also significantly reduced stray energy transfer for the grasper (18.3 ± 5.8 vs. 0.15 ± 0.21 °C, p < 0.001) and camera (9.0 ± 2.1 vs. 0.24 ± 0.34 °C, p < 0.001).
Stray energy transfer occurs during robotic surgery. The assistant grasper carries the highest risk for thermal injury. Similar to laparoscopy, stray energy transfer can be reduced by lowering the power setting, utilizing a low-voltage cut mode instead of coagulation mode and avoiding open air activation. These practical findings can aid surgeons performing robotic surgery to reduce injuries from stray energy.
在腹腔镜手术中，来自单极射频能量的杂散能量转移可能是灾难性的。机器人手术越来越受欢迎；然而，机器人手术过程中杂散能量转移的风险尚不清楚。本研究的目的是：(1)使用机器人器械量化杂散能量转移，(2)确定将能量转移最小化的策略，以及 (3)比较机器人杂散能量转移与腹腔镜手术。
在腹腔镜训练器中，使用达芬奇 Si（直觉，加利福尼亚州森尼韦尔）机器人器械激活单极器械（L 钩）。插入摄像头和助手夹具模拟微创胆囊切除术。在激活 L 钩时，将摄像头和夹具的非电尖端放置在模拟组织（盐水浸泡的海绵）附近。主要结果是测量非电仪器尖端附近的基线温度（°C）的变化。
模拟组织最接近机器人抓握器增加了 18.3 ± 5.8°C;p < 0.001 从基线开始。接近机器人摄像头尖端的组织增加了 9.0 ± 2.1°C;p < 0.001）。将功率从 30 瓦降低到 15 瓦（18.3 ± 5.8 对 2.6 ± 2.7°C;p < 0.001）或使用低电压切割模式（18.3 ± 5.8 对 3.1 ± 2.1°C;p < 0.001）可减少对机器人抓握器的杂散能量转移。与开放空气激活相比，干燥组织也显著减少了抓握器的杂散能量转移（18.3 ± 5.8 对 0.15 ± 0.21°C;p < 0.001）和摄像头（9.0 ± 2.1 对 0.24 ± 0.34°C;p < 0.001）。
在机器人手术过程中会发生杂散能量转移。助手夹具具有最高的热损伤风险。与腹腔镜手术类似，降低功率设置、使用低电压切割模式而不是凝血模式以及避免开放空气激活都可以减少杂散能量转移。这些实际发现可以帮助进行机器人手术的外科医生减少杂散能量造成的伤害。
