Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA.
Rocky Mountain Regional Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA.
Surg Endosc. 2021 Jun;35(6):2981-2985. doi: 10.1007/s00464-020-07742-x. Epub 2020 Jun 26.
Stray energy transfer from surgical monopolar radiofrequency energy instruments can cause unintended thermal injuries during laparoscopic surgery. Single-incision laparoscopic surgery transfers more stray energy than traditional laparoscopic surgery. There is paucity of published data concerning stray energy during single-incision robotic surgery. The purpose of this study was to quantify stray energy transfer during traditional, multiport robotic surgery (TRS) compared to single-incision robotic surgery (SIRS).
An in vivo porcine model was used to simulate a multiport or single-incision robotic cholecystectomy (DaVinci Si, Intuitive Surgical, Sunnyvale, CA). A 5 s, open air activation of the monopolar scissors was done on 30 W and 60 W coag mode (ForceTriad, Covidien-Medtronic, Boulder, CO) and Swift Coag effect 3, max power 180 W (VIO 300D, ERBE USA, Marietta, GA). Temperature of the tissue (°C) adjacent to the tip of the assistant grasper or the camera was measured with a thermal camera (E95, FLIR Systems, Wilsonville, OR) to quantify stray energy transfer.
Stray energy transfer was greater in the SIRS setup compared to TRS setup at the assistant grasper (11.6 ± 3.3 °C vs. 8.4 ± 1.6 °C, p = 0.013). Reducing power from 60 to 30 W significantly reduced stray energy transfer in SIRS (15.3 ± 3.4 °C vs. 11.6 ± 3.3 °C, p = 0.023), but not significantly for TRS (9.4 ± 2.5 °C vs. 8.4 ± 1.6 °C, p = 0.278). The use of a constant voltage regulating generator also minimized stray energy transfer for both SIRS (0.7 ± 0.4 °C, p < 0.001) and TRS (0.7 ± 0.4 °C, p < 0.001).
More stray energy transfer occurs during single-incision robotic surgery than multiport robotic surgery. Utilizing a constant voltage regulating generator minimized stray energy transfer for both setups. These data can be used to guide robotic surgeons in their use of safe, surgical energy.
手术单极射频能量仪器的杂散能量转移可能导致腹腔镜手术期间意外的热损伤。单切口腹腔镜手术比传统腹腔镜手术转移更多的杂散能量。关于单切口机器人手术期间杂散能量的数据很少。本研究的目的是量化传统多端口机器人手术（TRS）与单切口机器人手术（SIRS）相比杂散能量转移。
使用体内猪模型模拟多端口或单切口机器人胆囊切除术（达芬奇 Si，直觉外科公司，加利福尼亚州森尼韦尔）。在 30 W 和 60 W 凝血模式（ForceTriad，Covidien-Medtronic，博尔德，科罗拉多州）和 Swift Coag 效应 3、最大功率 180 W（VIO 300D，ERBE USA，玛丽埃塔，佐治亚州）下，对单极剪刀进行 5 秒的开放式空气激活。使用热像仪（E95，FLIR Systems，威尔逊维尔，俄勒冈州）测量靠近助手夹具或相机尖端的组织温度（°C），以量化杂散能量转移。
在助手夹具处，SIRS 装置的杂散能量转移明显大于 TRS 装置（11.6±3.3°C 与 8.4±1.6°C，p=0.013）。将功率从 60 W 降低到 30 W 可显著降低 SIRS 中的杂散能量转移（15.3±3.4°C 与 11.6±3.3°C，p=0.023），但对 TRS 影响不大（9.4±2.5°C 与 8.4±1.6°C，p=0.278）。使用恒压调节发电机也可最大程度地减少 SIRS（0.7±0.4°C，p<0.001）和 TRS（0.7±0.4°C，p<0.001）中的杂散能量转移。
单切口机器人手术中的杂散能量转移比多端口机器人手术多。使用恒压调节发电机可最大程度地减少两种设置的杂散能量转移。这些数据可用于指导机器人外科医生安全使用手术能量。
