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ThermoStapler - thermal spread
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ThermoStapler - thermal spread - 1

POLSKI PRZEGLĄD CHIRURGICZNY 2011, 83, 7, 355–360 10.2478/v10035-011-0056-y O R I G I N A L P A P E R S Comparison of lateral thermal spread using monopolar and bipolar diathermy, and the bipolar vessel sealing system ThermoStaplerTM during thyroidectomy* Jan Brzeziński1, Karolina Kałużna-Markowska2, Maciej Naze1, Grzegorz Stróżyk1, Marek Dedecjus1 Department of General, Oncological and Endocrine Surgery Medical University in Łódź, Polish Mother Memorial Hospital – Research Institute1 Kierownik: prof. dr hab. J. Brzeziński Laser Diagnostics and Therapy Centre of the Technical University in Łódź2 Kierownik: dr n. med. C. Peszyński-Drews Electric devices enabling the maintenance of haemostasis during surgery have found application in modern thyroidectomy procedures. The haemostatic effect is associated with generation of heat, which apart from the intended result may bring about thermal tissue injury. The aim of the study was to determine the thermal spread around the active tip of electric devices in the operating field during total thyroidectomy, and the safe temperature range during the operation of studied devices. Materials and methods. Over 14 months from December 2009 until January 2011, 76 total thyroidectomy procedures were analysed. The surgeries employed mono- and bipolar diathermy as well as the ThermoStapler TM bipolar vessel sealing system. During the procedures, the thermal spread around the active tips of used electric devices was recorded with the use of high-definition camera. Comparable 5-second periods of electric device use at two power ranges (30 W and 50 W) were selected from the recorded material. The highest temperature of the active tip of electric devices was determined, and the 42°C isotherm was found with the use of computer image analysis, thus determining the safe distance of important anatomic structures from the active tip of the electric device. Results. The temperature spread around the active tips of electric devices was recorded and the 42oC isotherm was determined. The diameter of this isotherm at the end of operation differed statistically significantly depending on the type of electric devices and power settings. The highest temperature, at both power ranges, was recorded for the bipolar vessel sealing system, while the lowest – for bipolar diathermy; at the same time a significantly lower 42°C isotherm diameter was found for ThermoStaplerTM as compared with other devices. In all studied cases, the largest heat spread was found for monopolar diathermy. Conclusions. The mean safe distance of the active tip of an electric device from important anatomic structures is 5 mm and depends on the device type and its power settings. Monopolar diathermy causes the strongest heating of surrounding tissues, and the ThermoStaplerTM bipolar vessel sealing system, despite producing the highest temperature during operation, causes relatively small thermal injury to the surrounding tissues. Key words: total thyroidectomy, electrocoagulation, thermography * Study funding: own project (Medical University) No 502-11-421. National Science Centre research project No 1036/B/ P01/2011/40

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ThermoStapler - thermal spread - 2

Reduction of surgical injury with the simul- taneous retention of current safety and radical nature of surgical procedures forces the work in a relatively small operating held. Inconsequence, it becomes necessary to use modern devices en- abling the maintenance of' haemostasis in the small space of operating field (1, 2, 3). Electric devices enabling the achievement of full and lasting haemostasis during total thyroidectomy supplant traditional surgical methods (ligature, haemostatic sutures) with no impact on the incidence of perioperative complications, while at the same time allowing to...

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ThermoStapler - thermal spread - 3

Monopolar, bipolar diathermy, and bipolar vessel sealing system in thyroidectomy Fig. 1. Representative operating field images: a) real image, b) thermovision camera image, c) image post digital processing enabling the isotherm determination In the statistical analysis of obtained re- sults, the Student's t-test was used, with the p < 0.05 being adopted as statistically signifi- The temperatures determined at the tips of electric devices at the end of operation differed statistically significantly depending on the type of the device. The highest temperature, ThermoStapler ™ bipolar vessel...

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ThermoStapler - thermal spread - 4

358 J. Brzeziński et al. Moc 30 W Moc 50 W 90 130 120 85 100 Temperatura [°C] Temperatura [°C] 110 80 75 70 90 80 70 60 65 50 60 4 4,5 5 5,5 40 6 4 4,5 Czas [s] Fig. 3 Moc urządzenia 50 W 3,5 3 2,5 4,5 5 5,5 6 Czas [s] Odległość końcówki od izotermy 42 Odległość końcówki od izotermy 42 [mm] Moc urządzenia 30 W 4 5,5 Fig. 4 4 2 5 Czas [s] 6 5,5 5 4,5 4 3,5 3 4 4,5 5 5,5 Czas [s] Fig. 5 Fig. 6 surgery of electric devices for haemostasis maintenance in the operating field, there is no information on the extent of thermal injury to the surrounding tissues. The presented study is, according to...

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ThermoStapler - thermal spread - 5

Monopolar, bipolar diathermy, and bipolar vessel sealing system in thyroidectomy 359 membranes (by increasing their permeability and rigidity) and the protein denaturation (19), and hence it results in irreversible changes that could be the cause of postoperative com- plications. It should be emphasised that the duration of coagulation is of crucial importance particularly in the area of important ana- tomic structures, since prolonged coagulation time significantly raises the temperature of the active tip of an electric device and could be the cause of thermal injury leading to postop-...

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ThermoStapler - thermal spread - 6

360 J. Brzeziński et al. 14. Humes DJ, Ahmed I et al.: The pedicIe effect and direct coupling: delayed thermal injuries to the bile duct after laparoscopic cholecystectomy. Arch Surg 2010 Jan; 145(1): 96-98. 15. Katsuno G, Nagakari K, Fukunaga M et al.:Comparison oftwo different energy-based vascular sealing systems for the hemostasis of various types of arteries: a porcine model-evaluation of LigaSure ForceTriad™. J Laparoendosc Adv Surg Tech A 2010 Nov; 20(9): 747-51. 16. Landman J, Kerbl K, Rehman J et al.: Evaluation of a vessel sealing system, bipolar electrosurgery, harmonic scalpel,...

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