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Background This study presents a post-operative energy dashboard to teach surgeons about electrosurgical device use. By analyzing the energy generator, we aim to add new information to the current assessment of surgical skills. This study evaluated how such a dashboard can provide insight into differences in electrosurgery application. Methods A semi-automated methodology for the energy dashboard was developed by acquiring intra-operative energy generator and video data, and computing metrics to compare device use. The energy dashboard quantified the use of the electrosurgical device based on the number of activations (N), the duration of individual activations (s), the total use time (s), and the total applied energy (kJ). The methodology and differences in device use were assessed based on forty-eight fundoplication surgeries performed by three surgeons. Results The methodology identified the device activations with an F1-score of 0.95. The comparison between the surgeons showed significant differences in total usage, turn-on count, and amount of applied energy. In addition, the dashboard showed a significant difference in total applied energy (kJ) over the dissections of the gastrohepatic and gastrosplenic ligament. Conclusion The study showed that energy monitoring can provide insights into application differences. In addition, the pilot study showed that the use of electrosurgical devices can differ significantly between surgeons. A broader application of the energy dashboard can enable a new source of information for surgical skill assessment.

Objective Through the investigation of the current situation of bladder cancer secondary electrotomy performed by urologists in China, it provides reference for further improvement and improvement of diagnosis and treatment norms. Methods From September 3, 2023 to October 7, 2023, questionnaires compiled by researchers were distributed and collected from urologists across the country in the form of electronic questionnaires through the questionnaire Star platform; The questionnaire data were exported online using SPSS 26.0 software (SPSS Inc, Chicago, IL, USA) and R language (R Foundation for Statistical Computing, Vienna, Austria, Austria). Version 4.2.1) for data analysis. Count data were described by percentages, and comparisons between groups were made by chi-square test or Fisher’s exact test. Logistic regression was used to screen out the influencing factors related to the status of secondary electrotomy for bladder cancer performed by Chinese urologists and to construct a predictive model for the column-line diagram. ROC curves, calibration curves, and DCA curves were plotted to evaluate the model and validate its efficacy. Results A total of 514 valid questionnaires were returned. 77.2% (397/514) of the physicians interviewed were from tertiary care hospitals. 21.2% (109/514) were from secondary care hospitals. The acceptance rate of secondary electrosurgical resection of bladder cancer among Chinese urologists was 87.74%, with 12.26% still opposed to the procedure.The majority of respondents believed that secondary electroresection could be performed if the indications recommended by the guidelines were met (75%), while a significant number felt that the initial electroresection was complete and did not require a second (37.74%), or they decided whether to perform a secondary electroresection based on their clinical experience (40.27%). Conclusion Survey results indicate that secondary transurethral resection enhances staging accuracy, eliminates residual lesions, and decreases recurrence and progression rates. However, it serves as a means to compensate for shortcomings in the initial resection. Advances in NMIBC treatment techniques assist in reducing or avoiding the need for secondary transurethral resection in bladder cancer cases. This study is the first to develop a predictive model for Chinese urologists’ acceptance of secondary transurethral resection for bladder cancer and analyzes their perspectives on the procedure, offering a reference for future research.

Objective To evaluate the efficacy and security of ERBE BiClamp ® forceps in radical abdominal hysterectomy for managing those cervical cancers, extending to other gynecologic cancers such as endometrial cancer and ovarian cancer as well. Methods A retrospective cohort study was made in 391 cases from 450 FIGO IA2-IIB cervical cancers between November 2005 and September 2010. After baseline character analysis, the conventional group ( n  = 195) was compared with the BiClamp group ( n  = 196) on the basis of surgical outcome and complications. Data analysis was based on intention to treat with statistics software SPSS17.0. Results Comparison between conventional suture ligation and BiClamp ® forceps is as follows: the operation time was 247.7 ± 47.7 min for the conventional suture ligation versus 224.1 ± 36.2 min ( P  < 0.001) for BiClamp ® forceps, estimated blood loss was 769.2 ± 310.4 ml versus 534.8 ± 232.5 ml ( P  < 0.001), gauze consumption was 35.3 ± 10.6 sheets versus 28.2 ± 7.4 sheets ( P  < 0.001), intra-operative blood transfusion rate was 75.9 versus 28.1% ( P  < 0.001), hemoglobin decline was 29.2 ± 10.1 g/L versus 26.5 ± 9.2 g/L ( P  = 0.085), postoperative blood transfusion rate was 17.0 versus 15.6% ( P  = 0.818), closed suction drainage was 268.8 ± 162.0 ml versus 208.3 ± 141.7 ml ( P  < 0.001), hospital stay was 8.8 ± 2.5 days versus 7.1 ± 2.2 days ( P  < 0.001), postoperative complications was 23.6 versus 14.8% ( P  = 0.027). Conclusion With obvious decrease of operation time, blood loss, postoperative complications, hospital stay and particularly, intra-operative blood transfusion rate, BiClamp ® forceps has been proved more efficient and controllable in radical abdominal hysterectomies of cervical cancers than conventional suture ligations, extending to endometrial cancers and ovarian cancers, hence deserves to be popularized.

Aim: To summarize data for cervical loop electrosurgical excision procedures (LEEP) in Israel from 2001 to 2007 inclusive. Methods: 16 colposcopy specialists in Israel completed yearly questionnaires that assessed their LEEP. Results: Of the 2,681 LEEP reported, cervical intraepithelial neoplasia 2/3 (CIN 2/3) and CIN 1 were the main indications, with 63.2 and 20.5%, respectively. CIN 2/3 was detected in 111 (20.4%) of those for whom CIN 1 was the indication for LEEP. Of those diagnosed with CIN 2/3 following LEEP, 34.8% (426/1,225) were in the 18- to 34-year age range. The agreement between punch and LEEP biopsies was 80.15% and the ĸ value was 0.536 (moderate agreement). Complications included severe bleeding in 3.02% during the procedure(s) and 2.99% in the 3 weeks following LEEP. Conclusions: In one-fifth of the women for whom CIN 1 was the indication for LEEP, CIN 2/3 was the final diagnosis. More than one-third of the cases of CIN 2/3 and carcinoma were diagnosed in women under the age of 35, the age at which Pap screening is offered in Israel. Based on these findings, the Israeli Society of Cervical Pathology and Colposcopy prepared guidelines for the treatment of CIN.

Background and Objectives: Surgical smoke generated by energy devices during surgery contains hazardous substances and poses health risks to staff in the operating room. Exposure to surgical smoke must be reduced to minimize the risk of health hazards. Many studies have evaluated surgical smoke qualitatively, but few have performed quantitative assessment. The aim of this study was to quantify the number of particles generated during various breast surgery procedures. Materials and Methods: In this prospective, randomized study, breast surgeries performed at Tokyo Medical and Dental University Hospital (the present Institute of Science Tokyo Hospital) between December 2022 and August 2023 were randomly assigned to two groups: the electrosurgical device group and the electrosurgical device with smoke evacuator group. The number of particles generated by energy devices during surgery was measured using a particle counter. Results: Surgical smoke was generated in all procedures. The number of measured particles was significantly less in the electrosurgical device with smoke evacuator group than in the electrosurgical device group during all procedures (all p < 0.001). Conclusions: All breast surgery procedures produced a significant amount of surgical smoke, which was effectively reduced by using an electrosurgical device with a smoke evacuator. These findings support the routine use of smoke evacuators in breast surgery to reduce occupational exposure to hazardous particles. Implementation of such devices could improve operating room safety and may inform future guidelines and institutional policies regarding surgical smoke management.

Background The quality of oral cancer resection is extremely important for patient outcomes, such as local control and survival. However, most current simulators either provide only rater-dependent feedback or are not compatible with electrosurgery. Therefore, we developed an electrosurgical simulation task for oral cancer resection that provides objective quantitative metrics and collected initial validity evidence. Methods We developed a soft tissue simulation task using a plant-derived model that supports electrosurgery. As quantitative measures demonstrating “ensuring appropriate margins” in oral cancer resection and “maintaining safety” during electrosurgery, we employed nine-directional margin error distance and tumor bed carbonization degree measured using a spectral colorimeter. As validity evidence of the task, 10 expert surgeons completed a questionnaire about the task. In addition, five experts and 12 novices performed the task, and quantitative data obtained from their performance was used for evaluation. Results The replication of oral cancer resection was highly evaluated (4.4 out of 5 points), and quantitative measures for evaluating the skills of surgeons (4.8 out of 5 points) were agreed upon by experts. The internal consistency of the measures was good (Cronbach's alpha: 0.803). Compared to novices, experts had smaller margin errors (0.79 mm vs 2.45 mm), lower carbonization (ΔE: 2.33 vs 8.70), faster resection times, and fewer grasping attempts (all P  < 0.001). Conclusion This user-friendly plant-derived simulation task is compatible with electrosurgery and provides objective quantitative performance metrics. These findings support its use as a practical assessment tool for formative feedback in simulation-based training.

BackgroundThere is much heterogeneity in the instrumentation used for parenchymal transection in minimally invasive liver surgery. Instruments specifically designed for robotic parenchymal transection of the liver are lacking. We aim to gain insight into the safety and effectiveness of the SynchroSeal (Intuitive Surgical, Inc., Sunnyvale, CA), a novel bipolar electrosurgical device, in the context of liver surgery.MethodsThe present study is a post-hoc analysis of prospectively collected data from patients undergoing robotic liver resection (RLR) using the SynchroSeal in two high-volume centres. The results of the SynchroSeal were compared with that of the previous generation bipolar-sealer; Vessel Sealer Extend (Intuitive Surgical, Inc., Sunnyvale, CA) using propensity score matching, after excluding the first 25 Vessel Sealer procedures per center.ResultsDuring the study period (February 2020–March 2023), 155 RLRs meeting the eligibility criteria were performed with the SynchroSeal (after implementation in June 2021) and 145 RLRs with the Vessel Sealer. Excellent outcomes were achieved when performing parenchymal transection with the SynchroSeal; low conversion rate (n = 1, 0.6%), small amounts of intraoperative blood loss (median 40 mL [IQR 10–100]), short hospital stays (median 3 days [IQR 2–4]), and adequate overall morbidity (19.4%) as well as severe morbidity (11.0%). In a matched comparison (n = 94 vs n = 94), the SynchroSeal was associated with less intraoperative blood loss (48 mL [IQR 10–143] vs 95 mL [IQR 30–200], p = 0.032) compared to the Vessel Sealer. Other perioperative outcomes were similar between the devices.ConclusionThe SynchroSeal is a safe and effective device for robotic liver parenchymal transection.

Purpose The aim of this study is to analyze a quality assurance program regarding the switch from loop electrosurgical excision procedure (LEEP) in general anesthesia (GA) to local anesthesia (LA) regarding patients’ perioperative pain levels, patients´ satisfaction, as well as resection margins. Methods We performed a single-center retrospective analysis of our quality assurance program including all patients undergoing LEEP at the Department of Obstetrics and Gynecology, Ordensklinikum Linz and Konventhospital Barmherzige Brueder Linz, from January 2021 to June 2024. 435 patients were questioned postoperatively after being treated with LEEP in LA regarding the perioperative pain as measured by a numeric rating scale (NRS) and patients’ satisfaction. Clinical data were collected from the patients’ electronic chart to investigate further parameters. Results Mean perioperative pain levels were stated as 1.3 (1.9). Five perioperative complications were reported. In seven out of 435 cases (1.6%) an inpatient readmission or a revision surgery under GA had to be performed. A R0 resection rate of 81.4% could be achieved. In 9.7% and 8.3% a R1 resection rate was reported on the ectocervix and on the endocervix, respectively. 95.3% of patients would choose LEEP in LA as their preferred method of anesthesia for a possible subsequent surgical LEEP procedure. Conclusions Our study showed that the implementation of LEEP in LA was successful at our department as a new standard of care, resulting in a high R0 resection status and a high level of patients’ satisfaction. We encourage physicians and organizations to switch from GA to LA when performing LEEP for cervical dysplasia.

Purpose To compare conventional bipolar electrosurgery with advanced bipolar vessel sealing (ABVS) devices for total laparoscopic hysterectomy (TLH). Methods A systematic review was conducted by searching Scopus, PubMed/MEDLINE, ScienceDirect, and Cochrane Library from January 1989 to November 2021. We identified all studies comparing ABVS devices with conventional bipolar electrosurgery in TLH and reporting at least one of the following outcomes: total blood loss, total operative time, hospital stay, perioperative complications, or costs. Meta-analysis was conducted with a random effect model reporting pooled mean differences and odds ratios (ORs) with related 95% confidence intervals (CIs). Results Two randomized controlled trials and two retrospective studies encompassing 314 patients were included out of 615 manuscripts. The pooled estimated total blood loss in the ABVS devices group was lower than conventional bipolar electrosurgery of 39 mL (95% CI − 65.8 to − 12.6 mL; p  = .004). The use of ABVS devices significantly reduced the total operative time by 8 min (95% CI − 16.7 to − 0.8 min; p  = .033). Hospital stay length did not differ between the two groups, and a comparable overall surgical complication rate was observed [OR of 0.9 (95% CI 0.256 – 3.200; p  = .878]. Conclusions High-quality evidence comparing ABVS devices with conventional bipolar electrosurgery for TLH is lacking. ABVS devices were associated with reduced total blood loss and operative time; however, observed differences seem clinically irrelevant. Further research is required to clarify the advantages of ABVS devices over conventional bipolar electrosurgery and to identify cases that may benefit more from their use.

Background The use of electrosurgery has expanded to a wide variety of surgical specialities, but it has also been accompanied by its share of complications, including thermal injuries to nontargeted tissues, caused by a break or defect in the insulation of the instrument’s coat. The purpose of this study was to determine the prevalence and the location of insulation failures (IFs) in electrosurgical instruments, then to assess the necessity of routine IF testing. Methods Electrosurgical instruments were visually inspected and checked for IF using a high-voltage detector. Two different detectors were used during two testing sessions: DTU-6 (Petel company) and DIATEG (Morgate company). Laparoscopic and non-laparoscopic instruments were determined to have IF if current crossed the instrument’s insulation, signaled by an alarm sound. Results A total of 489 instruments were tested. The overall prevalence of IFs was 24.1 % with only visual inspection and 37.2 % with the IF detector. Among the 489 instruments, 13.1 % were visually intact, but had an electric test failure. DTU-6 and DIATEG detectors showed comparable efficiency in detection of overall IFs and for laparoscopic and non-laparoscopic instruments. The median location of IFs was more pronounced for laparoscopic instruments (50.4 %) and the distal location for non-laparoscopic instruments (40.4 %). Conclusion Accidental burns are a hidden problem and can lead to patient complications. In Central Sterilization Service Department, prevention currently includes only visual control of electrosurgery instrumentation, but testing campaigns are now necessary in order to identify maximum instruments’ defects.