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Background Thermal damage during surgical procedures is a critical factor influencing patient safety and outcomes, particularly in minimally invasive laparoscopic surgeries. Advanced robotic-assisted surgical systems, such as the Anovo ® Surgical System, incorporate monopolar electrosurgical tools designed to optimize precision while minimizing collateral tissue damage. This study evaluates the thermal effects of the Anovo ® Hook Electrode and Curved Scissors compared to conventional off-the-shelf (OTS) tools. Methods An ex vivo study was conducted using 288 tissue samples from a swine model, including liver, kidney, and muscle tissues. Thermal effects during monopolar cutting and coagulation were evaluated at three power settings (low, medium, high) and durations (5, 10, 15 s). Histological analysis was performed on all samples to assess coagulation necrosis and thermal spread. Statistical equivalence testing was applied to compare the Anovo ® devices with OTS tools. Results The Anovo ® devices achieved precise and consistent thermal effects, meeting equivalence criteria in 97.57% of samples. Histological analysis confirmed well-defined coagulation zones with no unintended necrosis beyond the treated areas. Thermal spread increased proportionally with power settings and activation durations, but remained within clinically acceptable limits. The Anovo ® devices demonstrated performance comparable to, and occasionally superior to, OTS tools. Conclusion The Anovo ® Hook Electrode and Curved Scissors provide safe and effective monopolar electrosurgical performance with precise thermal effects. These findings support their use in robotic-assisted laparoscopic surgeries and highlight their potential to enhance surgical precision and patient outcomes.

Background Monopolar energy (ME) is routinely used in appendectomy. This study aimed to investigate the degree of lateral thermal spread generated by ME and to evaluate the thermal injury sustained by the close-lying tissues. Methods Appendectomy with a monopolar Maryland dissector was performed in 8 rabbits (at 30 and 60 W power settings). A high-resolution infrared camera was used to record tissue heating during the intervention. After autopsy macroscopic changes were evaluated and tissue samples were subjected to myeloperoxidase (MPO) assay and histological examination. Results No significant differences in the extent of thermal spread, MPO activity and histological signs of inflammation were observed between groups. Regardless of the power settings, the heat spread exceeded 2 cm laterally along the mesoappendix when application time exceeded 3 s. The spread of heat through tubular structures in both groups caused a significant temperature rise in the nearby intestinal loop, resulting in perforation ( n  = 3) and necrosis ( n  = 1). Conclusions Application time is critical in thermal spread during appendectomy aided by ME. Tubular anatomic structures can enhance thermal injury on distant tissues. The observed effects of ME bear clinical relevance that need further investigation.

Background Minimally invasive surgery is performed using an endoscope and other instruments including the electrosurgical units. However, concerns including surgical smoke, tissue sticking and thermal injury are remaining in electrosurgery. Aims Accordingly, a newly developed electrosurgical electrode coating with hydrogenated Cu-incorporated diamond-like carbon (DLC-Cu) film is purposed to improve the instrument performance. Methods The morphologies of DLC-Cu surfaces were characterized using transmission electron microscopy, scanning electron microscopy and atomic force microscopy. In this study, lesions were made on the liver lobes of adult rats, using a monopolar electrosurgical unit equipped with untreated stainless steel electrodes or treated-electrodes. Animals were killed for evaluations at 0, 3, 7 and 28 days postoperatively. Results Treated-electrodes generate less sticking tissues and adhesive blood cells. Thermography revealed that the surgical temperature in liver tissue from the treated-electrode was significantly lower than the untreated-electrode. Total injury area of livers treated with treated-electrodes was significantly smaller than the untreated-electrodes treatment. Moreover, treated-electrodes caused a relatively smaller area of lateral thermal injury, a smaller area of fibrotic tissue and a faster process of remodeling than the untreated-electrodes. Western blot analysis showed that rats treated with treated-electrode expressed lower levels of NF-κB, caspase-3 and MMP-9 than untreated-electrode. Immunofluorescence staining for caspase-3 revealed that the untreated-electrode caused more serious injury. Conclusions This study reveals that the plating of electrodes with hydrogenated Cu-incorporated diamond-like carbon film is an efficient method for improving the performance of electrosurgical units, and should benefit wound remodeling. However, more tests must be carried out to confirm these promising findings in human patients.

Background Electrosurgery is used in virtually every laparoscopic operation. In the early days of laparoscopic surgery, capacitive coupling, associated with hybrid trocars, was thought to be the major cause of laparoscopic electrosurgery injuries. Modern laparoscopy has reduced capacitive coupling, and now insulation failure is thought to be the main cause of electrosurgical complications. The aim of this study was (1) to determine the incidence of insulation failures, (2) to compare the incidence of insulation failure in reusable and disposable instruments, and (3) to determine the location of insulation failures. Methods At four major urban hospitals, reusable laparoscopic instruments were checked for insulation failure using a high-voltage porosity detector. Disposable L-hooks were collected following laparoscopic cholecystectomy and similarly evaluated for insulation failure. Instruments were determined to have insulation failure if 2.5 kV crossed the instrument’s insulation to create a closed loop circuit. Statistical analysis was performed using Fisher’s exact or χ 2 analysis (*denotes significance set at p  < 0.05). Results Two hundred twenty-six laparoscopic instruments were tested (165 reusable). Insulation failure occurred more often in reusable (19%; 31/165) than in disposable instruments (3%; 2/61; * p  < 0.01). When reusable sets were evaluated, 71% (12/17) were found to have at least one instrument with insulation failure. Insulation failure incidence in reusable instruments was similar between hospitals that routinely checked for insulation failure (19%; 25/130) and hospitals that do not routinely check for insulation failures (33%; 7/21; p  = 0.16). Insulation failure was most common in the distal third of the instruments (54%; 25/46) compared to the middle or proximal third of the instruments (* p  < 0.05). Conclusion One in five reusable laparoscopic instruments has insulation failure; a finding that is not altered by whether the hospital routinely checks for insulation defects. Disposable instruments have a lower incidence of insulation failure. The distal third of laparoscopic instruments is the most common site of insulation failure.

Technology is constantly changing, and it is important for perioperative nurses to stay current on new products and technologies in the perioperative setting. AORN's “Recommended practices for electrosurgery” addresses safety standards that all perioperative personnel should follow to minimize risks to both patients and staff members during the use of electrosurgical devices. Recommendations include how to select electrosurgical units and accessories for purchase, how to minimize the potential for patient and staff member injuries, what precautions to take during minimally invasive surgery, and how to avoid surgical smoke hazards. The recommendations also address education/competency, documentation, policies and procedures, and quality assurance/performance improvement. Perioperative nurses should consider the use of checklists and safety posters to remind staff members of the dangers of electrosurgery and the steps to take to minimize the risks for injury.

Advances in electrosurgical technology have led to the design of new products with a wider number of applications. Electrosurgical instruments are either monopolar or bipolar devices. The pulsed electron avalanche knife (PEAK) PlasmaBlade™ represents an advancement in monopolar electrosurgical technology. The PEAK PlasmaBlade is a low-temperature tissue-dissection instrument that uses pulsed radiofrequency plasma discharges to cut with simultaneous hemostasis and less collateral thermal damage than traditional electrosurgical instruments.

The influence of surgical operations on the systemic immune response is proportional to the degree of trauma. Ultrasonic surgery can dissect structures and divide vessels by the effect produced by vibrations in the tissues. It is believed to be less traumatic than the more commonly used monopolar electrosurgery. This randomized study compares the systemic immune response after laparoscopic cholecystectomy performed using either ultrasonic energy or monopolar electrosurgery. Eighteen patients scheduled for elective laparoscopic cholecystectomy were randomly assigned to treatment using either a harmonic scalpel and clips or monopolar electrosurgery and clips. Postoperative inflammatory response was assessed via changes in the white blood cell count and levels of C-reactive protein. Postoperative immune function was assessed by measuring monocyte HLA-DR expression. Both the harmonic scalpel and the use of monopolar electrosurgery resulted in activation of the systemic immune response. No significant differences between the two groups were observed. The harmonic scalpel and monopolar electrosurgery are equally traumatic in terms of activation of the systemic immune response.

Objective To evaluate the safety, adhesion rates, and perioperative outcomes of monopolar and bipolar electrosurgical hysteroscopic metroplasty in women with a septate uterus. Methods We conducted a single‐center retrospective analysis of 155 consecutive patients who underwent same-session laparoscopy and hysteroscopic septum resection between January 2021 and January 2025. Procedures were performed under surgeon discretion using either a monopolar loop with glycine distension or a bipolar loop with isotonic Ringer’s lactate. Postoperative prophylaxis against intrauterine adhesions comprised hyaluronic acid gel—with or without a copper intrauterine device—and, in selected extensive resections, a three‐month estrogen–progestin regimen. Endometriosis was diagnosed laparoscopically and, when lesions were excised, confirmed histologically. Results The most common indications for the surgery were endometriosis (40.6%), recurrent pregnancy loss (38.0%), and infertility (19.3%). Septal morphology was subseptate in 67.7%, septate in 20.0%, and complete septate in 12.2%, and bipolar energy was used in 65.1% of procedures. No uterine perforations, fluid-overload syndromes, or major hemorrhages occurred, and one case of postoperative endometritis (0.6%) was recorded. Second-look hysteroscopy, performed in 69 patients (44.5%), showed intrauterine adhesions in 3/69 (4.3%; grade I 2.9%, grade II 1.4%); residual septal tissue was observed in 50/69 (72.5%), predominantly in extensive septa. Histologically confirmed endometriosis, identified on concomitant laparoscopy, was present in 126/155 (81.3%) and did not differ across septal types ( p  = 0.103). Conclusions Monopolar and bipolar electrosurgical hysteroscopic metroplasty showed a good safety profile with negligible major complications, low adhesion rates, and minimal infection. Bipolar systems further enhance safety by enabling isotonic fluid use.

Objectives A clear understanding of energy devices would help achieve high effectiveness and safety and guide the selection of devices. The present review aimed to elucidate the efficacy and adverse events of energy devices in lung cancer to guide the selection of appropriate devices depending on the situation. Methods Four major databases were searched electronically for relevant articles published until 16 April 2021. The reference lists of the identified papers were examined. We excluded (1) irrelevant studies, (2) manuscripts published in languages other than English and Japanese, (3) duplicates, and (4) studies for which the full text was not available in the databases. The results and key information obtained were summarized by means of a narrative approach. Results A total of 78 papers were included in the review and these were categorized according to the main topic of investigation as follows: (1) electrosurgery-related injuries, (2) fundamentals of electrosurgery, (3) monopolar devices, (4) bipolar electrosurgical devices, (5) ultrasonic energy devices, (6) energy devices in lung cancer surgery, (7) operating room fire risks, and (8) basic principles of surgery. Conclusions Understanding energy devices could help us use them in a more effective and safer manner. Knowledge of their selection criteria (suitability), merits, risks, and safety precautions relevant to each process of lung cancer surgery could guide appropriate selection.

Objective To determine whether exposure to monopolar electrosurgery during subsequent surgeries following Bonebridge implantation has negative impact on the implant. Study Design Retrospective study. Setting Tertiary medical center. Methods Fifty‐six patients who received Bonebridge implantation between December 2014 and June 2024 were reviewed. Twelve patients with exposure to monopolar electrosurgery during subsequent operation were included. Bonebridge‐aided sound field thresholds, as well as subjective outcomes based on patient experience were analyzed to determine if there are any adverse effects on the implant after monopolar electrosurgery exposure. Results The mean age at receiving Bonebridge implantation and subsequent operation were 15.1 ± 6.8 (range, 7.7‐29.9) years and 16.5 ± 6.5 (range, 10.2‐30.1) years, respectively. Each of the included patients experienced one episode of monopolar electrosurgery exposure after Bonebridge implantation. All monopolar electrosurgery exposures were in the head‐and‐neck region, but none of them involved the ipsilateral temporoparietal area. The mean pre‐monopolar electrosurgery and post‐monopolar electrosurgery Bonebridge aided sound field thresholds pure tone average were 31.8 ± 3.3 decibel hearing level and 29.5 ± 3.9 decibel hearing level, respectively (Wilcoxon signed‐rank test, P = .203). No adverse events associated with implant malfunction occurred after monopolar electrosurgery exposure. Conclusion No adverse events or hearing impairment were observed in this series of Bonebridge‐implanted patients who underwent operations involving monopolar electrosurgery. Notably, the exposures were of relatively brief duration and limited to areas outside the ipsilateral temporoparietal region. Further multicenter, prospective studies with larger cohorts and comprehensive adverse event analysis are warranted to better corroborate these findings.