Evaluation of thermal spread during the application of laparoscopic bipolar and ultrasonic devices

Objective: Energy based laparoscopic instruments can introduce undesirable injuries due to thermal spread to adjacent structures. We assessed thermal spread during application of bipolar PlasmaKinetic™, LigaSure™ V and Harmonic ACE™ devices.

Materials and methods: The extent of in vitro thermal spread of each device was measured by using infrared and electrode thermometer for superficial and deep temperatures, respectively. Measurement of temperatures was repeated 5 and 10 mm away from the application area of laparoscopic instruments at a minimum and maximum power level.

Results: The mean increase of temperature for the duration of ultrasonic scalpel was significantly lower than bipolar energy modalities. PlasmaKinetic™ bipolar energy produced the highest mean temperatures in surrounding superficial tissues, and LigaSure™ V developed the highest mean temperature increase in surrounding deep tissues.

Conclusion: Thermal spread was measured only in a limited the area of the surrounding tissues with all devices; however, ultrasonic scalpel may constitute safer option for energized dissection and hemostasis compared to bipolar energy. Particular care should be taken when these instruments are used during laparoscopy, and further research is indicated to optimize the applications of these devices.