Kenneth S K Law1, Jason A Abbott2, Stephen D Lyons3. 1. Consultant Obstetrician and Gynecologist, Greenslopes Obstetrics and Gynaecology, Greenslopes; Senior Lecturer, School of Medicine, The University of Queensland, Brisbane. 2. Associate Professor. 3. Senior Lecturer, School of Women and Children's Health, The University of New South Wales, Sydney, Australia.
Abstract
IMPORTANCE: A range of energy sources are used in gynecologic laparoscopy. These energy sources include monopolar electrosurgery, bipolar electrosurgery (including "advanced bipolar" devices that incorporate tissue feedback monitoring), and various types of laser and ultrasonic technologies. Gynecologists using these tools should be aware of the potential benefits and potential dangers of these instruments. OBJECTIVE: This review provides an overview of the biophysics of these energy sources, their tissue effects, and the complications that may arise. It aims to highlight any potential advantages or disadvantages of various energy sources, as reported by clinical and laboratory studies. EVIDENCE ACQUISITION: Literature relating to energy sources used in gynecologic laparoscopy was reviewed. RESULTS: While laboratory-based studies have reported differences between various energy sources, these differences may not be clinically significant. The choice of instrumentation may depend on the nature of the surgical task being performed, but other factors, such as the surgeon's training/experience, cost, and industry marketing, may also influence the decision. CONCLUSIONS: TAn awareness of the pros and cons of each energy modality and their relative efficacy profiles is paramount. RELEVANCE: It is important that surgeons have an understanding of the biophysics of these technologies in order to understand their limitations and potential dangers and to utilize the most appropriate energy source(s) in the appropriate clinical setting, in order to both minimize the risk of inadvertent injuries during gynecologic laparoscopy and to maximize cost-efficient delivery of health care.
IMPORTANCE: A range of energy sources are used in gynecologic laparoscopy. These energy sources include monopolar electrosurgery, bipolar electrosurgery (including "advanced bipolar" devices that incorporate tissue feedback monitoring), and various types of laser and ultrasonic technologies. Gynecologists using these tools should be aware of the potential benefits and potential dangers of these instruments. OBJECTIVE: This review provides an overview of the biophysics of these energy sources, their tissue effects, and the complications that may arise. It aims to highlight any potential advantages or disadvantages of various energy sources, as reported by clinical and laboratory studies. EVIDENCE ACQUISITION: Literature relating to energy sources used in gynecologic laparoscopy was reviewed. RESULTS: While laboratory-based studies have reported differences between various energy sources, these differences may not be clinically significant. The choice of instrumentation may depend on the nature of the surgical task being performed, but other factors, such as the surgeon's training/experience, cost, and industry marketing, may also influence the decision. CONCLUSIONS: TAn awareness of the pros and cons of each energy modality and their relative efficacy profiles is paramount. RELEVANCE: It is important that surgeons have an understanding of the biophysics of these technologies in order to understand their limitations and potential dangers and to utilize the most appropriate energy source(s) in the appropriate clinical setting, in order to both minimize the risk of inadvertent injuries during gynecologic laparoscopy and to maximize cost-efficient delivery of health care.
Authors: Hang Cheng; Jeffrey W Clymer; Behnam Sadeghirad; Nicole C Ferko; Chris G Cameron; Joseph F Amaral Journal: World J Surg Oncol Date: 2018-01-04 Impact factor: 2.754