Clinical application of a cordless laparoscopic ultrasonic device, "Beyond the Abstract," by Fernando J. Kim, MD, FACS, et al

BERKELEY, CA (UroToday.com) - Minimally invasive surgery (MIS) is a fast-growing field in urology. With the introduction of laparoscopic procedures in the arsenal of therapeutic options, a variety of new devices have been developed intending to improve surgical outcomes and/or help surgeons in ergonomics.[1] MIS has altered the way surgeons interact within the surgical field. Surgeons and patients are faced with numerous ergonomic challenges with respect to instruments and endoscopes. The prolonged and frequent use of laparoscopic equipment raises ergonomic risks that may cause physical distress for surgeons.[2] The use of laparoscopy, ultrasonic dissectors, intraoperative ultrasound, lasers, and other medical equipment increases patient safety and surgical outcomes. However, new technological equipment occupies a significant amount of space but is required in modern operating rooms.

In our recent article, we described the first clinical use of a Sonicision™ cordless ultrasonic dissector (SCUD) (Covidien-Mansfield, MA USA) after FDA approval.[3] The SCUD is a 5-mm cordless energy-based dissector designed for laparoscopic surgery. It utilizes reusable batteries, and the generator is placed in the hand-piece of the instrument. The instrument enables dual-mode energy for coagulation and cutting in the same button, eliminating the need for pedals or a two-button device.

We performed two procedures (one laparoscopic radical nephrectomy and one pelvic lymphadenectomy) to evaluate the device, and a non-validated questionnaire was performed by the surgical team (four surgeons and three scrub technicians). The ability to assemble the device, ability to pass the device to other members of the surgical team, space saved in the operating room, and overall satisfaction were classified as satisfactory by all surgical staff present at the procedure.

For each case, one battery was sufficient for the entire procedure. We did not run the battery low enough to activate the warning signal which switches on when 20% of the battery is remaining. The dual-mode energy button was evaluated by the surgical team as intuitive and safe. There was no inadvertent activation of the cutting setting under 181 activations on the coagulation mode.[3]

Plume generation is another concern for visibility during laparoscopy.[4, 5] Previously, we described plume generation from the SCUD as minimal compared to other non-cordless devices.[6]

We performed the first clinical use of a cordless ultrasonic dissector with success. The cordless technology satisfied staff regarding fast and easy assembly and safe use for patients and surgeons. Surgeons must encourage and help companies develop new surgical tools to improve ergonomics, patient safety, and surgical outcomes.

References:

  1. Kim FJ, Sehrt DE, Molina WR, Huh JS, Rassweiler J, Turner C. Initial experience of a novel ergonomic surgical chair for laparoscopic pelvic surgery. Int Braz J Urol. 2011;37(4):455-60.
  2. Liang B, Qi L, Yang J, Cao Z, Zu X, Liu L, et al. Ergonomic status of laparoscopic urologic surgery: survey results from 241 urologic surgeons in china. PLoS One. 2013;8(7):e70423.
  3. Kim FJ, Sehrt D, Molina WR, Pompeo A. Clinical Use of a Cordless Laparoscopic Ultrasonic Device. JSLS. 2014;18(3).
  4. da Silva RD, Sehrt D, Molina WR, Moss J, Park SH, Kim FJ. Significance of surgical plume obstruction during laparoscopy. JSLS. 2014;18(3).
  5. Kim FJ, Sehrt D, Pompeo A, Molina WR. Laminar and turbulent surgical plume characteristics generated from curved- and straight-blade laparoscopic ultrasonic dissectors. Surg Endosc. 2014;28(5):1674-7.
  6. Kim FJ, Sehrt D, Pompeo A, Molina WR. Comparison of surgical plume among laparoscopic ultrasonic dissectors using a real-time digital quantitative technology. Surg Endosc. 2012;26(12):3408-12.

Written by:
Rodrigo Donalisio da Silva, MD,a Diedra Gustafson,a Leticia Nogueira,a Wilson R. Molina, MD,b and Fernando J. Kim, MD, FACSa, b as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

aDivision of Urology, Denver Health Medical Center, Denver, CO USA
bDivision of Urology, University of Colorado, Denver, CO USA

Clinical use of a cordless laparoscopic ultrasonic device - Abstract

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