Risk of nerve injury after use of energy based surgical devices
2015 (English)Manuscript (preprint) (Other academic)
The use of energy based surgical devices (EBD) is well established in surgery. Iatrogenic nerve injury is a common problem in many areas of surgery and may be caused by collateral thermal injury from EBD.
The sciatic nerve of anaesthetized rats was used in an experimental model. A bipolar scissors (ES) was compared to an ultrasonic device (UD) by cutting the femoris muscle longitudinal during 3 seconds at 1 mm from the sciatic nerve. Temperature and electromyography (EMG) were recorded before, during and after activation of the devices. The nerves were examined blinded with light (LM) and electronic microscope (EM).
The temperature increase was significantly less and with shorter duration after instrument activationfor the UD compared to bipolar ES. The EMG potential was reduced by 3 % in the UD group and 6% in the ES group respectively (n.s.). LM and EM demonstrated a loss of density in the myelin sheath in a small number of nerves in both groups.
This study indicates less thermal spread in tissue following activation of the ultrasonic devices compared to bipolar ES. EMG and morphology assessment with LM and EM indicate a small risk and probably reversible thermal injury after clinical relevant instrument activation at 1 mm from the nerve.
Place, publisher, year, edition, pages
Energy based devices, nerve injury, electron microscope
IdentifiersURN: urn:nbn:se:liu:diva-122145OAI: oai:DiVA.org:liu-122145DiVA: diva2:862157