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Risk of nerve injury after use of energy based surgical devices
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Department of Surgery and Center for Clinical Research Uppsala University, Västmanland County Hospital, Västerås, Sweden.
Department of Endocrine Surgery, University Hospital CHU Sart-Tilman, Liege, Belgium.
Physikalisch-Technische Bundesanstalt, Braunschweig, Germany.
Department of animal laboratory, Liege, Belgium.
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2015 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background

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.

Methods

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).

Results

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.

Conclusion

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
2015.
Keyword [en]
Energy based devices, nerve injury, electron microscope
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-122145OAI: oai:DiVA.org:liu-122145DiVA: diva2:862157
Available from: 2015-10-20 Created: 2015-10-20 Last updated: 2015-10-20Bibliographically approved
In thesis
1. Energy based surgical instruments: With particular focus on collateral thermal injury
Open this publication in new window or tab >>Energy based surgical instruments: With particular focus on collateral thermal injury
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Iatrogenic post-operative nerve dysfunction is a significant problem in many areas of surgery and can be caused by collateral thermal injury from activation of energy based surgical devices (EBD).

The aims of this thesis were to: create an animal model in order to compare mono- and bipolar electrosurgery (ES) and an ultrasonic dissection (UD) with regard to collateral thermal nerve injury, and with data of a national multicenter register to study the use of EBD and their potential effects on operation time and complication rates in thyroid surgery.urgical devices (EBD).

Material and Methods: The biceps femoris muscle of 104 anesthetized rats was cut in a standard manner adjacent to the sciatic nerve using clinical relevant settings of mono- and bipolar ES and UD. The sciatic nerve was stimulated supramaximally and the electromyographic (EMG) potential recorded before and after each experiment. Nerve dysfunction was defined as > 10% reduction of the evoked EMG potential. In Paper II and III temperature was measured before, during and after instrument activation. The sciatic nerves were coded and examined blinded with light (LM) and electron microscopy (EM). Advanced temperature measurements were conducted in Paper II and III. In Paper IV, the use of EBD was specifically registered in the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery (SQRTPA) during one year and 1297 patients were included. Operation time, recurrent laryngeal nerve (RLN) injury, post-operative hypoparathyroidism and the use of topical haemostatic agents were compared between bipolar ES, electric vessel sealing (EVS) and UD. Clamp and Tie technique (C-A-T) being without thermal risk constituted the control group.

Results: In Paper I the EMG potential was significantly more frequent reduced in the monopolar and bipolar ES group compared to the UD group and LM showed significantly less nerve damage in the UD group. In Paper II exact temperature measurements was possible with thermoelectric micros sensors and the thermal dose was significantly less and with less variation for the UD compared to the bipolar ES. Similar to the Paper I the EMG potential was significantly more frequent reduced in the ES group. Moderate and severe morphological damage was significantly less common in the UD group compared to monopolar ES. We found no statistical correlation between the highest temperatures/doses and the degree of morphological damage or functional loss. In Paper III the temperature increase was significantly less and with shorter duration in the UD group, compared to bipolar ES. LM and EM demonstrated loss of density in the myelin sheet only in a small number of nerves in all groups after instrument activation 1 mm from the nerve.

In Paper IV, operation time was significantly shorter in the UD group and significantly longer in the EVS and bipolar ES group, compared to C-A-T. Postoperative hypoparathyroidism with need for Calcium treatment at discharge and at 6 weeks was significantly higher with ES instruments compared to UD. The incidence of reported RLN injury was 2.5% at 6 weeks postoperatively without statistical differences between the groups. Topical haemostatic agents were more frequently used in the EBD groups compared to C-A-T.

Conclusion: The experimental Papers (I-III) demonstrated a lower risk of adverse collateral thermal nerve injury with activation of the mechanical UD technique compared to ES techniques. In the nationwide multicenter register Paper (IV), the use of UD shortened end EVS increased operation time compared to the low cost C-A-T. The UD instruments had a lower risk of hypoparathyroidism than electrosurgery.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 66 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1491
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-122147 (URN)10.3384/diss.diva-122147 (DOI)978-91-7685-902-5 (print) (ISBN)
Public defence
2015-11-20, Elsa Brännströmsalen, Campus US, Linköping, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2015-10-20 Created: 2015-10-20 Last updated: 2015-10-20Bibliographically approved

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