Comparison of surgical plume among laparoscopic ultrasonic dissectors using a real-time digital quantitative technology

• Published in: Surgical endoscopy Vol. 26; no. 12; pp. 3408 - 3412
• Main Authors: Kim, Fernando J., Sehrt, David, Pompeo, Alexandre, Molina, Wilson R.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-12-2012; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Animals; Applied physiology; Biological and medical sciences; Cattle; Computer Systems; Digestive system. Abdomen; Dissection - instrumentation; Endoscopy; Equipment Design; Ergonomics. Work place. Occupational physiology; Gastroenterology; Gynecology; Hepatology; Human physiology applied to population studies and life conditions. Human ecophysiology; Investigative techniques, diagnostic techniques (general aspects); Laparoscopes; Laparoscopy; Medical sciences; Medicine; Medicine & Public Health; Proctology; Software; Surgery; Ultrasonic Surgical Procedures - instrumentation; Urology; Variance analysis; United States > US; ImageJ; Ultrasonic dissector; ACE; Ergonomics; Cordless; Laparoscopy; New technology; Sonicision; SonoSurg; Plume; Treatment; Surgery; Endoscopy; Comparative study
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-012-2351-z

Background
This study aimed to analyze the effect of surgical plume generation from various ultrasonic dissectors on laparoscopic visibility, including the first cordless ultrasonic dissector, using a novel real-time digital quantification technique.
Methods
The Covidien Cordless Sonicision, the Harmonic ACE, and the Olympus SonoSurg were applied to bovine liver with industry-specified settings. Consecutive activations were digitally captured from a laparoscope positioned to replicate the clinical setting. Plume was recognized by ImageJ software, and the percentage of pixels containing plume in each video frame was calculated. Analysis of variance statistical multi-analysis and Welch’s
t
test were computed for all
p
values.
Results
The average maximum plume produced by the Sonicision, ACE, and SonoSurg with the maximum setting were respectively 8.76 % (range, 4.32–17.41 %), 18.04 % (range, 9.07–55.12 %), and 9.46 % (range, 5.68–22.12 %) (
p
 = 0.026). The deviations between the ACE and the other devices were significant (
p
 < 0.05). The average maximum plumes produced with the coagulation setting were 4.80 % (range, 0.24–19.83 %) for the Sonicision, 26.63 % (range, 8.12–73.50 %) for the ACE, and 0.21 % (range, 0.06–1.05 %) for the SonoSurg (
p
 < 0.001). The differences between all the instruments in the coagulation setting were significant.
Conclusion
To the authors’ knowledge, this is the first report on a real-time digital analysis of surgical plume generation using ImageJ software. In the coagulation setting, the SonoSurg generated minimal plume. The Sonicision obstructed approximately 4 %, whereas the ACE generated plume that obstructed 25 % of the laparoscopic field. In the cutting setting, the SonoSurg and Sonicision generated the least obstruction, whereas the ACE caused the most obstruction.