Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2012 Dec;26(12):3408-12.
doi: 10.1007/s00464-012-2351-z. Epub 2012 Jun 4.

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

Fernando J Kim  1 , David Sehrt, Alexandre Pompeo, Wilson R Molina
Affiliations
Comparative Study

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

Fernando J Kim et al. Surg Endosc. 2012 Dec.

Abstract

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.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Experimental model
Fig. 2
Fig. 2
Digital analysis. A Plume recorded by the laparoscope. B Removal of the instrument and tissue. C Isolation and recognition of plume
Fig. 3
Fig. 3
Average plume obstruction in coagulation mode versus time with confidence intervals
Fig. 4
Fig. 4
Average plume obstruction in cutting mode versus time with confidence intervals
See this image and copyright information in PMC

References

    1. Cimino W, Bond L. Physics of ultrasonic surgery using tissue fragmentation: part I. Ultrasound Med Biol. 1996;1:89–100. doi: 10.1016/0301-5629(95)02021-7. - DOI - PubMed
    1. Kim FJ, Chammas MF, Jr, Gewehr E, et al. Temperature safety profile of laparoscopic devices: Harmonic ACE (ACE), Ligasure V (LV), and plasma trisector (PT) Surg Endosc. 2008;22:1464–1469. doi: 10.1007/s00464-007-9650-9. - DOI - PubMed
    1. Barneet WL, Garger SM. Surgical smoke: a review of the literature. Surg Endosc. 2003;17:978–987. - PubMed
    1. DesCoteaux J, Picard P, Poulin E, et al. Preliminary study of electrocautery smoke particles produced in vitro and during laparoscopic procedures. Surg Endosc. 1996;10:152. doi: 10.1007/BF00188362. - DOI - PubMed
    1. Van Det M, Meijerink W, Hoff C, Totte E, Pierie J. Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg Endosc. 2009;23:1279–1285. doi: 10.1007/s00464-008-0148-x. - DOI - PubMed

Publication types

LinkOut - more resources