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Robotic stray energy with constant-voltage versus constant-power regulating electrosurgical generators

  • 2021 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Stray energy from surgical energy instruments can cause unintended thermal injuries. There are no published data regarding electrosurgical generators and their influence on stray energy transfer during robotic surgery. There are two approved generators for the DaVinci Xi robotic platform: a constant-voltage regulating generator (cVRG) and a constant-power regulating generator (cPRG). The purpose of this study was to quantify and compare stray energy transfer in the robotic Xi platform using a cVRG versus a cPRG.

Methods

An ex vivo bovine model was used to simulate a standard multiport robotic surgery. The DaVinci Xi (Intuitive Surgical, Sunnyvale, CA) robotic platform was attached to a trainer box using robotic ports. A 5 s, open-air activation of the monopolar scissors was done with commonly used electrosurgical settings using a cPRG (ForceTriad, Covidien-Medtronic, Boulder, CO) or cVRG (ERBE VIO 300 dV 2.0, ERBE USA, Marietta, GA). Stray energy transfer was quantified as the change in tissue temperature (°C) nearest the tip of the assistance grasper (which was not in direct contact with the active monopolar scissors).

Results

Stray energy transfer occurred with both generators. Utilizing common, comparable settings for standard coagulation, significantly less stray energy was transferred with the cVRG versus cPRG (4.4 ± 1.6 °C vs. 41.1 ± 13.0 °C, p < 0.001). Similarly, less stray energy was transferred using cut modes with the cVRG compared to the cPRG (5.61 ± 1.79 °C vs. 33.9 ± 18.4 °C, p < 0.001).

Conclusion

Stray energy transfer increases tissue temperatures more than 45C in the DaVinci Xi robotic platform. Low voltage modalities, such as cut or blend; as well as a cVRG generator, significantly reduces stray energy. Robotic surgeons can minimize the risk of stray energy injuries by using these low risk modes and/or generator.

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Reproduced from Overbey et al. [21]

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Authors and Affiliations

  1. Department of Surgery, The University of Colorado School of Medicine, Aurora, CO, USA

    Krzysztof J. Wikiel, Franklin J. Powlan, Teresa S. Jones, Thomas N. Robinson & Edward L. Jones

  2. Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA

    Krzysztof J. Wikiel, Teresa S. Jones, Thomas N. Robinson & Edward L. Jones

Authors
  1. Krzysztof J. Wikiel
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  2. Franklin J. Powlan
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  3. Teresa S. Jones
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  4. Thomas N. Robinson
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  5. Edward L. Jones
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Corresponding author

Correspondence to Krzysztof J. Wikiel.

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Disclosures

Krzysztof J. Wikiel has received travel reimbursement from Intuitive Surgical, Inc. to participate in resident training labs in Sunnyvale, CA and Houston, TX. Edward L. Jones is a consultant for Boston Scientific. Teresa S. Jones, Franklin J. Powlan, and Thomas N. Robinson have no conflicts of interest or financial ties to disclose.

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This study was be presented at the 2021 SAGES Annual Meeting in Las Vegas, NV.

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Wikiel, K.J., Powlan, F.J., Jones, T.S. et al. Robotic stray energy with constant-voltage versus constant-power regulating electrosurgical generators. Surg Endosc 37, 580–586 (2023). https://doi.org/10.1007/s00464-022-09316-5

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  • DOI: https://doi.org/10.1007/s00464-022-09316-5

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