title: Ultrasonic thermal damage during robotic hysterectomy.
abstract: Application of energy in minimally invasive hysterectomy creates thermal injury which may increase vaginal cuff dehiscence. The purpose of this study was to compare vaginal tissue damage in a swine model between the two power settings of ultrasonic energy. This was an IACUC-approved, prospective, single-blinded study analyzing energy-induced damage to the swine vagina during robotic hysterectomy. Multiple colpotomy transections were performed on 18 animals using robotic ultrasonic energy, the exact same platform used in human surgery. Specimens (n = 72) were analyzed by a veterinary pathologist blinded to the energy source. Thermal injury was microscopically measured. Mean thermal injury (µm) was not statistically different between Max-Setting 5 and Min-Setting 3 (1243 ± 544 vs. 1293 ± 554; 95 % CI -310 to 210, p = 0.66). Time (s) to complete transection was significantly shorter when using Setting 5 (13.00 ± 7.75 vs. 17.92 ± 9.03; 95 % CI -4.92 to -8.88, p = 0.001). The rate of injury (µm/s) for Setting 5 also trended toward being higher (118.98 ± 72.81 vs. 93.03 ± 62.34; 95 % CI -5.91 to 57.81, p = 0.053). In these swine vaginal specimens, energy-induced tissue damage was not statistically different for the two ultrasonic power settings. Max-Setting 5 was faster and trended toward a higher rate of damage; this was balanced by equivalent distance of tissue injury compared with Min-Setting 3. In larger human specimens, the use of Max-Setting 5 may be recommended to decrease surgical time as it is faster and causes an equivalent amount of injury to Min-Setting 3.
authors.affiliation: Wright-Patterson Medical Center, Women's Health Clinic, 4881 Sugar Maple Dr, Wright-Patterson AFB, OH, 45433, USA. jason.massengill@gmail.com.
authors.forename: Jason
authors.initials: J
authors.lastname: Massengill
authors.affiliation: Armed Forces Radiobiology Research Institute, 8901 Wisconsin Avenue, Building 42, Bethesda, MD, 20889-5603, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Lombardini
authors.affiliation: Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Oliva
authors.affiliation: Office of the Surgeon General, Defense Health Headquarters, Falls Church, VA, 22042, USA.
authors.forename: Jerome
authors.initials: J
authors.lastname: Buller
authors.affiliation: Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gruber
keywords: Colpotomy; Robotic hysterectomy; Thermal injury; Ultrasonic energy