Thermal injury to the ovary and uterus in a porcine model: a comparison of four energy sources

Abstract

Thermal injury to the ovary and uterus in a porcine model: a comparison of four energy sources N.C. Llarena1, A.B. Shah2, C. Biscotti3, T. Falcone1, M.J. Uy-Kroh1,4 1Women’s Health Institute, 2Glickman Urological and Kidney Institute, 3Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio (USA) 4Department of Gynecology, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi (United Arab Emirates) Summary Background: Laparoscopic energy results in thermal injury to the ovary during adnexal surgery that may contribute to a decrease in reproductive function postoperatively. Plasma energy is an alternative to traditional laparoscopic energy sources that is created by passing an inert gas over an electrically charged surgical blade designed to energize the gas to a plasma stream for coagulation and dissection. Data suggest that plasma may have less thermal spread than traditional energy sources, but its effects on ovarian histology have not been compared to other electrosurgical modalities. Materials and Methods: Thermal injuries were created on porcine ovaries and uterine horns with bipolar forceps, monopolar pencil, ultrasonic shears, and a helium plasma device. The depth of thermal injury was evaluated histologically. Results: Monopolar electrosurgery resulted in the greatest depth of thermal injury in ovarian tissue (mean 0.99 ± 0.82 mm), whereas the helium plasma device produced the smallest injury (mean 0.57 ± 0.4 mm) (p = 0.018). In uterine tissue, the bipolar instrument produced the greatest depth of injury (mean 1.15 ± 0.2 mm) and plasma device resulted in the lowest level of injury (mean 0.42 ± 0.13 mm) (p = 0.0002). The ultrasonic shears also resulted in less injury to the uterus than the bipolar device (mean 0.48 ± 0.23 mm) (p = 0.0027). Conclusion: Helium plasma energy may represent a less injurious alternative to the monopolar device for use during adnexal surgery. Key words: Electrosurgery; Plasma energy; Gynecology; Ovary; Thermal injury.