Review of advanced energy devices for the minimal access gynaecologist
M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 3 – C O R E S U R G I C A L S K I L L S
Advanced Energy Devices for the Minimal Access Gynaecologist Bentham GL, Preshaw J. Review of advanced energy devices for the minimal access gynaecologist. TOG 2021;23:301–309. doi:10.1111/tog.12774
7 mm 42°C 0.5–1.0 cm VESSEL SEAL LIMIT – ADVANCED BIPOLAR & TEMPERATURE ABOVE WHICH TISSUE DAMAGE SAFE MARGIN FROM VITAL TISSUE (ABD) THUNDERBEAT OCCURS
DO N' T-M IS S FA C TS
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Vessel seal limits: ABD 7 mm · UD 5 mm (Harmonic Ace+7 = 7 mm) · Thunderbeat 7 mm · CO₂ laser 1 mm · plasma = small vessels only
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Tissue damage occurs above 42°C; coagulation/desiccation 60–80°C; vaporisation 100°C; carbonisation >100°C
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ABD lateral thermal spread up to 7 mm — keep 0.5–1.0 cm from vital tissue, minimum power and activation time
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Residual heat is highest with UDs and Thunderbeat: minimise activation, minimal energy, irrigate the tip, keep in view/quiver, wait before manipulating tissue
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Plasma: hold ~5 mm from tissue for haemostasis/ablation, closer for cutting; never touch tissue while active; lowest gas flow; non-defeatable pressure alarms (argon/helium → fatal gas emboli)
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Relax tissue tension to coagulate; apply tension to cut (ABD, UD, Thunderbeat). Light UD trigger grip = coagulation; firm grip = cutting
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Back-scoring (jaws open, back of lower blade) delivers ultrasound energy without grasping — the only way to use Thunderbeat ultrasound independently
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CO₂ laser 10 600 nm, penetrance 0.1–0.5 mm, LTS 0.5 mm, ~30 W; risks: retinal damage from aiming beam, fire, plume — appoint a laser safety officer
DEVICE SELECTION IN ONE LINE
Routine hysterectomy / basic adnexal, big pedicles → ABD
Complex dissection: DIE, ureterolysis, myomectomy → UD or Thunderbeat
Superficial peritoneal endometriosis, endometrioma → plasma Lesions on ureter/bladder/bowel serosa → CO₂ laser
Large vessels → NOT plasma or laser
ABBREVIATION KEY
ABD — advanced bipolar device LTS — lateral thermal spread
UD — ultrasonic device MAS — minimal access surgery
HD — hybrid device LASER — Light Amplification by Stimulated Emission of Radiation
PD — plasma device ABC — argon beam coagulator (ConMed)
LD — laser device CIN — cervical intraepithelial neoplasia
CD — conventional device RF — radiofrequency
Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — doi:10.1111/tog.12774
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