Comparative Assessment of Thermal Damage Induced by Bipolar Forceps in a Bovine Liver

Abstract

BACKGROUND AND OBJECTIVES: Bipolar electrocautery systems in neurosurgical procedures may induce thermal damage to adjacent tissues, especially neural tissues. Therefore, it is crucial to control thermal spread from the tips of bipolar forceps into adjacent tissues. The goal of this study was to compare the thermal damage induced in unintended adjacent tissues during coagulation with 6 different bipolar forceps. METHODS: Fresh ex vivo bovine liver tissues were coagulated with 6 different bipolar forceps: Aesculap (R) nonstick, Atlas Choice (TM), ISOCOOL (R), SilverGlide (R), Spetzler (TM)-Malis (R), and VersaTru (R) (45 trials per bipolar forceps). For all forceps, coagulation was performed with a power setting of 35 Malis units, 1-mm tip spacing, and 3-second activation time. Tissue samples were evaluated for the extent of thermal damage (30 trials per bipolar forceps). Tissue temperatures were measured with thermocouples placed in the tissues (15 trials per bipolar forceps). The area and maximum depth of thermal damage were measured manually with image analysis software. RESULTS: The injury area induced by ISOCOOL (R) and Atlas Choice (TM) bipolar forceps was significantly less than that of the Aesculap (R) nonstick (P < .001), SilverGlide (R) (P < .001), Spetzler (TM)-Malis (R) (P < .001), and VersaTru (R) (P < .001). The areas of thermal injury caused by the ISOCOOL (R) and Atlas Choice (TM) forceps were not statistically significantly different from each other (P = .08). Lesions from the ISOCOOL (R) and Atlas Choice (TM) forceps showed significantly less depth of injury than the Aesculap (R) nonstick (P = .001), SilverGlide (R) (P < .001), Spetzler (TM)-Malis (R) (P < .001), and VersaTru (R) (P < .001). There was no statistically significant difference in the depth of thermal injury between the ISOCOOL (R) and Atlas Choice (TM) forceps (P = 1.0). CONCLUSION: Bipolar forceps that effectively limit excessive thermal dissipation reduce the risk of unintended injury to adjacent or peripheral tissues. In an ex vivo bovine liver model, coagulation tests with ISOCOOL (R) and Atlas Choice (TM) bipolar forceps resulted in less depth and lower mean injury areas compared with other forceps.