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Erschienen in:
01.02.2016 | Editorial
Should high-frequency electrosurgery be discouraged during laparoscopic surgery?
Erschienen in: Surgical Endoscopy | Ausgabe 2/2016
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This reason for this editorial arose following the publication in Surgical Endoscopy: Biomolecular inflammatory response to surgical energy usage in laparoscopic surgery: results of a randomized study [1]. This RCT is interesting in attempting to quantify the inflammatory response produced by laparoscopic cholecystectomy (LC), conducted with use of electrosurgical dissection (ED) and compared to dissection without use of electrosurgery [1]. Whilst we can no more than agree with the authors on most of their findings, we consider some issues need addressing. In essence by this RCT, the authors conclude that during an LC, the inflammatory response to surgical trauma is significantly greater when ED, on the basis of a sequential increase in IL-6 and TNF-a levels. What is of some concerns to us and other readers of this publication is that the clinical significance, indeed consequence of this rise in cytokines is not addressed by the authors. At our institution, we perform LC with regular use of ED using minilaparoscopic approach, including cauterization of the cystic artery. In a series of more than 2000 patients (Table 1) with strict adherence to the well-known principles governing safe ED [2], we have not encountered any CBD injury and not observed any objective adverse effect of ED which delayed recovery, with the vast majority of these patients being discharged within the first 24 h after their operation, and without any major complaint [3‐5].
Table 1
Principles for safe use of electrocautery (EC) in minilaparoscopic cholecystectomy
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Electrocautery mandates the use of a return electrode monitor
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Use bipolar or monopolar energy with blend mode (30 w cut, 25 w coagulation, or less)
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Never use a metal clip, if use of EC is intended close to the clipped structure
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Short pulses should always be used, never exceeding more than 1 s
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To avoid damage, EC must be used at least 10 mm away from vital structures (pedicle, duodenum, colon, etc.)
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Use dissecting forceps to coagulate, if artery diameter is >2 mm—Hint: Compare with 3-mm forceps
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