Use of an electrocautery device during shoulder arthroscopy- is it really safe?
ESSKA Academy. Pokorny-Olsen A. 11/08/19; 284418; epESA-32
Dr. Alexandra Pokorny-Olsen
Dr. Alexandra Pokorny-Olsen
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Use of an electrocautery device during shoulder arthroscopy- is it really safe?

ePoster - epESA-32

Topic: Basic Science and Biomechanics

Pokorny-Olsen A.1, Papakyriacou M.2, Weger R.2, Wurnig C.1
1Orthopaedice Hospital Speising, Vienna, Austria, 2MaPaTec, Vienna, Austria

Aim: The aim of the present study was to measure the in-vivo and in-vitro heat generation of an electrocautery device in a sterile and reproducible matter.
Methods: To achieve the in vivo-temperature measurements, we performed shoulder arthroscopies in typical beach chair position. A heat sensor camera (FLIR-E60bx) was used to continuously determine the temperature development over time in 10 second intervals.
Additionally, a digital thermometer measured temperature at the endpoint of the outflow hose.
To verify in-vivo measurements and to evaluate in-vitro heat generation of the VAPR (DePuy, Warsaw) electrocautery device under reproducible conditions, further testings were conducted in different settings: unobstructed outflow, different levels of outflow suction, obstructed outflow, insufficient perfusion. Temperature measurements were again achieved by the use of a heat-sensor camera (FLIR-E60bx)as well as a digital thermometer. A flow-sensor at the outflow hose measured the outflow-rate to evaluate the suction necessary at the end of the outflow in order to prevent temperature peaks.
Results: Analysis of the in-vivo heat sensor data showed temperatures of 55°C-60°C on the surface of the outflow hose, indicating temperatures of more than 60°C of the outflow-fluid. The increase in temperature was time-dependent. Levels of over 60°C were reached within the first 40 seconds. The superficial skin temperature did not exceed 31°C at any time. Temperatures measured with the heat sensor camera matched those found with the digital probe.
In vitro-testings achieved similar results with temperature peaks of over 60° in case of insufficient flow, blockage of the outflow or insufficient suction at the end of the outflow hose. A „safe-zone“ for sufficient flow in the VAPR outflow was determined.
Conclusions: Complications due to electrocautery during shoulder arthroscopy seem to be a rare but severe phenomenon. The high temperature measured in the outflow cable in this study is a serious concern. It might lead to dermal burns, which can cause scarring, limitations on ROM or subsequent surgery. especially with leaking fluid through additional arthroscopy portals or direct contact between the overheated outflow hose of the device and the skin.
In case of insufficient outflow of the electrocautery device, temperature peaks around the head of the probe are possible. This could potentially lead to implications on tendon healing and cartilage. Surgeons have to be aware of the risk and to use sufficient outflow suction as a precaution. This needs to be constantly monitored and can only be achieved by a specialised alarm-unit measuring the flow.
Use of an electrocautery device during shoulder arthroscopy- is it really safe?

ePoster - epESA-32

Topic: Basic Science and Biomechanics

Pokorny-Olsen A.1, Papakyriacou M.2, Weger R.2, Wurnig C.1
1Orthopaedice Hospital Speising, Vienna, Austria, 2MaPaTec, Vienna, Austria

Aim: The aim of the present study was to measure the in-vivo and in-vitro heat generation of an electrocautery device in a sterile and reproducible matter.
Methods: To achieve the in vivo-temperature measurements, we performed shoulder arthroscopies in typical beach chair position. A heat sensor camera (FLIR-E60bx) was used to continuously determine the temperature development over time in 10 second intervals.
Additionally, a digital thermometer measured temperature at the endpoint of the outflow hose.
To verify in-vivo measurements and to evaluate in-vitro heat generation of the VAPR (DePuy, Warsaw) electrocautery device under reproducible conditions, further testings were conducted in different settings: unobstructed outflow, different levels of outflow suction, obstructed outflow, insufficient perfusion. Temperature measurements were again achieved by the use of a heat-sensor camera (FLIR-E60bx)as well as a digital thermometer. A flow-sensor at the outflow hose measured the outflow-rate to evaluate the suction necessary at the end of the outflow in order to prevent temperature peaks.
Results: Analysis of the in-vivo heat sensor data showed temperatures of 55°C-60°C on the surface of the outflow hose, indicating temperatures of more than 60°C of the outflow-fluid. The increase in temperature was time-dependent. Levels of over 60°C were reached within the first 40 seconds. The superficial skin temperature did not exceed 31°C at any time. Temperatures measured with the heat sensor camera matched those found with the digital probe.
In vitro-testings achieved similar results with temperature peaks of over 60° in case of insufficient flow, blockage of the outflow or insufficient suction at the end of the outflow hose. A „safe-zone“ for sufficient flow in the VAPR outflow was determined.
Conclusions: Complications due to electrocautery during shoulder arthroscopy seem to be a rare but severe phenomenon. The high temperature measured in the outflow cable in this study is a serious concern. It might lead to dermal burns, which can cause scarring, limitations on ROM or subsequent surgery. especially with leaking fluid through additional arthroscopy portals or direct contact between the overheated outflow hose of the device and the skin.
In case of insufficient outflow of the electrocautery device, temperature peaks around the head of the probe are possible. This could potentially lead to implications on tendon healing and cartilage. Surgeons have to be aware of the risk and to use sufficient outflow suction as a precaution. This needs to be constantly monitored and can only be achieved by a specialised alarm-unit measuring the flow.
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