Energy Sources for Gynecologic Laparoscopic Surgery: A Review of the Literature

IMPORTANCEA range of energy sources are used in gynecologic laparoscopy. These energy sources include monopolar electrosurgery, bipolar electrosurgery (including “advanced bipolar” devices that incorporate tissue feedback monitoring), and various types of laser and ultrasonic technologies. Gynecologists using these tools should be aware of the potential benefits and potential dangers of these instruments. OBJECTIVEThis review provides an overview of the biophysics of these energy sources, their tissue effects, and the complications that may arise. It aims to highlight any potential advantages or disadvantages of various energy sources, as reported by clinical and laboratory studies. EVIDENCE ACQUISITIONLiterature relating to energy sources used in gynecologic laparoscopy was reviewed. RESULTSWhile laboratory-based studies have reported differences between various energy sources, these differences may not be clinically significant. The choice of instrumentation may depend on the nature of the surgical task being performed, but other factors, such as the surgeon’s training/experience, cost, and industry marketing, may also influence the decision. CONCLUSIONSAn awareness of the pros and cons of each energy modality and their relative efficacy profiles is paramount.RelevanceIt is important that surgeons have an understanding of the biophysics of these technologies in order to understand their limitations and potential dangers and to utilize the most appropriate energy source(s) in the appropriate clinical setting, in order to both minimize the risk of inadvertent injuries during gynecologic laparoscopy and to maximize cost-efficient delivery of health care. TARGET AUDIENCEObstetricians and gynecologists, family physicians LEARNING OBJECTIVESAfter completing this CME activity, physicians should be better able to analyze the principle biophysics of electrosurgery and its application to surgery, evaluate the types of injuries that can occur when using energy sources in gynecologic laparoscopy and how these injuries can be minimized, and compare the properties of different laparoscopic energy sources, highlighting the potential advantages and disadvantages of each device.