Comparison of surgical plume among laparoscopic ultrasonic dissectors using a real-time digital quantitative technology

BACKGROUND: This study aimed to analyze the effect of surgical plume generation from various ultrasonic dissectors on laparoscopic visibility, including the first cordless ultrasonic dissector, using a novel real-time digital quantification technique. METHODS: The Covidien Cordless Sonicision, the Harmonic ACE, and the Olympus SonoSurg were applied to bovine liver with industry-specified settings. Consecutive activations were digitally captured from a laparoscope positioned to replicate the clinical setting. Plume was recognized by ImageJ software, and the percentage of pixels containing plume in each video frame was calculated. Analysis of variance statistical multi-analysis and Welch’s t test were computed for all p values. RESULTS: The average maximum plume produced by the Sonicision, ACE, and SonoSurg with the maximum setting were respectively 8.76 % (range, 4.32–17.41 %), 18.04 % (range, 9.07–55.12 %), and 9.46 % (range, 5.68–22.12 %) (p = 0.026). The deviations between the ACE and the other devices were significant (p < 0.05). The average maximum plumes produced with the coagulation setting were 4.80 % (range, 0.24–19.83 %) for the Sonicision, 26.63 % (range, 8.12–73.50 %) for the ACE, and 0.21 % (range, 0.06–1.05 %) for the SonoSurg (p < 0.001). The differences between all the instruments in the coagulation setting were significant. CONCLUSION: To the authors’ knowledge, this is the first report on a real-time digital analysis of surgical plume generation using ImageJ software. In the coagulation setting, the SonoSurg generated minimal plume. The Sonicision obstructed approximately 4 %, whereas the ACE generated plume that obstructed 25 % of the laparoscopic field. In the cutting setting, the SonoSurg and Sonicision generated the least obstruction, whereas the ACE caused the most obstruction.