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October 2010

Energized Dissection, Energized Hemostasis—Reply

Author Affiliations

Author Affiliations: Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, England.

Arch Surg. 2010;145(10):1021. doi:10.1001/archsurg.2010.199

In reply

We thank Dr Agarwal for his comments on our recent article1 and are pleased that he shares our concern for the indiscriminate use of monopolar diathermy and other electrosurgical instruments during both open and minimally invasive surgery. He rightly points out that the temperature at the tip of electrosurgical instruments remains elevated for a while after their use. Recent work from our group2 has shown that after use of a monopolar diathermy instrument for 15 seconds, its tip's temperature can be elevated above 42°C (the temperature at which coagulative necrosis occurs) for 55 seconds. Shorter durations of elevated temperatures were seen with bipolar diathermy, the Ligasure (Valleylab, Boulder, Colorado), and the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, Ohio). More importantly, application of monopolar diathermy to ex vivo tissue at 40 W for 10 seconds resulted in a temperature rise up to 60°C in contiguous tissue 1 cm away from the point of application. We support Dr Agarwal's call for the judicious use of electrosurgical instruments and feel that surgeons should be aware of these potential dangers.

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