Gross and histologic characteristics of laparoscopic injuries with four different energy sources

Objective: To compare the gross and histologic effects of bipolar and monopolar cautery, ultrasonic scalper, and CO2 laser on porcine ureter, bladder, and rectum. Design: Experimental prospective study. Setting: Cleveland Clinic Foundation Animal Research Laboratory, Cleveland, Ohio. Animal(s): Nonpregnant adult female pigs. Intervention(s): The rectum, bladder, and ureters of 12 female pigs were injured with four different laparoscopic energy sources. Main Outcome Measure(s): Gross measurements of injured tissue and histologic analysis of the depth of the tissue injury. Result(s): Gross assessment results were that monopolar injuries of the bower and bladder were significantly longer than ultrasonic injuries (P<0.01). Injuries were generally manifest as coagulative denaturation collagen bundles. This resulted in an eosinophilic homogenization of tissue. Nuclei were retained in the injured tissue, although in most cases they had a pyknotic, streamed appearance. The CO2 laser caused: no deep-tissue injury. Conclusion(s): Laparoscopic energy sources injure tissue differently. Monopolar cautery appears to have the most lateral spread of thermal energy. The CO2 laser appears to cause the least deep-tissue injury. (FertilSteril<(R)> 2001;75:806-10. (C) 2001 by American Society for Reproductive Medicine.)