Dr. Greenberg is Chief, Division of Gynecology, Brigham & Women’s Faulkner Hospital, and Associate Professor, Harvard Medical School, Boston, Massachusetts.
Dr Greenberg reports on his results with an anti-stick solution for electrosurgery and a wireless endoscope camera.
This anti-stick solution is designed to keep instruments clean.
Photo courtesy of Eagle Surgical Products
Core surgical rule: hemorrhage bad; hemostasis good. With that insightful gem out of the way, let’s turn our focus to electrosurgery, in which electrical current is employed to coagulate bleeding blood vessels by denaturing blood and blood vessel proteins. While that technique is generally effective, the process often results in unwanted sticking and char build-up on the coagulating device. Because both of those effects are detrimental to achieving hemostasis, preventing them is important. Electro Lubeis that prevention in a bottle.
Approved by the US Food and Drug Administration in 2004, Electro Lubeis typically recognized by surgeons as “that yellow goop” that is applied to Da Vinci monopolar scissors to minimize the risk of current arcing. While it is helpful for minimizing arcing, its real modus operandi is preventing sticking and char buildup during electrosurgery. Derived from soybean oil, it is a lecithin-based phospholipid mixture that is non-synthetic, non-flammable, and non-allergenic. It comes in a sterile single-use 8-cc plastic vial and is applied to the tip of any electrosurgical instrument prior to the instrument’s use.
In clinical use, Electro Lubeworked exactly as expected. In my parlance, it was just like good sports referees: If you don’t notice them, they are doing their job. In our operating room (OR), the Storz RoBi bipolar Maryland forceps is our go-to coagulation workhorse. With Electro Lubeapplied, I have yet to need to clean an instrument during a case or to experience sticking to tissues.
Instrument sticking and char build up is definitely a real problem in certain coagulation-heavy procedures. When there is active bleeding, you really want a fully functional coagulation instrument and Electro Lubeis the “grease that helps the wheel turn.” In addition, less char build-up means less scraping and less scraping means less damage to expensive, delicate surgical instruments. Given all these pluses, I think this soybean oil byproduct is pretty clever.
I don’t think that a bottle of Electro Lubeneeds to be opened for every OR case but I do think every OR needs to stock it. In this day and age, surgery-particularly minimally invasive surgery-is too refined to allow something as common as char build-up to reduce an instrument’s functionality when something as simple as Electro Lubeis readily available.
Photo courtesy of The Prometheus Group
Through the generosity of the Greek deity Prometheus, man was introduced to fire. Let there be no doubt, fire was a major enabling technology in humankind’s evolution and ranks only below the iPhone as the most significant advance since we arose from primordial muck. Given this legacy, it should be of little surprise that once again, Prometheus is trying to change mankind; only this time, instead of fire, we are getting an untethered endoscopic camera and light source.
The WiCAM Wireless Digital Endoscope Camera and LED Light Source has multiple components that integrate to make any standard endoscope (cystoscope, hysteroscope, laparoscope, etc.) cordless. The camera is a standard-sized, lightweight (.35 lb, 158 g) device with a standard c-coupler that fits onto any standard eyepiece. Real-time images are wirelessly transmitted from the camera head to a USB receiver plugged into a monitor, laptop or tablet and a rechargeable battery screws a lightweight LED light source directly onto any standard light port.
In use for an office hysteroscopy, the Prometheus wireless digital endoscope camera and LED light source was pretty “wow.” When stationary, the picture was excellent with full 640 x 480 resolution and the light was comparable to what I am used to. There were only 2 buts. But #1: During rapid movement of the camera there were occasions when the image deteriorated as the transmission speed lagged behind the image. This problem is minimized by keeping the camera and tablet at high power and selecting another channel on the camera and receiver if there is interference but it is still a little annoying. But #2: The company is a little vague about the cleaning and sterilization protocols for the devices. The company says they intend to remedy this issue with proprietary sterile drapes or bags but, as of this writing, they are not available.
Game changer alert! This wireless product may be the first of its kind that you use but it will not be the last. Rather, I suspect within short order most of our wired cameras and light cords will go the way of wooden teeth, iron lungs, and written medical records.
The Prometheus wireless digital endoscope camera and LED light source is super cool. After years of using scopes with camera heads connected to cameras via wires and illuminated by light transmitted through fiber-optic cords, the fully wireless Prometheus almost defies belief. For those of us old enough to remember our first mobile phone experience, this camera has that same otherworldly feel. The device does present some challenges. It has some digital lagging issues when it is moved too quickly and the company definitely needs to clarify its cleaning and sterilization procedures. But overall, I am convinced this is the future of office endoscopy and perhaps OR endoscopy as well.