Prospective control trial: flexible co2 laser vs. Monopolar electrocautery for robotic microsurgical denervation of the spermatic cord

ABSTRACT Microsurgical denervation of the spermatic cord (MDSC) is a treatment option in patients with chronic orchialgia. This procedure requires precise care to avoid any thermal damage to

crucial adjacent tissues (arteries, veins, and lymphatics). Monopolar electrocautery is the standard ligation energy source, but may cause extensive collateral damage to the tissues.

However, CO2 laser is known to produce a very predictable tissue penetration and minimal collateral spread. The goal of this study was to compare the extent of collateral thermal damage in

both monopolar electrocautery and CO2 laser ablation in the spermatic cord during a robotic assisted MDSC (RMDSC) procedure as well as the feasibility for utilizing the flexible fiber-optic

CO2 laser probe after “RMDSC” procedure. RMDSC was performed using standard monopolar electrocautery on the spermatic cord of one side of a fresh human male cadaver (randomly selected) and

then compared to RMDSC using the CO2 laser on the contralateral spermatic cord. Nine histological cross-sections from each cord were measured for depth of collateral thermal/cautery injury.

The mean collateral thermal injury with CO2 laser was 0.17 ± 0.031 mm (range: 0.15–0.25 mm), and with standard electrocautery 0.72 ± 0.046 mm (range: 0.60–0.75 mm). CO2 laser resulted

significantly less collateral thermal injury than standard electrocautery (_p_ < 0.0001). The CO2 laser probe was easy to manipulate with the Black Diamond micro-forceps (Intuitive

Surgical, CA) and allowed for convenient tissue plane dissection. Human cadaveric targeted RMDSC using a flexible CO2 laser energy results in significantly decreased collateral thermal

injury compared to standard monopolar electrocautery. These initial findings suggest potential advantages of the CO2 laser over traditional monopolar cautery in cases requiring minimal

collateral tissue damage. Future studies are needed to assess its clinical potential in microsurgery. Access through your institution Buy or subscribe This is a preview of subscription

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disclosures AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey Ahmet Gudeloglu * John H. Stronger Jr. Hospital of

Cook County, Chicago, IL, USA Ajoe John Kattoor * The PUR Clinic, South Lake Hospital, Clermont, FL, USA Jamin Brahmbhatt & Sijo Parekattil * Cleveland Clinic, Center for Reproductive

Medicine, Cleveland, OH, USA Ashok Agarwal Authors * Ahmet Gudeloglu View author publications You can also search for this author inPubMed Google Scholar * Ajoe John Kattoor View author

publications You can also search for this author inPubMed Google Scholar * Jamin Brahmbhatt View author publications You can also search for this author inPubMed Google Scholar * Sijo

Parekattil View author publications You can also search for this author inPubMed Google Scholar * Ashok Agarwal View author publications You can also search for this author inPubMed Google

Scholar CORRESPONDING AUTHOR Correspondence to Ahmet Gudeloglu. ETHICS DECLARATIONS CONFLICT OF INTEREST The authors declare that they have no conflict of interest. ADDITIONAL INFORMATION

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THIS ARTICLE CITE THIS ARTICLE Gudeloglu, A., Kattoor, A.J., Brahmbhatt, J. _et al._ Prospective control trial: flexible CO2 laser vs. monopolar electrocautery for robotic microsurgical

denervation of the spermatic cord. _Int J Impot Res_ 32, 623–627 (2020). https://doi.org/10.1038/s41443-020-00352-0 Download citation * Received: 16 August 2019 * Revised: 13 August 2020 *

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