Tissue effects of advanced energy devices: a systematic review and descriptive analysis of vascular sealing and lateral thermal damage in human tissue

Introduction

Advanced energy devices such as bipolar and ultrasonic devices are used ubiquitously in all aspects of surgery. Despite studies demonstrating differences between animal and human tissues, existing human studies have only been conducted in terms of operative outcomes such as blood loss, with a paucity of data on vessel sealing and lateral thermal spread. This study aims to consolidate all existing literature on these characteristics for each device in human tissues to inform clinician decision making.

Methods

A systematic review of the literature was carried out using PRISMA guidelines. Papers which discussed vessel sealing or lateral thermal spread with any methodology were included. Exclusion criteria included animal studies, conference abstracts or papers where full text English language papers were not available. Risk of bias was assessed using ROB2, ROBINS-I v2, CASP case–control and JBI case series checklists as appropriate for the study design. A descriptive analysis was undertaken.

Results and discussion

Across the twenty-eight included studies, most vessel seals with bipolar and ultrasonic devices exceeded physiological burst pressures. Seal failures occurred unpredictably. Lateral thermal spread varied widely (0–7.64 mm) depending on the device and tissue examined as well as the testing methodology and definitions of lateral thermal spread. Due to substantial variation in study methods, direct statistical comparisons were not possible and a reliable device-to-device comparison cannot currently be made from the available literature. This highlights the need for standardized testing methodology.

PROSPERO registration and full protocol availability: CRD420251239034