Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Common uses and cited complications of energy in surgery



Instruments that apply energy to cut, coagulate, and dissect tissue with minimal bleeding facilitate surgery. The improper use of energy devices may increase patient morbidity and mortality. The current article reviews various energy sources in terms of their common uses and safe practices.


For the purpose of this review, a general search was conducted through NCBI, SpringerLink, and Google. Articles describing laparoscopic or minimally invasive surgeries using single or multiple energy sources are considered, as are articles comparing various commercial energy devices in laboratory settings. Keywords, such as laparoscopy, energy, laser, electrosurgery, monopolar, bipolar, harmonic, ultrasonic, cryosurgery, argon beam, laser, complications, and death were used in the search.


A review of the literature shows that the performance of the energy devices depends upon the type of procedure. There is no consensus as to which device is optimal for a given procedure. The technical skill level of the surgeon and the knowledge about the devices are both important factors in deciding safe outcomes.


As new energy devices enter the market increases, surgeons should be aware of their indicated use in laparoscopic, endoscopic, and open surgery.

This is a preview of subscription content, log in to check access.


  1. 1.

    Wu M-P, Ou C-S, Chen S-L, Yen EYT, Rowbotham R (2000) Complications and recommended practices for electrosurgery in laparoscopy. Am J Surg 179(1):67–73

  2. 2.

    Feldman L, Fuchshuber P, Jones D, Mischna J, Schwaitzberg S, Force FT (2012) Surgeons don’t know what they don’t know about the safe use of energy in surgery. Surg Endosc 26(10):2735–2739. doi:10.1007/s00464-012-2263-y

  3. 3.

    Cushing H, Bovie WT (1928) Electrosurgery as an aid to the removal of intracranial tumors. Surg Gynecol Obstet 47:751–784

  4. 4.

    Albert M, Ellis CN, Fleshman J, Margolin D, Ng PC, Podnos YD (2010) The effective use of the ENSEAL system in colorectal surgery

  5. 5.

    Lee J (2002) Update on electrosurgery. Outpatient Surg 3(2)

  6. 6.

    Govekar H, Robinson T, Varosy P, Girard G, Montero P, Dunn C et al (2012) Effect of monopolar radiofrequency energy on pacemaker function. Surg Endosc 26(10):2784–2788. doi:10.1007/s00464-012-2279-3

  7. 7.

    Montero P, Robinson T, Weaver J, Stiegmann G (2009) Insulation failure in laparoscopic instruments. Surg Endosc 24(2):462–465. doi:10.1007/s00464-009-0601-5

  8. 8.

    Vancaillie TG (1998) Active electrode monitoring. Surg Endosc 12(8):1009–1012. doi:10.1007/s004649900769

  9. 9.

    Valleylab. (1999) Basics of bipolar electrosurgery. Clin Inform Hotline News

  10. 10.

    Kim F, Chammas M, Gewehr E, Morihisa M, Caldas F, Hayacibara E et al (2008) Temperature safety profile of laparoscopic devices: harmonic ACE (ACE), Ligasure V(LV), and plasma trisector (PT). Surg Endosc 22(6):1464–1469

  11. 11.

    Box GN, Lee HJ, Abraham JB, Deane LA, Elchico ER, Abdelshehid CA et al (2009) Comparative study of in vivo lymphatic sealing capability of the porcine thoracic duct using laparoscopic dissection devices. J Urol 181(1):387–391

  12. 12.

    Sutton PA, Awad S, Perkins AC, Lobo DN (2010) Comparison of lateral thermal spread using monopolar and bipolar diathermy, the Harmonic Scalpel™ and the Ligasure™. Br J Surg 97(3):428–433

  13. 13.

    Tulikangas PK, Smith T, Falcone T, Boparai N, Walters MD (2001) Gross and histologic characteristics of laparoscopic injuries with four different energy sources. Fertil Steril 75(4):806–810

  14. 14.

    Gol M, Kizilyar A, Eminoglu M (2007) Laparoscopic hysterectomy with retroperitoneal uterine artery sealing using LigaSure: Gazi hospital experience. Arch Gynecol Obstet 276(4):311–314

  15. 15.

    Kriplani A, Garg P, Sharma M, Lal S, Agarwal N (2008) A review of total laparoscopic hysterectomy using LigaSure uterine artery-sealing device: AIIMS experience. J Laparoendosc Adv Surg Tech A 18(6):825–829

  16. 16.

    Polychronidis A, Tsaroucha AK, Karayiannakis AJ, Perente S, Efstathiou E, Simopoulos C (2005) Delayed perforation of the large bowel due to thermal injury during laparoscopic cholecystectomy. J Int Med Res 33:360–363

  17. 17.

    Siperstein A, Garland A, Engle K, Rogers S, Berber E, Foroutani A et al (2000) Local recurrence after laparoscopic radiofrequency thermal ablation of hepatic tumors. Ann Surg Oncol 7(2):106–113

  18. 18.

    Darai E, Ackerman G, Bazot M, Rouzier R, Dubernard G (2007) Laparoscopic segmental colorectal resection for endometriosis: limits and complications. Surg Endosc 21(9):1572–1577

  19. 19.

    Berber E, Siperstein A (2008) Local recurrence after laparoscopic radiofrequency ablation of liver tumors: an analysis of 1032 tumors. Ann Surg Oncol 15(10):2757–2764

  20. 20.

    Peterson HB, Ory HW, Greenspan JR Jr, Tyler CW Jr (1981) Deaths associated with laparoscopic sterilization by unipolar electrocoagulating devices, 1978 and 1979. Am J Obstet Gynecol 139(2):141–143

  21. 21.

    Willson PD, McAnena OJ, Peters EE (1994) A fatal complication of diathermy in laparoscopic surgery. Minim Invasive Ther Allied Technol 3(1):19–20. doi:10.3109/13645709409152989

  22. 22.

    Agarwal B, Gupta M, Agarwal S, Mahajan K (2007) Anatomical footprint for safe laparoscopic cholecystectomy without using any energy source: a modified technique. Surg Endosc 21(12):2154–2158

  23. 23.

    Matthews B, Nalysnyk L, Estok R, Fahrbach K, Banel D, Linz H et al (2008) Ultrasonic and nonultrasonic instrumentation: a systematic review and meta-analysis. Arch Surg 143(6):592–600. doi:10.1001/archsurg.143.6.592

  24. 24.

    Hubner M, Demartines N, Muller S, Dindo D, Clavien PA, Hahnloser D (2008) Prospective randomized study of monopolar scissors, bipolar vessel sealer and ultrasonic shears in laparoscopic colorectal surgery. Br J Surg 95(9):1098–1104

  25. 25.

    Targarona EM, Balague C, Marin J, Neto RB, Martinez C, Garriga J et al (2005) Energy sources for laparoscopic colectomy: a prospective randomized comparison of conventional electrosurgery, bipolar computer-controlled electrosurgery and ultrasonic dissection. Operative outcome and costs analysis. Surg Innov 12(4):339–344. doi:10.1177/155335060501200409

  26. 26.

    Hruby GW, Marruffo FC, Durak E, Collins SM, Pierorazio P, Humphrey PA et al (2007) Evaluation of surgical energy devices for vessel sealing and peripheral energy spread in a porcine model. J Urol 178(6):2689–2693

  27. 27.

    Edelman DS, Unger SW (1995) Bipolar versus monopolar cautery scissors for laparoscopic cholecystectomy: a randomized, prospective study. Surg Laparosc Endosc 5(6):459–462

  28. 28.

    Campagnacci R, de Sanctis A, Baldarelli M, Rimini M, Lezoche G, Guerrieri M (2007) Electrothermal bipolar vessel sealing device vs. ultrasonic coagulating shears in laparoscopic colectomies: a comparative study. Surg Endosc 21(9):1526–1531

  29. 29.

    Demirturk F, Aytan H, Caliskan AC (2007) Comparison of the use of electrothermal bipolar vessel sealer with harmonic scalpel in total laparoscopic hysterectomy. J Obstet Gynaecol Res 33:341–345

  30. 30.

    Lamberton GR, Hsi RS, Jin DH, Lindler TU, Jellison FC, Baldwin DD (2008) Prospective comparison of four laparoscopic vessel ligation devices. J Endourol 22(10):2307–2312

  31. 31.

    Dodde R, Gee JS, Geiger JD, Shih AJ (2010) Monopolar electrosurgical thermal management system to reduce lateral thermal damage during surgery. J Med Device 4(2):1–027505

  32. 32.

    Davison T, Amaral J, Geis P, Swansrom L, Sinha UK (2008) The science of ultrasonic energy‐based dissection. General Surgery News.

  33. 33.

    Amaral JF (1995) Laparoscopic cholecystectomy in 200 consecutive patients using an ultrasonically activated scalpel. Surg Laparosc Endosc 5(4):255–262

  34. 34.

    O’Daly BJ, Morris E, Gavin GP, O’Byrne JM, McGuinness GB (2008) High-power low-frequency ultrasound: a review of tissue dissection and ablation in medicine and surgery. J Mater Process Technol 200(1–3):38–58

  35. 35.

    Smith R, Pasic R (2008) The role of vessel sealing technologies in laparoscopic surgery. Surg Technol Int 17:208–212

  36. 36.

    Kinoshita T, Kanehira E, Omura K, Kawakami K, Watanabe Y (1999) Experimental study on heat production by a 23.5‐kHz ultrasonically activated device for endoscopic surgery. Surgical Endoscopy 13(6):621–625

  37. 37.

    Lee SJ, Park KH (1999) Ultrasonic energy in endoscopic surgery. Yonsei Med J 40(6):545–549

  38. 38.

    Liano C (2004) Curbing laparoscopy burns. The Washington Times website. http://www.upi.com/Science_News/2004/06/21/Feature-Curbing-laparoscopy-burns/UPI-52511087842993/. Accessed 39 June 2004

  39. 39.

    Ghosh P (1999) Ultrasonic devices in cardiac surgery. Asian Cardiovasc Thorac Ann 7(4):333–338

  40. 40.

    Clements R, Palepu R (2007) In vivo comparison of the coagulation capability of SonoSurg and Harmonic Ace on 4-mm and 5-mm arteries. Surg Endosc 21(12):2203–2206

  41. 41.

    Harold KL, Pollinger H, Matthews BD, Kercher KW, Sing RF, Heniford BT (2003) Comparison of ultrasonic energy, bipolar thermal energy, and vascular clips for the hemostasis of small-, medium-, and large-sized arteries. Surg Endosc 17(8):1228–1230

  42. 42.

    Wolfe BM, Gardiner BN, Leary BF, Frey CF (1991) Endoscopic cholecystectomy: an analysis of complications. Arch Surg 126(10):1192–1198. doi:10.1001/archsurg.1991.01410340030005

  43. 43.

    Kadesky KM, Schopf B, Magee JF, Blair GK (1997) Proximity injury by the ultrasonically activated scalpel during dissection. J Pediatr Surg 32(6):878–879

  44. 44.

    Awwad JT, Isaacson K (1996) The harmonic scalpel: an intraoperative complication. Obstet Gynecol 88(4):718–720

  45. 45.

    McNally ML, Erturk E, Oleyourryk G, Schoeniger L (2001) Laparoscopic cyst decortication using the harmonic scalpel for symptomatic autosomal dominant polycystic kidney disease. J Endourol 15(6):597–599

  46. 46.

    Kim JS, Hattori R, Yamamoto T, Yoshino Y, Gotoh M (2010) How can we safely use ultrasonic laparoscopic coagulating shears? Int J Urol 17:377–381

  47. 47.

    Emam TA, Cuschieri A (2003) How safe is high-power ultrasonic dissection? Ann Surg 237(2):186–191

  48. 48.

    Kinoshita T, Kanehira E, Omura K (1999) Basic experiments to evaluate the safety of a fine caliber ultrasonically activated device. JSES 4:473–478.

  49. 49.

    Schwartz RO (1994) Total laparoscopic total hysterectomy with the harmonic scalpel. J Gynecol Surg 10(1):33–34

  50. 50.

    Giannopoulos T, Chipchase J, Tailor A, Butler-Manuel S (2005) The use of harmonic shears (Ultracision) for laparoscopic lymphadenectomies in women with gynaecological malignancies. Gynecol Surg 2(2):97–100

  51. 51.

    Jansen FW, Trimbos-Kemper T, Baptist Trimbos J (2002) Ultrasonic scalpel in laparoscopic gynaecological surgery: an observational study in 354 cases. Gynaecol Endosc 11(1):47–51

  52. 52.

    Lin J, Zhang X, Xu K (2001) Application of ultrasonic scalpel in gynecologic operative laparoscopy. Chin Med J 114(12):1283–1285

  53. 53.

    Amarin NS (2008) Harmonic scalpel and clipless cholecystectomy. World J Laparosc Surg 1(2):6–8

  54. 54.

    Gelmini R, Franzoni C, Zona S, Andreotti A, Saviano M (2010) Laparoscopic cholecystectomy with harmonic scalpel. JSLS 14(1):14–19

  55. 55.

    Janssen IMC, Swank DJ, Boonstra O, Knipscheer BC, Klinkenbijl JHG, van Goor H (2003) Randomized clinical trial of ultrasonic versus electrocautery dissection of the gallbladder in laparoscopic cholecystectomy. Br J Surg 90(7):799–803

  56. 56.

    Elattar OM, Naga AAE, Maged H (2005) Laparoscopic appendectomy by ultrasonically activated scalpel: a prospective study. Egypt J Surg 24(3):164–167

  57. 57.

    Lin PC, Thyer A, Soules MR (2004) Intraoperative ultrasound during a laparoscopic myomectomy. Fertil Steril 81(6):1671–1674

  58. 58.

    Stringer NH (1994) Laparoscopic myomectomy with the harmonic scalpel: a review of 25 cases. J Gynecol Surg 10(4):241–245

  59. 59.

    Msika S, Deroide G, Kianmanesh R, Iannelli A, Hay J-M, Fingerhut A et al (2001) Harmonic scalpel in laparoscopic colorectal surgery. Dis Colon Rectum 44(3):432–436

  60. 60.

    Vetere PF, Apostolis C (2010) Ureteral injury due to a harmonic scalpel during laparoscopic salpingo-oophorectomy. JSLS 14(1):115–119

  61. 61.

    Chachan S, Waters N, Kent A (2011) Laparoscopic management of cornual heterotopic pregnancy with the use of Harmonic ACE®—a case report. Gynecol Surg 8: 243–246

  62. 62.

    Tanaka T, Ueda K, Hayashi M, Hamano K (2009) Clinical application of an ultrasonic scalpel to divide pulmonary vessels based on laboratory evidence. Interact Cardiovasc Thorac Surg 8(6):615–618. doi:10.1510/icvts.2008.200584

  63. 63.

    Driscoll P (2006) Energy-based devices in general surgery. MedMarket Diligence

  64. 64.

    Bruhat M, Mage C, Manhes M (1979) Use of carbon dioxide laser via laparoscopy. Laser Surgery III Proceedings of the Third Congress for the International Society for Laser Surgery, Kaplan

  65. 65.

    Sutton C (1986) Initial experience with carbon dioxide laser laparoscopy. Lasers Med Sci 1(1):25–31

  66. 66.

    Hamman BL, Theologes TT (2009) Surgical treatment of atrial fibrillation with diode-pumped laser. Baylor Univ Med Center Proc 22:218–220

  67. 67.

    Williams MR, Casher JM, Russo MJ, Hong KN, Argenziano M, Oz MC (2006) Laser energy source in surgical atrial fibrillation ablation: preclinical experience. Ann Thorac Surg 82(6):2260–2264

  68. 68.

    Welch AJ, Torres JH, Cheong W-F (1989) Laser physics and laser–tissue interaction. Tex Heart Inst J 16(3):141–149

  69. 69.

    Gerber GS (1995) Lasers in the treatment of benign prostatic hyperplasia. Urology 45(2):193–199

  70. 70.

    Baggish MS, Daniell JF (1989) Death caused by air embolism associated with neodymium:yttrium–aluminum–garnet laser surgery and artificial sapphire tips. Am J Obstet Gynecol 161(4):877–878

  71. 71.

    Challener RC, Kaufman B (1990) Fatal venous air embolism following sequential unsheathed (bare) and sheathed quartz fiber Nd:YAG laser endometrial ablation. Anesthesiology 73(3):548–551

  72. 72.

    Greville AC, Clements EAF, Erwin DC, McMillan DL, Wellwood JM (1991) Pulmonary air embolism during laparoscopic laser cholecystectomy. Anaesthesia 46:113–114

  73. 73.

    Lang NP, Wait GM, Read RR (1991) Cardio-cerebrovascular complications from Nd:YAG laser treatment of lung cancer. Am J Surg 162(6):629–632

  74. 74.

    Messiant F, Marquette C, Neviere R, Ramon P, Duverger D, Mathieu D (1995) Systemic air embolism after laser resection of a tracheal tumor. Intensive Care Med 21(2):192–193

  75. 75.

    Peachey T, Eason J, Moxham J, Jarvis D, Driver M (1988) Systemic air embolism during laser bronchoscopy. Anaesthesia 43(10):872–875

  76. 76.

    Ross DJ, Mohsenifar Z, Potkin RT, Roston WL, Shapiro SM, Alexander JM (1988) Pathogenesis of cerebral air embolism during neodymium-YAG laser photoresection. Chest 94(3):660–662

  77. 77.

    Yuan HB, Poon KS, Chan KH, Lee TY, Lin CY (1993) Fatal gas embolism as a complication of Nd-YAG laser surgery during treatment of bilateral choanal stenosis. Int J Pediatr Otorhinolaryngol 27(2):193–199

  78. 78.

    Baggish MS, Daniell JF (1989) Catastrophic injury secondary to the use of coaxial gas-cooled fibers and artificial sapphire tips for intrauterine surgery: a report of five cases. Lasers Surg Med 9(6):581–584

  79. 79.

    Kelly M, Mathews HML, Weir P (1997) Carbon dioxide embolism during laser endometrial ablation. Anaesthesia 52(1):65–67

  80. 80.

    Schröder TM, Puolakkainen PA, Hahl J, Rämö OJ (1989) Fatal air embolism as a complication of laser-induced hyperthermia. Lasers Surg Med 9(2):183–185

  81. 81.

    Tellides G, Ugurlu BS, Kim RW, Hammond GL (1998) Pathogenesis of systemic air embolism during bronchoscopic Nd:YAG laser operations. Ann Thorac Surg 65(4):930–934

  82. 82.

    Genyk YS, Keller FS, Halpern NB (1994) Hepatic artery pseudoaneurysm and hemobilia following laser laparoscopic cholecystectomy. Surg Endosc 8(3):201–204

  83. 83.

    Ewen S, Sutton CJG (1995) Complications of laser laparoscopy: eleven years experience. Minim Invasive Ther Allied Technol 4(1):27–29. doi:10.3109/13645709509152749

  84. 84.

    Reddick EJ, Olsen DO (1989) Laparoscopic laser cholecystectomy. Surg Endosc 3(3):131–133

  85. 85.

    Goldenberg M, Bider D et al (1994) Pregnancy: laparoscopic laser surgery of primary ovarian pregnancy. Hum Reprod 9(7):1337–1338

  86. 86.

    Langebrekke A, Kirschner R, SkÃ¥r OJ, Sørnes T, Urnes A (1991) Treatment of tubal pregnancy by laparoscopic laser surgery. Acta Obstet Gynecol Scand 70(4–5):331–334. doi:10.3109/00016349109007882

  87. 87.

    Langebrekke A, Sarnes T, Urnes A (1993) Fertility outcome after treatment of tubal pregnancy by laparoscopic laser surgery. Acta Obstet Gynecol Scand 72(7):547–549. doi:10.3109/00016349309058161

  88. 88.

    Sutton CJG, Ewen SP, Jacobs SA, Whitelaw NL (1997) Laser laparoscopic surgery in the treatment of ovarian endometriomas. J Am Assoc Gynecol Laparosc 4(3):319–323

  89. 89.

    Weather LJ (1988) Carbon dioxide laser laparoscopy in treatment of infertility and disorders associated with pelvic pain. J Natl Med Assoc 80(2):185–187

  90. 90.

    Shumalinsky D, Lobik L, Cytron S, Halpern M, Vasilyev T, Ravid A et al (2004) Laparoscopic laser soldering for repair of ureteropelvic junction obstruction in the porcine model. J Endourol 18(2):177–181. doi:10.1089/089277904322959833

  91. 91.

    Karaman Y, Bingol B, Günenç Z (2006) Prevention of complications in laparoscopic hysterectomy: experience with 1120 cases performed by a single surgeon. J Minim Invasive Gynecol 14(1):78–84

  92. 92.

    Liu CY (1992) Laparoscopic hysterectomy. A review of 72 cases. J Reprod Med 37(4):351–354

  93. 93.

    Wishnow KI, Johnson DE, Cromeens DM, Ro JY (1989) Laser photoirradiation of the canine ureteral orifice: comparison between contact and noncontact techniques. Lasers Surg Med 9(5):485–489

  94. 94.

    Ward PH, Castro DJ, Ward S (1989) A significant new contribution to radical head and neck surgery: the argon beam coagulator as an effective means of limiting blood loss. Arch Otolaryngol Head Neck Surg 115(8):921–923. doi:10.1001/archotol.1989.01860320031013

  95. 95.

    Low RK, Moran ME (1993) Laparoscopic argon beam coagulation: implications for reconstructive urology. Minim Invasive Ther Allied Technol 2(2):75–78. doi:10.3109/13645709309152671

  96. 96.

    Bowling DM (2002) Argon beam coagulation for post-tonsillectomy hemostasis. Otolaryngol Head Neck Surg 126(3):316–320

  97. 97.

    Cornejo A, Liao L, Kenneth W (2010) Argon gas embolism with the use of argon beam coagulation during open hepatic resection. Internet J Surg 22(2)

  98. 98.

    Ikegami T, Shimada M, Imura S, Nakamura T, Kawahito S, Morine Y et al (2009) Argon gas embolism in the application of laparoscopic microwave coagulation therapy. J Hepatobiliary Pancreat Surg 16(3):394–398

  99. 99.

    Bateman SN, Noorily AD, McGuff HS (1996) Sharp dissection, electrosurgery, and argon-enhanced electrosurgery in porcine skin flaps. Otolaryngol Head Neck Surg 114(3):435–442

  100. 100.

    Kono M, Yahagi N, Kitahara M, Fujiwara Y, Sha M, Ohmura A (2001) Cardiac arrest associated with use of an argon beam coagulator during laparoscopic cholecystectomy. Eur J Cardiothorac Surg 87(4):644–646. doi:10.1093/bja/87.4.644

  101. 101.

    Sezeur A, Partensky C, Chipponi J, Duron J–J (2008) Death during laparoscopy: can 1 gas push out another? Danger of argon electrocoagulation. Surg Laparosc Endosc Percutan Tech 18(4):395–397

  102. 102.

    (1994) Fatal gas embolism caused by overpressurization during laparoscopic use of argon enhanced coagulation. Health Devices 23(6):257–259

  103. 103.

    Ousmane ML, Fleyfel M, Vallet B (2002) Venous gas embolism during liver surgery with argon-enhanced coagulation. Eur J Anaesthesiol 19(3):225

  104. 104.

    Kizer N, Zighelboim I, Rader JS (2009) Cardiac arrest during laparotomy with argon beam coagulation of metastatic ovarian cancer. Int J Gynecol Cancer 19(2):237–238. doi:10.1111/IGC.0b013e31819c54db

  105. 105.

    Mastragelopulos N, Sarkar MR, Kaissling G, Bähr R, Daub D (1992) Argon gas embolism in laparoscopic cholecystectomy with the Argon Beam One coagulator. Chirurg 63(12):1053–1054

  106. 106.

    Reddy C, Majid A, Michaud G, Feller-Kopman D, Eberhardt R, Herth F et al (2008) Gas embolism following bronchoscopic argon plasma coagulation. Chest 134(5):1066–1069. doi:10.1378/chest.08-0474

  107. 107.

    Stojeba N, Mahoudeau G, Segura P, Meyer C, Steib A (1999) Possible venous argon gas embolism complicating argon gas enhanced coagulation during liver surgery. Acta Anaesthesiol Scand 43(8):866–867

  108. 108.

    Veyckemans F, Michel I (1996) Venous gas embolism from an argon coagulator. Anesthesiology 85(2):443–444

  109. 109.

    Kwon AH, Inui H, Kamiyama Y (2001) Successful laparoscopic haemostasis using an argon beam coagulator for blunt traumatic splenic injury. Eur J Surg 167(4):316–318

  110. 110.

    Lurie S, Gur D, Glezerman M (2002) Argon beam coagulation during caesarean section. BJOG 109(12):1415

  111. 111.

    Lucioni A, Orvieto MA, Zorn KC, Lotan T, Gong EM, Steinberg GD et al (2008) Efficacy of the argon beam coagulator alone in obtaining hemostasis after laparoscopic porcine heminephrectomy: a pilot study. Can J Urol 15(3):4091–4096

  112. 112.

    Meyer-Junghaenel L, Giest H, Waldschmidt Jr (2001) Laparoscopic argon-beam coagulation in relapsing congenital dysontogenetic splenic cysts. Pediatr Endosurg Innov Tech 5(3):315–318. doi:10.1089/10926410152634466

  113. 113.

    Okada T, Sasaki F, Kurauchi N, Kubota M, Itoh T, Honda S et al (2007) Laparoscopic liver biopsy using cup-shaped punch biopsy forceps and argon beam coagulator in children. Pediatr Surg Int 23(10):947–951

  114. 114.

    Dowling RD, Ochoa J, Yousem SA, Peitzman A, Udekwu AO (1991) Argon beam coagulation is superior to conventional techniques in repair of experimental splenic injury. J Trauma 31(5):717–721

  115. 115.

    Palmer M, Miller CW III, Orton EC (1993) Venous gas embolism associated with argon-enhanced coagulation of the liver. J Invest Surg 6(5):391–399

  116. 116.

    Falbo B, Vene M, Visini R, Grottola T, Di Paolo S, Picardi N (2004) Experimental study of the effect of the argon beam coagulator on organic tissues from the viewpoint of surgical utilization. Ann Ital Chir 75(1):59–62

  117. 117.

    Bobbio A, Ampollini L, Internullo E, Caporale D, Cattelani L, Bettati S et al (2006) Thoracoscopic parietal pleural argon beam coagulation versus pleural abrasion in the treatment of primary spontaneous pneumothorax. Eur J Cardiothorac Surg 29(1):6–8. doi:10.1016/j.ejcts.2005.10.034

  118. 118.

    Beyer E, Lee R, Lam B-K (2009) Minimally invasive bipolar radiofrequency ablation of lone atrial fibrillation: early multicenter results. J Thorac Cardiovasc Surg 137(3):521–526

  119. 119.

    Currò G, Iapichino G, Melita G, Lorenzini C, Cucinotta E (2005) Laparoscopic cholecystectomy in Child-Pugh class C cirrhotic patients. JSLS 9(3):311–315

  120. 120.

    Saad EB, Marrouche NF, Saad CP, Ha E, Bash D, White RD et al (2003) Radiofrequency treatment of abnormal heart rhythm can damage the vessels that return blood from the lungs to the heart. Ann Intern Med 138(8):1

  121. 121.

    Keltner JR, Donegan E, Hynson JM, Shapiro WA (2001) Acute renal failure after radiofrequency liver ablation of metastatic carcinoid tumor. Anesth Analg 93:587–589

  122. 122.

    Kocovic DZ, Harada T, Shea JB, Soroff D, Friedman PL (1993) Alterations of heart rate and of heart rate variability after radiofrequency catheter ablation of supraventricular tachycardia. Delineation of parasympathetic pathways in the human heart. Circulation 88(4):1671–1681

  123. 123.

    Curley SA, Marra P, Beaty K et al (2004) Early and late complications after radiofrequency ablation of malignant liver tumors in 608 patients. Ann Surg 239(4):450–458

  124. 124.

    Protsenko DE, Zemek A, Wong BJF (2007) Simulation of laser induced thermo-mechanical changes in tissue using RF heating method. In: Thermal treatment of tissue: energy delivery and assessment IV; Proc. SPIE 6440, San Jose, CA, USA.

  125. 125.

    Koffron AJ, Stein JA (2008) Laparoscopic liver surgery: parenchymal transection using saline-enhanced electrosurgery. HPB (Oxford) 10(4):225–228

  126. 126.

    Yim APC, Rendina EA, Hazelrigg SR, Chow LTC, Lee T-W, Wan S et al (2002) A new technological approach to nonanatomical pulmonary resection: saline enhanced thermal sealing. Ann Thorac Surg 74(5):1671–1676

  127. 127.

    Gozen AS, Teber D, Rassweiler JJ (2007) Principles and initial experience of a new device for dissection and hemostasis. Minim Invasive Ther Allied Technol 16(1):58–65. doi:10.1080/13645700701191537

  128. 128.

    Zarebczan B, Mohanty D, Chen H (2011) A comparison of the LigaSure and harmonic scalpel in thyroid surgery: a single institution review. Ann Surg Oncol 18(1):214–218

  129. 129.

    Munver R, Del Pizzo J, Sosa R (2003) Adrenal-preserving minimally invasive surgery: the role of laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation of the adrenal gland. Curr Urol Rep 4(1):87–92

  130. 130.

    Smulders J, de Hingh I, Stavast J, Jackimowicz J (2007) Exploring new technologies to facilitate laparoscopic surgery: creating intestinal anastomoses without sutures or staples, using a radio-frequency-energy-driven bipolar fusion device. Surg Endosc 21(11):2105–2109

  131. 131.

    Soon PSH, Yeh MW, Sywak MS, Sidhu SB (2006) Use of the Ligasure vessel sealing system in laparoscopic adrenalectomy. ANZ J Surg 76(9):850–852

  132. 132.

    Hope WW, Burns JM, Newcomb WL, Heniford BT, Sing RF (2009) Safety and efficacy of the electrothermal bipolar vessel sealer in trauma. J Endourol 40(5):564–566

  133. 133.

    Kimura M, Baba S, Polascik TJ (2010) Minimally invasive surgery using ablative modalities for the localized renal mass. Int J Urol 17(3):215–227

  134. 134.

    Oefelein MG (2006) Delayed presentation of urinoma after radiofrequency ablation-assisted laparoscopic partial nephrectomy. J Endourol 20(1):27–30. doi:10.1089/end.2006.20.27

  135. 135.

    Onishi T, Nishikawa K, Hasegawa Y et al (2007) Assessment of health-related quality of life after radiofrequency ablation or laparoscopic surgery for small renal cell carcinoma: a prospective study with medical outcomes study 36-item health survey (SF-36). Jpn J Clin Oncol 37(10):750–754

  136. 136.

    Bachellier P, Ayav A, Pai M, Jean-Christopher W, Edoardo R, Daniel J et al (2007) Laparoscopic liver resection assisted with radiofrequency. Am J Surg 193(4):427–430

  137. 137.

    Hompes D, Aerts R, Penninckx F, Topal B (2007) Laparoscopic liver resection using radiofrequency coagulation. Surg Endosc 21(2):175–180

  138. 138.

    Tan BJ, El-Hakim A, Nora M, Yavor S, Arthur S, Benjamin R (2004) Comparison of laparoscopic saline infused to dry radio frequency ablation of renal tissue: evolution of histological infarct in the porcine model. J Urol 172(5):2007–2012

  139. 139.

    Asahina Y, Nakanishi H, Izumi N (2009) Laparoscopic radiofrequency ablation for hepatocellular carcinoma. Dig Endosc 21(2):67–72

  140. 140.

    Sadiq TS, Shrestha R, Weeks S, Gerber DA (2004) Laparoscopic radiofrequency ablation provides local control of hepatocellular carcinoma in patients awaiting liver transplant. J Am Coll Surg 199(3):16

  141. 141.

    van den Bos R, Lidia A, Michael K, Martino N, Tamar N (2009) Endovenous therapies of lower extremity varicosities: a meta-analysis. J Vasc Surg 49(1):230–239

  142. 142.

    Weil L Jr, Glover JP, Weil LS Sr (2008) A new minimally invasive technique for treating plantar fasciosis using bipolar radiofrequency: a prospective analysis. Foot Ankle Spec 1(1):13–18

  143. 143.

    Hüscher CGS, Lirici MM, Di Paola M, Crafa F, Napolitano C, Mereu A et al (2003) Laparoscopic cholecystectomy by ultrasonic dissection without cystic duct and artery ligature. Surg Endosc 17(3):442–451

  144. 144.

    Redwan AA (2010) Single-working-instrument, double-trocar, clipless cholecystectomy using harmonic scalpel: a feasible, safe, and less invasive technique. J Laparoendosc Adv Surg Tech 20(7):597–603. doi:10.1089/lap.2009.0375

  145. 145.

    Harrell AG, Kercher KW, Heniford BT (2004) Energy sources in laparoscopy. Surg Innov 11(3):201–209. doi:10.1177/107155170401100310

  146. 146.

    Berry SM, Ose KJ, Bell RH, Fink AS (1994) Thermal injury of the posterior duodenum during laparoscopic cholecystectomy. Surg Endosc 8(3):197–200

  147. 147.

    Giger U, Michel JM, Vonlanthen R, Becker K, Kocher T, Krähenbühl L (2005) Laparoscopic cholecystectomy in acute cholecystitis: indication, technique, risk and outcome. Langenbecks Arch Surg 390(5):373–380

  148. 148.

    Peters JH, Ellison EC, Innes JT, Liss JL, Nichols KL, Lomano JM et al (1991) Safety and efficacy of laparoscopic cholecystectomy. A prospective analysis of 100 initial patients. Ann Surg 213(1):3–12

  149. 149.

    Kandil T, El Nakeeb A, El Hefnawy E (2010) Comparative study between clipless laparoscopic cholecystectomy by harmonic scalpel versus conventional method: a prospective randomized study. J Gastrointest Surg 14(2):323–328

  150. 150.

    Tsimoyiannis EC, Jabarin M, Glantzounis G, Lekkas ET, Siakas P, Stefanaki-Nikou S (1998) Laparoscopic cholecystectomy using ultrasonically activated coagulating shears. Surg Laparosc Endosc 8(6):421–424

  151. 151.

    Lane GE, Lathrop JC (1993) Comparison of results of KTP/532 laser versus monopolar electrosurgical dissection in laparoscopic cholecystectomy. J Laparoendosc Surg 3(3):209–214

  152. 152.

    Bordelon BM, Hobday KA, Hunter JG (1993) Laser vs electrosurgery in laparoscopic cholecystectomy. A prospective randomized trial. Arch Surg 128(2):233–236

  153. 153.

    El Nakeeb A, Askar W, El Lithy R, Farid M (2010) Clipless laparoscopic cholecystectomy using the Harmonic scalpel for cirrhotic patients: a prospective randomized study. Surg Endosc 24(10):2536–2541

  154. 154.

    (1991) A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 324(16):1073–1078. doi:10.1056/NEJM199104183241601

  155. 155.

    Kurauchi N, Kamii N, Kazui K, Saji Y, Uchino J (1998) Laparoscopic cholecystectomy: a report on the community hospital experience in Hokkaido. Surg Today 28(7):714–718. doi:10.1007/bf02484617

  156. 156.

    Hideki N, Masato N, Norihiro Y et al (2003) Electrosurgical devices for abdominal surgery: comparison between monopolar devices and bipolar scissors. Surg Ther 89(1):8–13

  157. 157.

    Mantke R, Halangk W, Habermann A, Peters B, Konrad S, Guenther M et al (2011) Efficacy and safety of 5-mm-diameter bipolar and ultrasonic shears for cutting carotid arteries of the hybrid pig. Surg Endosc 25(2):577–585

  158. 158.

    Richter S, Kollmar O, Schilling M, Pistorius G, Menger M (2006) Efficacy and quality of vessel sealing. Surg Endosc 20(6):890–894

  159. 159.

    Carbonell AM, Joels CS, Kercher KW, Matthews BD, Sing RF, Heniford BT (2003) A comparison of laparoscopic bipolar vessel sealing devices in the hemostasis of small-, medium-, and large-sized arteries. J Laparoendosc Adv Surg Tech 13(6):377–380

  160. 160.

    Goldstein SL, Harold KL, Lentzner A, Matthews BD, Kercher KW, Sing RF et al (2002) Comparison of thermal spread after ureteral ligation with the laparo-sonic ultrasonic shears and the Ligasure system. J Laparoendosc Adv Surg Tech 12(1):61–63. doi:10.1089/109264202753486957

  161. 161.

    Phillips CK, Hruby GW, Durak E, Lehman DS, Humphrey PA, Mansukhani MM et al (2008) Tissue response to surgical energy devices. Urology 71(4):744–748

  162. 162.

    Newcomb W, Hope W, Schmelzer T, Heath J, Norton H, Lincourt A, et al. (2009) Comparison of blood vessel sealing among new electrosurgical and ultrasonic devices. Surg Endosc 23(1):90–6.

  163. 163.

    Wetter PA, Kavic MS et al (1999) Prevention and management of laparoendoscopic surgical complications. Society of Laparoendoscopic Surgeons, Boston

Download references


Drs. Ganesh Sankaranarayanan, Rajeswara Resapu, Daniel B. Jones, Steven Schwaitzberg, and Suvranu De have no conflict of interest or financial ties to disclose.


NIBIB/NIH Grants # R01EB010037, # R01 EB009362, # R01 EB005807 and # R01 EB014305.

Author information

Correspondence to Suvranu De.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Sankaranarayanan, G., Resapu, R.R., Jones, D.B. et al. Common uses and cited complications of energy in surgery. Surg Endosc 27, 3056–3072 (2013). https://doi.org/10.1007/s00464-013-2823-9

Download citation


  • Minimally invasive surgery
  • Electrosurgery
  • Ultrasonic
  • Harmonic scalpel
  • Argon beam coagulation
  • Laser
  • Radio frequency ablation
  • Thermal damage
  • Embolism
  • Fire