Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Prospective control trial: flexible CO2 laser vs. monopolar electrocautery for robotic microsurgical denervation of the spermatic cord

International Journal of Impotence Research volume 32, pages 623–627 (2020)Cite this article

Subjects

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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Robotic instrument setup for the CO2 laser dissection side.
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Davis BE, Noble MJ, Weigel JW, Foret JD, Mebust WK. Analysis and management of chronic testicular pain. J Urol. 1990;143:936–9.

    Article  CAS  Google Scholar 

  2. Sibert L, Safsaf A, Rigaud J, Delavierre D, Labat JJ. Impact of chronic pelvic pain on sexual functions and fertility. Prog Urol. 2010;20:917–21.

    Article  CAS  Google Scholar 

  3. Oliveira RG, Camara C, Alves Jde M, Coelho RF, Lucon AM, Srougi M. Microsurgical testicular denervation for the treatment of chronic testicular pain initial results. Clinics. 2009;64:393–6.

    PubMed Central  Google Scholar 

  4. Strom KH, Levine LA. Microsurgical denervation of the spermatic cord for chronic orchialgia: long-term results from a single center. J Urol. 2008;180:949–53.

    Article  Google Scholar 

  5. Baggish MS, Tucker RD. Tissue actions of bipolar scissors compared with monopolar devices. Fertil Steril. 1995;63:422–6.

    Article  CAS  Google Scholar 

  6. Tulikangas PK, Smith T, Falcone T, Boparai N, Walters MD. Gross and histologic characteristics of laparoscopic injuries with four different energy sources. Fertil Steril. 2001;75:806–10.

    Article  CAS  Google Scholar 

  7. Ryan RW, Spetzler RF, Preul MC. Aura of technology and the cutting edge: a history of lasers in neurosurgery. Neurosurg Focus 2009;27:E6.

    Article  Google Scholar 

  8. Parekattil SJ, Gudeloglu A, Brahmbhatt JV, Priola KB, Vieweg J, Allan RW. Trifecta nerve complex: potential anatomical basis for microsurgical denervation of the spermatic cord for chronic orchialgia. J Urol. 2013;190:265–70.

    Article  Google Scholar 

  9. Hanby DF, Gremillion G, Zieske AW, Loehn B, Whitworth R, Wolf T, et al. Harmonic scalpel versus flexible CO2 laser for tongue resection: a histopathological analysis of thermal damage in human cadavers. World J Surg Oncol. 2011;9:83.

    Article  PubMed Central  Google Scholar 

  10. Cheetham PJ, Truesdale MD, Lee DJ, Landman JM, Badani KK. Use of a flexible carbon dioxide laser fiber for precise dissection of the neurovascular bundle during robot-assisted laparoscopic prostatectomy. J Endourol/Endourol Soc. 2010;24:1091–6.

    Article  Google Scholar 

  11. Barton SE, Garguilo AR. Robot-assisted laparoscopic myomectomy and adenomyomectomy with a flexible CO2 laser device. J Robot Surg. 2013;7:157–62.

    Article  Google Scholar 

  12. Calixte N, Brahmbhatt J, Parekattil S. Chronic testicular and groin pain: pathway to relief. Curr Urol Rep. 2017;18:83.

    Article  Google Scholar 

  13. Gudeloglu A, Brahmbhatt JV, Parekattil SJ. Robotic microsurgery in male infertility and urology—taking robotics to the next level. Transl Androl Urol. 2014;3:102–12.

    PubMed Central  Google Scholar 

  14. Devaiah AK, Shapshay SM, Desai U, Shapira G, Weisberg O, Torres DS, et al. Surgical utility of a new carbon dioxide laser fiber: functional and histological study. Laryngoscope. 2005;115:1463–8.

    Article  Google Scholar 

  15. Anandasabapathy S, Maru D, Klumpp S, Uthamanthil R, Borne A, Bhutani MS. Novel endoscopic application of a new flexible-fiber CO2 laser for esophageal mucosal ablation in a porcine model. Endoscopy. 2009;41:138–42.

    Article  CAS  Google Scholar 

  16. Ramasamy R, Sterling J, Li PS, Robinson BD, Parekattil S, Chen J, et al. Multiphoton imaging and laser ablation of rodent spermatic cord nerves: potential treatment for patients with chronic orchialgia. J Urol. 2012;187:733–8.

    Article  Google Scholar 

Download references

Funding

Funding for the fresh human cadaver and instrumentation was provided by OmniGuide, Inc. All authors have no disclosures

Author information

Authors and Affiliations

  1. Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Ahmet Gudeloglu

  2. John H. Stronger Jr. Hospital of Cook County, Chicago, IL, USA

    Ajoe John Kattoor

  3. The PUR Clinic, South Lake Hospital, Clermont, FL, USA

    Jamin Brahmbhatt & Sijo Parekattil

  4. Cleveland Clinic, Center for Reproductive Medicine, Cleveland, OH, USA

    Ashok Agarwal

Authors
  1. Ahmet Gudeloglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ajoe John Kattoor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jamin Brahmbhatt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sijo Parekattil
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ashok Agarwal
    View author publications

    You can also search for this author in PubMed 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

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-020-00352-0

This article is cited by

Search

Advanced search

Quick links