Dissection using pulsed radiofrequency energy device (PlasmaBlade) is safe and efficient in experimental revision neuromodulation implant surgery

ABSTRACT

Background

The use of functional neurosurgical implants has increased over the past 10 years. PlasmaBlade is an innovative electrosurgical appliance harnessing pulsed radiofrequency (RF) energy. Our aim was to assess the risk of damage to neuromodulation hardware during PlasmaBlade dissection.

Materials and methods

A simulated setting with chicken breast threaded with different hardware and PlasmaBlade used in three configurations. . Post dissection, the wires were inspected naked eye and under an operating microscope. The induced current was assessed contemporaneously using an oscilloscope.

Results

Five surgeons tested the PlasmaBlade at different generator settings. Sixty dissections were undertaken. No structural damage or induced current was identified at CUT 3/4, COAG 5. At CUT 6, COAG 5 and during dissection in a perpendicular orientation with prolonged hardware contact, opacification of insulation material occurred in 15/20 dissections. There was no dissolution of insulation even at this setting. On deviation from Medtronic advice, hardware damaged occurred if one was reckless with the PlasmaBlade.

Conclusion

When using the recommended settings and operational technique, PlasmaBlade dissection did not cause any damage to implant wiring/tubing in this simulated setting. This report seeks to add to clinical data suggesting PlasmaBlade is safe for dissection around deep brain stimulator (DBS), vagal nerve stimulator (VNS), and spinal cord stimulator (SCS) hardware.

KEYWORDS:

• PlasmaBlade
• neuromodulation
• DBS
• SCS
• VNS

Acknowledgements

We acknowledge the support, provision of equipment and images provided by Medtronic Inc. to allow this study to take place.

Disclosure statement

No potential competing interest was reported by the author(s).

Figure 1. Image from Medtronic Product Brochure. Medtronic PlasmaBlade AEX generator with CUT/COAG settings displayed.

Figure 2. (a–d) Images from Medtronic Product Brochure. These images provide a comparison between operating temperature, thermal injury, temperature change near critical structures and surgical smoke produced between conventional electrosurgery and PlasmaBlade¹¹.

Figure 3. Neuromodulation hardwares used in our simulated experiment.

Figure 4. Experimental mount showing chicken breast threaded with SCS (MRI non-compatible), Vectris (SCS MRI compatible) and VNS hardware and oscilloscope recording probe.

Figure 5. Evidence of slight deformation of VNS wire following direct contact with the PlasmaBlade at CUT6 COAG 5.