Energetic soft-tissue treatment technologies: an overview of procedural fundamentals and safety factors

Surg Endosc. 2013 Sep;27(9):3085-99. doi: 10.1007/s00464-013-2923-6. Epub 2013 Apr 10.


Background: Energy administered during soft-tissue treatments may cauterize, coagulate, seal, or otherwise affect underlying structures. A general overview of the functionality, procedural outcomes, and associated risks of these treatments, however, is not yet generally available. In addition, literature is sometimes inconsistent with regards to terminology. Along with the rapid expansion of available energetic instruments, particularly in the field of endoscopic surgery, these factors may complicate the ability to step back, review available treatment options, and identify critical parameters for appropriate use.

Methods: Online databases of PubMed, Web of Science, and Google Scholar were used to collect literature on popular energetic treatments, such as electrosurgery, plasma surgery, ultrasonic surgery, and laser surgery. The main results include review and comparison studies on the working mechanisms, pathological outcomes, and procedural hazards.

Results: The tissue response to energetic treatments can be largely explained by known mechanical and thermal interactions. Application parameters, such as the interaction time and power density, were found to be of major influence. By breaking down treatments to this interaction level, it is possible to differentiate the available options and reveal their strengths and weaknesses. Exact measures of damage and alike quantifications of interaction are, although valuable to the surgeon, often either simply unknown due to the high impact of tissue and application-dependent parameters or badly documented in previous studies. In addition, inconsistencies in literature regarding the terminology of used techniques were observed and discussed. They may complicate the formulation of cause and effect relations and lead to misconceptions regarding the treatment performance.

Conclusions: Some basic knowledge on used energetic treatments and settings and a proper use of terminology may enhance the practitioner's insight in allowable actions to take, improve the interpretation and diagnosis of histological and mechanical tissue changes, and decrease the probability of iatrogenic mishaps.

Publication types

  • Review

MeSH terms

  • Argon Plasma Coagulation / adverse effects
  • Argon Plasma Coagulation / instrumentation*
  • Electrosurgery / adverse effects
  • Electrosurgery / instrumentation*
  • Endoscopy*
  • Equipment Safety
  • Humans
  • Iatrogenic Disease
  • Laser Therapy / adverse effects
  • Laser Therapy / instrumentation*
  • Patient Safety
  • Soft Tissue Injuries / etiology*
  • Soft Tissue Injuries / prevention & control
  • Terminology as Topic
  • Ultrasonic Therapy / adverse effects
  • Ultrasonic Therapy / instrumentation*