da Vinci hot shears
I use the da Vinci hot shears in my dominant (right) hand. I find it useful to take down adhesions from the sigmoid to the pelvis by cutting.
It provides excellent hemostasis by using cautery for the bladder neck or seminal vesicles, and is an excellent scissor to open the endopelvic fascia and to release the neurovascular bundle.
The only negative is the increased production of smoke that happens with this instrument compared to the hook.
For non-nerve sparing procedures, I still use the hook cautery.
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I use the hot shears throughout a dVP. I have not noticed the increased smoke that you mentioned, but, as I indicated earlier, I will look for that the next time I use them. They are a bigger instrument than the paddle cautery and I wonder if the surface area has something to do with the smoke?
Since it is larger, there are times when that might be a problem. I open the blades and cauterize with just one blade to get more precise control of the cautery efffect.
Using one instrument to do two things helps a bit with the costs of reimbursables, obviously. I now usually do a dVP with four instruments (3-arm machine): hot shears, bipolar Maryland, and two needle drivers.
Posted by: Dale Russell, M.D. | November 24, 2005 2:21 PM