Thank you for your interest on our article. The aim was to evaluate the histologic effects of various energy devices on the vaginal cuff at the time of hysterectomy. We strove to use the equipment, settings, and terminology most commonly used in clinical practice. The only difference from the actual clinical setting is the subject was a swine, not a human.

Concerning terminology, Dr Munro is correct; some terms we used are not technically precise. Perhaps electrosurgery would have been a better term than cautery. We used commonly accepted vernacular that is understood within a clinical setting. For example, energy is a generic term (however, not incorrect), whereas electrosurgery is more precise.

Three electrosurgery sources were utilized: ultrasonic, monopolar, and bipolar. “Ultrasonic converts ultrasonic energy into mechanical energy … this produces heat, which leads to … separation of tissue.” As Dr Munro stated, monopolar and bipolar sources work when heat is created because of the inherent resistance of tissue.

With regard to monopolar needle or blade, there are numerous combinations when choosing instruments and settings, making it impossible to encompass all methods. The choice of instruments and setting was based on availability and most commonly used.

The generators and settings used are the exact same as those commonly used in surgery, the standard gyrus unit, G400 generator and Valley Lab Force 2.

The bipolar forceps was used to seal the tissue and then an endosheer scissors transected the tissue in the middle of the visible burn area. We noted the limitation of this and therefore acquired the bipolar J hook.

The concern about the heterogeneity of bipolar instruments for Figure 6 is legitimate. That is why we split the 2 bipolar sources and displayed their individual results in Figure 7.

We appreciate Dr Munro’s advocacy for advancing the understanding of electrosurgery because that is our goal as well. There are 2 ways this research can be performed: using a well-controlled laboratory approach or a practical clinical approach. We chose to experiment with current clinical techniques. The infinite combinations of variables and techniques prove the need for further study.

Regardless of the terms used and that more precise definitions are ideal, this does not change the facts and results of this study: that electrosurgical techniques have variability in their tissue destruction. We will continue to strive to advance the understanding of energy effects within surgery and welcome further discussion.