Weld Kyle J, Dryer Stephen, Ames Caroline D, Cho Kuk, Hogan Chris, Lee Myonghwa, Biswas Pratim, Landman Jaime
Division of Urology, Washington University School of Medicine, St. Louis, Missouri, USA.
J Endourol. 2007 Mar;21(3):347-51. doi: 10.1089/end.2006.9994.
We analyzed the smoke plume produced by various energy-based laparoscopic instruments and determined its effect on laparoscopic visibility.
The Bipolar Macroforceps, Harmonic Scalpel, Floating Ball, and Monopolar Shears were applied in vitro to porcine psoas muscle. An Aerodynamic Particle Sizer and Electrostatic Classifier provided a size distribution of the plume for particles >500 nm and <500 nm, and a geometric mean particle size was calculated. A Condensation Particle Counter provided the total particle-number concentration. Electron microscopy was used to characterize particle size and shape further. Visibility was calculated using the measured-size distribution data and the Rayleigh and Mie light-scattering theories.
The real-time instruments were successful in measuring aerosolized particle size distributions in two size ranges. Electron microscopy revealed smaller, homogeneous, spherical particles and larger, irregular particles consistent with cellular components. The aerosol produced by the Bipolar Macroforceps obscured visibility the least (relative visibility 0.887) among the instruments tested. Particles from the Harmonic Scalpel resulted in a relative visibility of 0.801. Monopolar-based instruments produced plumes responsible for the poorest relative visibility (Floating Ball 0.252; Monopolar Shears 0.026).
Surgical smoke is composed of two distinct particle populations caused by the nucleation of vapors as they cool (the small particles) and the entrainment of tissue secondary to mechanical aspects (the large particles). High concentrations of small particles are most responsible for the deterioration in laparoscopic vision. Bipolar and ultrasonic instruments generate a surgical plume that causes the least deterioration of visibility among the instruments tested.
我们分析了各种基于能量的腹腔镜器械产生的烟雾，并确定其对腹腔镜视野的影响。
将双极大抓钳、超声刀、浮球和单极剪在体外应用于猪腰大肌。空气动力学粒度分析仪和静电分级仪提供了粒径大于500 nm和小于500 nm的烟雾颗粒大小分布，并计算了几何平均粒径。凝聚粒子计数器提供了总粒子数浓度。电子显微镜用于进一步表征颗粒大小和形状。使用测量的粒度分布数据以及瑞利和米氏光散射理论计算视野清晰度。
实时仪器成功测量了两个粒径范围内的雾化颗粒大小分布。电子显微镜显示有较小的、均匀的球形颗粒以及与细胞成分一致的较大的不规则颗粒。在测试的器械中，双极大抓钳产生的烟雾对视野清晰度的影响最小（相对视野清晰度0.887）。超声刀产生的颗粒导致相对视野清晰度为0.801。基于单极的器械产生的烟雾导致相对视野清晰度最差（浮球0.252；单极剪0.026）。
手术烟雾由两种不同的颗粒群组成，一种是蒸汽冷却时成核形成的（小颗粒），另一种是由于机械作用夹带的组织（大颗粒）。高浓度的小颗粒是导致腹腔镜视野恶化的主要原因。在测试的器械中，双极和超声器械产生的手术烟雾对视野清晰度的影响最小。
