Kim F J, Chammas M F, Gewehr E, Morihisa M, Caldas F, Hayacibara E, Baptistussi M, Meyer F, Martins A C
Department of Surgery, Division of Urology, University of Colorado Health Sciences Center, 777 Bannock Street (MC0206), Denver, Colorado 80204, USA.
Surg Endosc. 2008 Jun;22(6):1464-9. doi: 10.1007/s00464-007-9650-9. Epub 2007 Nov 20.
Reports of iatrogenic thermal injuries during laparoscopic surgery using new generation vessel-sealing devices, as well as anecdotal reports of hand burn injuries during hand-assisted surgeries, have evoked questions about the temperature safety profile and the cooling properties of these instruments.
This study involved video recording of temperatures generated by different instruments (Harmonic ACE [ACE], Ligasure V [LV], and plasma trisector [PT]) applied according the manufacturers' pre-set settings (ACE setting 3; LV 3 bars, and the PT TR2 50W). The video camera used was the infrared Flex Cam Pro directed to three different types of swine tissue: (1) peritoneum (P), (2) mesenteric vessels (MV), and (3) liver (L). Activation and cooling temperature and time were measured for each instrument.
The ACE device produced the highest temperatures (195.9 degrees +/- 14.5 degrees C) when applied against the peritoneum, and they were significantly higher than the other instruments (LV = 96.4 degrees +/- 4.1 degrees C, and PT = 87 degrees +/- 2.2 degrees C). The LV and PT consistently yielded temperatures that were < 100 degrees C independent of type of tissue or "on"/ "off" mode. Conversely, the ACE reached temperatures higher than 200 degrees C, with a surprising surge after the instrument was deactivated. Moreover, temperatures were lower when the ACE was applied against thicker tissue (liver). The LV and PT cooling times were virtually equivalent, but the ACE required almost twice as long to cool.
The ACE increased the peak temperature after deactivation when applied against thick tissue (liver), and the other instruments inconsistently increased peak temperatures after they were turned off, requiring few seconds to cool down. Moreover, the ACE generated very high temperatures (234.5 degrees C) that could harm adjacent tissue or the surgeon's hand on contact immediately after deactivation. With judicious use, burn injury from these instruments can be prevented during laparoscopic procedures. Because of the high temperatures generated by the ACE device, particular care should be taken when it is used during laparoscopy.
关于使用新一代血管封闭设备进行腹腔镜手术期间医源性热损伤的报告，以及手辅助手术期间手部烧伤的轶事报道，引发了对这些器械的温度安全性和冷却特性的质疑。
本研究涉及对按照制造商预设设置（ACE设置3；Ligasure V [LV] 3档，等离子三分器 [PT] TR2 50W）应用的不同器械（谐波ACE [ACE]、Ligasure V [LV] 和等离子三分器 [PT]）产生的温度进行视频记录。使用的摄像机是红外Flex Cam Pro，对准三种不同类型的猪组织：（1）腹膜（P）、（2）肠系膜血管（MV）和（3）肝脏（L）。测量每种器械的激活温度、冷却温度和时间。
ACE设备在作用于腹膜时产生的温度最高（195.9摄氏度±14.5摄氏度），且显著高于其他器械（LV = 96.4摄氏度±4.1摄氏度，PT = 87摄氏度±2.2摄氏度）。LV和PT产生的温度始终低于100摄氏度，与组织类型或“开”/“关”模式无关。相反，ACE达到的温度高于200摄氏度，在器械停用后出现惊人的温度飙升。此外，ACE作用于较厚组织（肝脏）时温度较低。LV和PT的冷却时间几乎相同，但ACE冷却所需时间几乎是其两倍。
ACE作用于厚组织（肝脏）时在停用后会使峰值温度升高，其他器械在关闭后峰值温度升高情况不一，冷却只需几秒钟。此外，ACE产生的温度非常高（234.5摄氏度），在停用后立即接触可能会伤害相邻组织或外科医生的手。通过谨慎使用，在腹腔镜手术过程中可预防这些器械造成的烧伤。由于ACE设备产生高温，在腹腔镜检查期间使用时应格外小心。
