Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria.
Surg Endosc. 2010 Oct;24(10):2492-501. doi: 10.1007/s00464-010-0991-4. Epub 2010 Mar 26.
The aim of this study was to investigate the use of surgical smoke-producing procedures such as laser ablation or electrosurgery in minimally invasive microendoscopic procedures. This study proposes a technical solution to efficiently remove surgical smoke from very small endoscopic cavities using microports as small as 20 G (0.9 mm) in diameter.
The experimental laboratory study used small, rigid, transparent plastic cavity models connected with tubes and pressure sensors to establish an endoscopic in vitro laboratory model. A Kalium-Titanyl-Phosphate (KTP) laser with a 0.5-mm fiber optic probe was used to produce smoke from bovine scleral tissue in the cavity. Endoscopic gas insufflation into the model was generated by pressurized air and a microvalve. A laboratory vacuum pump provided smoke and gas suction via a microvalve. A self-built control and steering system was utilized to control intracavital pressure during experimental insufflation and suction.
Problems related to smoke-generating processes, such as laser vaporization or electrocautery, in small closed cavities were first analyzed. A theoretical and mechatronic laboratory model was established and tested. Intracavital pressure and gas flow were measured first without and then with smoke generation. A new construction design for the suction tube was proposed due to rapid obstruction by smoke particles.
Surgical smoke evacuation from endoscopic cavities that are as small as 2 cm in diameter via minimally invasive ports as small as 20 G (0.9 mm) in diameter may be safe and efficient if sufficient gas exchange is provided during smoke generation by laser or electrosurgical instruments. However, maintaining a low and constant pressure in the cavity during gas exchange and adopting a special construction design for the suction tube are essential to provide an excellent view during the surgical maneuver and to minimize potential toxic side effects of the smoke.
本研究旨在探讨在微创微内窥镜手术中使用产生手术烟雾的程序，如激光消融或电外科。本研究提出了一种技术解决方案，通过使用直径仅为 20G（0.9 毫米）的微型端口，从非常小的内窥镜腔中有效地清除手术烟雾。
本实验性实验室研究使用小的、刚性的、透明的塑料腔模型，通过管道和压力传感器连接，建立内窥镜体外实验室模型。使用带有 0.5 毫米光纤探头的 Kalium-Titanyl-Phosphate（KTP）激光从牛巩膜组织中产生烟雾。通过加压空气和微型阀向模型内进行内窥镜气体充气。实验室真空泵通过微型阀提供烟雾和气体抽吸。使用自制的控制和转向系统在实验充气和抽吸过程中控制腔内压力。
首先分析了在小封闭腔中与产生烟雾的过程相关的问题，如激光蒸发或电灼。建立并测试了一个理论和机电实验室模型。首先在没有产生烟雾的情况下测量腔内压力和气流，然后在产生烟雾的情况下测量。由于烟雾颗粒迅速堵塞，提出了一种新的抽吸管结构设计。
如果激光或电外科仪器在产生烟雾时提供足够的气体交换，通过最小侵入性端口（直径 20G（0.9 毫米））从直径小至 2 厘米的内窥镜腔中安全有效地清除手术烟雾是可能的。然而，在气体交换过程中保持腔内低且恒定的压力，并采用特殊的抽吸管结构设计，对于提供手术操作期间的良好视野和最小化烟雾的潜在毒性副作用至关重要。
