如何安全使用超声腹腔镜凝血剪？

How can we safely use ultrasonic laparoscopic coagulating shears?

机构信息

Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

出版信息

Int J Urol. 2010 Apr;17(4):377-81. doi: 10.1111/j.1442-2042.2010.02506.x.

DOI:10.1111/j.1442-2042.2010.02506.x

PMID:20409232

Abstract

PURPOSE

To investigate changes in temperature of the tissue pad (contrary to active blade) of ultrasonic laparoscopic coagulation shears (LCS) and histological changes of tissue surrounding the pad during activation.

METHODS

Three types of ultrasonic LCS were assessed: SonoSurg (SSg) (Olympus, Tokyo, Japan), AutoSonix (AS) (Tyco, Pembroke, Bermuda) and Harmonic Scalpel (HS) (Johnson & Johnson, Cincinnati, OH, USA). Vibration amplitudes were 70%/100% (SSg), Level 3/Level 5 (AS) and Level 5 (HS). Durations of vibration were 5 s, 10 s, 15 s and 20 s. Changes in temperature of the tissue pad were evaluated by cutting chicken parts extracorporeally with the three types of LCS. Histological changes around the tissue pad of the SSg were evaluated in a laparoscopic porcine model.

RESULTS

At intermediate power (70% or Level 3), the SSg tissue pad temperatures were 33 degrees C, 42 degrees C, 55 degrees C and 70 degrees C, whereas the AS tissue pad temperatures were 45 degrees C, 72 degrees C, 80 degrees C and 100 degrees C. At maximum power, the temperatures of the SSg tissue pad were 38 degrees C, 45 degrees C, 70 degrees C and 95 degrees C, those of the AS were 50 degrees C, 65 degrees C, 70 degrees C and 90 degrees C and those of the HS were 49 degrees C, 65 degrees C, 75 degrees C and 90 degrees C. Histological changes occurred at 10 s, 15 s and 20 s.

CONCLUSION

Surgeons should be aware that the temperature of the tissue pad also becomes elevated when using ultrasonic LCS. Thus, they should be concerned with surrounding tissues and organs around both the tissue pad and the active blade during activation. Regardless of the LCS type and power, a short activation time within 5 s is a safe method for using the instrument.

摘要

目的

研究超声腹腔镜凝血剪刀（LCS）工作时组织垫（与活动刀片相反）的温度变化以及组织垫周围组织的组织学变化。

方法

评估了三种类型的超声 LCS：SonoSurg（SSg）（奥林巴斯，东京，日本）、AutoSonix（AS）（泰科，百慕大彭布罗克）和 Harmonic Scalpel（HS）（强生，辛辛那提，俄亥俄州，美国）。振动幅度分别为 70%/100%（SSg）、Level 3/Level 5（AS）和 Level 5（HS）。振动持续时间分别为 5 s、10 s、15 s 和 20 s。通过使用这三种 LCS 在体外切割鸡的部分来评估组织垫的温度变化。通过腹腔镜猪模型评估 SSg 组织垫周围组织的组织学变化。

结果

在中等功率（70%或 Level 3）下，SSg 组织垫的温度分别为 33°C、42°C、55°C 和 70°C，而 AS 组织垫的温度分别为 45°C、72°C、80°C 和 100°C。在最大功率下，SSg 组织垫的温度分别为 38°C、45°C、70°C 和 95°C，AS 的温度分别为 50°C、65°C、70°C 和 90°C，HS 的温度分别为 49°C、65°C、75°C 和 90°C。在 10 s、15 s 和 20 s 时出现组织学变化。