Section of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada.
J Endourol. 2010 Dec;24(12):1991-6. doi: 10.1089/end.2010.0392. Epub 2010 Oct 7.
Energy-based hemostasis of the prostatic vascular pedicles (PVP) during robot-assisted radical prostatectomy (RARP) may cause collateral thermal injury to adjacent neural tissue and has been shown to negatively impact sexual function recovery. The unique engineering design of the EnSeal(®) (Ethicon, Cincinnati, OH) has been demonstrated to limit collateral thermal tissue damage to <1.0 mm. Use of tissue and instrument cooling before and during device activation may potentially further reduce thermal spread. As such, we sought to evaluate the collateral tissue effects of EnSeal with or without cold saline irrigation (CSI) during PVP control.
The EnSeal Trio device was used for PVP control in 20 consecutive men undergoing bilateral, non-nerve-sparing RARP. Ipsilateral vascular pedicles were randomly selected to EnSeal plus CSI (<4 °C) application to the tissue before and during device activation or EnSeal alone. The primary end point was the distance of thermal injury from the inked margin using both hematoxylin and eosin (H&E) and terminal transferase uridyl nick end-labeling (TUNEL) apoptosis staining. A mean of three measurements was taken for each pedicle. Pathologic analysis was performed by a single, blinded uropathologist.
Mean distance of thermal injury from the inked margin using H&E staining was 0.31 mm (range 0.15-0.40 mm) and 0.98 mm (range 0.7-1.2 mm) for the EnSeal plus CSI and EnSeal alone, respectively (P < 0.0001). TUNEL staining also demonstrated lateral tissue damage of 0.39 mm (range 0.2-0.5 mm) and 1.12 mm (range 0.9-1.3 mm), respectively (P < 0.001). No complications related to hemostasis or postoperative bleeding were observed in the study.
The hemostatic properties of EnSeal work effectively when submerged in CSI. Adjacent thermal tissue damage is significantly minimized with the addition of CSI. This may have a beneficial impact on nerve preservation and sexual function outcomes after RARP.
在机器人辅助根治性前列腺切除术（RARP）中，基于能量的前列腺血管蒂（PVP）止血可能导致相邻神经组织的热损伤，并已被证明对性功能恢复产生负面影响。EnSeal（®）（Ethicon，辛辛那提，俄亥俄州）的独特工程设计已被证明可将热损伤限制在<1.0mm 以内。在设备激活前后使用组织和仪器冷却可能会进一步减少热扩散。因此，我们试图评估在 PVP 控制中使用 EnSeal 联合或不联合冷盐水灌流（CSI）的情况下对相邻组织的影响。
20 例连续行双侧非神经保留性 RARP 的男性患者，使用 EnSeal Trio 设备进行 PVP 控制。随机选择同侧血管蒂，在设备激活前后将 EnSeal 联合<4°C 的 CSI 应用于组织，或单独使用 EnSeal。主要终点是使用苏木精和伊红（H&E）和末端转移酶尿嘧啶核苷尼克末端标记（TUNEL）凋亡染色标记从墨迹边缘测量的热损伤距离。每个蒂都进行了三次测量。由一名单一的、盲法泌尿科病理学家进行病理分析。
使用 H&E 染色，从墨迹边缘测量的热损伤平均距离分别为 EnSeal 联合 CSI 组 0.31mm（范围 0.15-0.40mm）和 EnSeal 单独组 0.98mm（范围 0.7-1.2mm）（P<0.0001）。TUNEL 染色也显示出侧向组织损伤，分别为 0.39mm（范围 0.2-0.5mm）和 1.12mm（范围 0.9-1.3mm）（P<0.001）。研究中未观察到与止血或术后出血相关的并发症。
EnSeal 在 CSI 中浸泡时具有有效的止血性能。CSI 的加入可显著减少相邻的热损伤。这可能对 RARP 后神经保留和性功能结果产生有益影响。
