Department of Otolaryngology Head Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, USA.
World J Surg Oncol. 2011 Aug 1;9:83. doi: 10.1186/1477-7819-9-83.
Monopolar cautery is the most commonly used surgical cutting and hemostatic tool for head and neck surgery. There are newer technologies that are being utilized with the goal of precise cutting, decreasing blood loss, reducing thermal damage, and allowing faster wound healing. Our study compares thermal damage caused by Harmonic scalpel and CO2 laser to cadaveric tongue.
Two fresh human cadaver heads were enrolled for the study. Oral tongue was exposed and incisions were made in the tongue akin to a tongue tumor resection using the harmonic scalpel and flexible C02 laser fiber at various settings recommended for surgery. The margins of resection were sampled, labeled, and sent for pathological analysis to assess depth of thermal damage calculated in millimeters. The pathologist was blinded to the surgical tool used. Control tongue tissue was also sent for comparison as a baseline for comparison.
Three tongue samples were studied to assess depth of thermal damage by harmonic scalpel. The mean depth of thermal damage was 0.69 (range, 0.51 - 0.82). Five tongue samples were studied to assess depth of thermal damage by CO2 laser. The mean depth of thermal damage was 0.3 (range, 0.22 to 0.43). As expected, control samples showed 0 mm of thermal damage. There was a statistically significant difference between the depth of thermal injury to tongue resection margins by harmonic scalpel as compared to CO2 laser, (p = 0.003).
In a cadaveric model, flexible CO2 laser fiber causes less depth of thermal damage when compared with harmonic scalpel at settings utilized in our study. However, the relevance of this information in terms of wound healing, hemostasis, safety, cost-effectiveness, and surgical outcomes needs to be further studied in clinical settings.
单极电凝是头颈部手术中最常用的手术切割和止血工具。现在有一些新技术被应用于手术中，其目的是实现精准切割、减少失血、降低热损伤，并促进伤口更快愈合。本研究比较了 Harmonic 超声刀和 CO2 激光在尸体舌头上造成的热损伤。
本研究纳入了 2 具新鲜的人体头颅标本。暴露口腔舌部，使用 Harmonic 超声刀和柔性 CO2 激光纤维，按照推荐用于手术的各种设置，在舌部模拟进行肿瘤切除术。切除边缘的样本被标记并送检病理分析，以评估毫米级的热损伤深度。病理学家对使用的手术工具不了解。同时送检正常舌组织作为对照。
研究了 3 个舌样本以评估 Harmonic 超声刀造成的热损伤深度。热损伤的平均深度为 0.69mm（范围 0.51-0.82mm）。研究了 5 个舌样本以评估 CO2 激光造成的热损伤深度。热损伤的平均深度为 0.3mm（范围 0.22-0.43mm）。正如预期的那样，对照样本显示无热损伤。与 CO2 激光相比，Harmonic 超声刀造成的舌切除边缘的热损伤深度有统计学显著差异（p = 0.003）。
在尸体模型中，与我们研究中使用的设置相比，柔性 CO2 激光纤维造成的热损伤深度小于 Harmonic 超声刀。然而，在临床环境中，关于其在伤口愈合、止血、安全性、成本效益和手术结果方面的相关性还需要进一步研究。
