MacDonald Joel D, Bowers Christian A, Chin Steven S, Burns Greg
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA,
Surg Today. 2014 Jun;44(6):1116-22. doi: 10.1007/s00595-013-0712-4. Epub 2013 Sep 5.
Multiple energy-based surgical dissection and coagulation modalities are available to facilitate surgical dissection and hemostasis, but there is limited information regarding the acute tissue effects of these devices. Our objective was to compare the functional characteristics and tissue effects of four energy-based surgical dissection and coagulation modalities on the rabbit liver.
Linear incisions were created in the rabbit liver using monopolar electrocautery, a harmonic scalpel, a PlasmaBlade and a new ferromagnetic induction loop device. Subjective cutting and coagulation characteristics for each device were recorded, and the histological tissue effects were evaluated.
Each of the modalities successfully incised the liver tissue. The PlasmaBlade and the ferromagnetic induction loop exhibited significantly less perceived tissue drag during the incision, significantly less collateral tissue damage and significantly better margin uniformity than the monopolar electrocautery device. Each device showed comparable subjective hemostasis. The harmonic scalpel did not demonstrate a significant difference compared with any of the other devices in any of the parameters examined. The histological analysis revealed that the least lateral thermal damage resulted when the PlasmaBlade, harmonic scalpel and ferromagnetic induction loop were used, and the most damage occurred with the use of monopolar electrocautery.
Each of the newer energy-based surgical tools showed improvement over monopolar electrocautery with regard to lateral thermal injury, and the ferromagnetic induction device and the PlasmaBlade demonstrated superior surgical tissue handling characteristics to the monopolar electrocautery device.
有多种基于能量的手术解剖和凝血方式可用于促进手术解剖和止血，但关于这些设备对组织的急性影响的信息有限。我们的目的是比较四种基于能量的手术解剖和凝血方式对兔肝脏的功能特性和组织影响。
使用单极电灼、超声刀、PlasmaBlade和一种新型铁磁感应环设备在兔肝脏上制作线性切口。记录每种设备的主观切割和凝血特性，并评估组织学组织影响。
每种方式均成功切开肝脏组织。与单极电灼设备相比，PlasmaBlade和铁磁感应环在切口过程中表现出明显更少的组织牵拉感、明显更少的附带组织损伤以及明显更好的切缘均匀性。每种设备的主观止血效果相当。超声刀在任何检查参数中与其他任何设备相比均未显示出显著差异。组织学分析显示，使用PlasmaBlade、超声刀和铁磁感应环时产生的侧向热损伤最小，而使用单极电灼时损伤最大。
每种新型基于能量的手术工具在侧向热损伤方面均比单极电灼有所改进，并且铁磁感应设备和PlasmaBlade表现出比单极电灼设备更优越的手术组织处理特性。
