Chen Roland K, Than Khoi D, Wang Anthony C, Park Paul, Shih Albert J
Department of Mechanical Engineering/Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA.
Surg Neurol Int. 2013 Sep 6;4:113. doi: 10.4103/2152-7806.117709. eCollection 2013.
Coagulation accomplished using bipolar forceps is common in neurosurgery. Control of thermal spread from the forceps tips into surrounding neural tissues is a persistent concern, as neural tissues are especially vulnerable to heat injury. The purpose of our investigation was to compare the efficacy of cooling mechanisms for four different bipolar forceps and to understand thermal spread when coagulating vessels on the spinal cord.
Immediately following euthanasia, the dura mater of an ex vivo porcine model was opened to expose vessels on the spinal cord for coagulation. Temperature profiles were measured at generator power of 25 W and at fixed 5-second activation times. The bipolar forceps used in this study included regular stainless steel, titanium, heat-pipe embedded, and SILVERGlide forceps. Temperature was measured by micro-thermistor at the midpoint between the bipolar tips, and 1 and 2 mm away from the midpoint along the centerline. Statistical analysis was performed to evaluate temperature differences.
Temperature profiles indicated that heat-pipe embedded forceps create the least amount of temperature increase and the highest normalized temperature decreasing slope after activation. The decreasing slope of SILVERGlide forceps is slightly higher than that of regular stainless steel forceps.
Bipolar forceps incorporating either heat-pipe embedded technology or SILVERGlide coating can effectively limit excessive thermal spread, thus decreasing potential injury to adjacent tissues when compared with standard stainless steel and titanium bipolar forceps. Of the two, heat-pipe embedded technology appeared safest, having better cooling efficiency at higher temperature.
在神经外科手术中，使用双极镊子进行凝血操作很常见。由于神经组织特别容易受到热损伤，控制热量从镊子尖端扩散到周围神经组织一直是人们关注的问题。我们研究的目的是比较四种不同双极镊子的冷却机制的效果，并了解在脊髓血管凝血时的热扩散情况。
在对猪实施安乐死后，立即打开其离体模型的硬脑膜，暴露脊髓上的血管以进行凝血。在发生器功率为25W且激活时间固定为5秒的情况下测量温度曲线。本研究中使用的双极镊子包括普通不锈钢镊子、钛镊子、嵌入热管的镊子和SILVERGlide镊子。通过微型热敏电阻在双极尖端之间的中点以及沿中心线距中点1毫米和2毫米处测量温度。进行统计分析以评估温度差异。
温度曲线表明，嵌入热管的镊子在激活后产生的温度升高最少，归一化温度下降斜率最高。SILVERGlide镊子的下降斜率略高于普通不锈钢镊子。
与标准不锈钢和钛双极镊子相比，采用嵌入热管技术或SILVERGlide涂层的双极镊子可以有效限制过多的热扩散，从而减少对相邻组织的潜在损伤。在这两种技术中，嵌入热管技术似乎最安全，在较高温度下具有更好的冷却效率。
