Kim Fernando J, Sehrt David, Pompeo Alexandre, Molina Wilson R
Division of Urology, Denver Health Medical Center, University of Colorado Cancer Center Denver (UCCCD), 777 Bannock St, MC0206, Denver, CO, 80204, USA,
Surg Endosc. 2014 May;28(5):1674-7. doi: 10.1007/s00464-013-3369-6. Epub 2014 Jan 8.
To characterize laparoscopic ultrasonic dissector surgical plume emission (laminar or turbulent) and investigate plume settlement time between curved and straight blades.
A straight and a curved blade laparoscopic ultrasonic dissector were activated on tissue and in a liquid environment to evaluate plume emission. Plume emission was characterized as either laminar or turbulent and the plume settlement times were compared. Devices were then placed in liquid to observed consistency in the fluid disruption.
Two types of plume emission were identified generating different directions of plume: laminar flow causes minimal visual obstruction by directing the aerosol downwards, while turbulent flow directs plume erratically across the cavity. Laminar plume dissipates immediately while turbulent plume reaches a second maximum obstruction approximately 0.3 s after activation and clears after 2 s. Turbulent plume was observed with the straight blade in 10 % of activations, and from the curved blade in 47 % of activations. The straight blade emitted less obstructive plume.
Turbulent flow is disruptive to laparoscopic visibility with greater field obstruction and requires longer settling than laminar plume. Ultrasonic dissectors with straight blades have more consistent oscillations and generate more laminar flow compared with curved blades. Surgeons may avoid laparoscope smearing from maximum plume generation depending on blade geometry.
描述腹腔镜超声刀手术烟雾排放特征（层流或湍流），并研究弯形和直形刀头的烟雾沉降时间。
在组织和液体环境中启动直形和弯形刀头的腹腔镜超声刀，以评估烟雾排放情况。将烟雾排放特征描述为层流或湍流，并比较烟雾沉降时间。然后将器械置于液体中，观察液体扰动的一致性。
识别出两种产生不同烟雾方向的烟雾排放类型：层流通过将气溶胶向下引导，造成的视觉阻碍最小，而湍流使烟雾在腔内无规律地扩散。层流烟雾立即消散，而湍流烟雾在激活后约0.3秒达到第二次最大阻碍，并在2秒后消散。在10%的激活操作中，直形刀头观察到湍流烟雾，在47%的激活操作中，弯形刀头观察到湍流烟雾。直形刀头产生的阻碍性烟雾较少。
与层流烟雾相比，湍流对腹腔镜视野有干扰，造成更大的视野阻碍，且需要更长的沉降时间。与弯形刀头相比，直形刀头的腹腔镜超声刀振荡更一致，产生的层流更多。根据刀头形状，外科医生可以避免因最大烟雾产生而导致腹腔镜镜头模糊。
