Gao Tao, Lau Bik Ee, Yamaguchi Tadashi, Hanari Naoyuki, Gunji Hisashi, Kano Masayuki, Matsubara Hisahiro, Hayashi Hideki
Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Graduate School of Engineering, Chiba University, Chiba, Japan.
Surg Today. 2017 Jan;47(1):122-129. doi: 10.1007/s00595-016-1345-1. Epub 2016 May 6.
Recently, the incidence of postoperative pancreatic leakage has been reported to have significantly increased after laparoscopic gastrectomy for gastric cancers in comparison to open surgery. Although their lateral thermal spread has been shown to be smaller than that of other electrosurgical devices, ultrasonically activated surgical devices (USADs) have been suggested as one of the causes. We therefore hypothesized that cavitation generated by USADs could cause injuries to pancreatic tissue. Our retrospective study showed that the amylase activity in the drainage fluid of patients in whom surgery was performed using a USAD with a curved blade was significantly higher than that in patients in whom surgery was performed using a USAD with a straight blade. We therefore focused on the effects of straight and curved USAD blades.
The distribution of microbubbles generated in degassed water, which produce mechanical and biological tissue destructive forces, was measured and compared between the two types of USAD.
More microbubbles were found to be generated from the side aspect of the curved blade, and the mechanical and biological destructive forces were found to be significantly higher than those generated by the side aspect of the straight blade.
These findings strongly suggest that cavitation generated by USADs could injure pancreatic tissues in the clinical cases. Surgeons should be aware of these properties of devices to achieve safe and secure surgeries.
最近有报道称，与开放手术相比，腹腔镜胃癌根治术后胰漏的发生率显著增加。尽管超声激活手术器械（USAD）的侧向热扩散已被证明小于其他电外科设备，但它仍被认为是原因之一。因此，我们推测USAD产生的空化作用可能会对胰腺组织造成损伤。我们的回顾性研究表明，使用弯形刀片USAD进行手术的患者引流液中的淀粉酶活性显著高于使用直形刀片USAD进行手术的患者。因此，我们重点关注直形和弯形USAD刀片的影响。
测量并比较了两种类型的USAD在脱气水中产生的微气泡分布，这些微气泡会产生机械和生物组织破坏力。
发现弯形刀片侧面产生的微气泡更多，并且其机械和生物破坏力显著高于直形刀片侧面产生的破坏力。
这些发现有力地表明，在临床病例中，USAD产生的空化作用可能会损伤胰腺组织。外科医生应了解这些器械的特性，以实现安全可靠的手术。
