Bram Richard, Fiore Susan, McHugh Daryl, Samara Ghassan J, Davis Raphael P
Department of Neurological Surgery, HST, L-12, Room 080, Stony Brook Medicine, Stony Brook, NY 11794-8122, USA.
Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
J Clin Neurosci. 2017 Jul;41:81-85. doi: 10.1016/j.jocn.2017.02.061. Epub 2017 Mar 9.
A major challenge during endoscopic transsphenoidal surgery is adequate intraoperative hemostasis. The Aquamantys® is a relatively new bipolar sealing device which uses radiofrequency energy and saline. This promotes hemostasis while decreasing charring and thermal spread. In this paper, we describe our experience with the Aquamantys® Mini EVS 3.4 Epidural Vein Sealer Bipolar Electrocautery System (Medtronic Advanced Energy, Portsmouth, NH, USA) during endoscopic surgery for tumors of the skull base with particular attention to ergonomic benefits and technical nuances.
We conducted a retrospective review of all patients undergoing endoscopic surgery for skull base tumors from September 2012 to June 2016 at our institution. All procedures used the Aquamantys® system. 45 cases were identified.
Successful hemostasis was achieved in all cases with an average estimated blood loss (EBL) of 46mL (Range 10-250). There were no intraoperative complications. The single-shaft design allowed for excellent manipulation compared to pistol-grip bipolar forceps. The thermal energy provided excellent radial coverage without extensive penetration into viable pituitary tissue.
To our knowledge, this is the largest series documenting the use of the Aquamantys® system in skull base surgery. The device is easily mobile and highly effective within the endonasal corridor and should be a tool in the repertoire of the endoneurosurgeon. Randomized control trials would be useful in comparing EBL between the Aquamantys® and standard bipolar electrocautery.
内镜经蝶窦手术中的一个主要挑战是术中充分止血。Aquamantys®是一种相对较新的双极密封设备，它利用射频能量和盐水。这在减少碳化和热扩散的同时促进了止血。在本文中，我们描述了我们在使用Aquamantys® Mini EVS 3.4硬膜外静脉封闭双极电灼系统（美敦力高级能量公司，美国新罕布什尔州朴茨茅斯）进行内镜下颅底肿瘤手术时的经验，特别关注其人体工程学优势和技术细节。
我们对2012年9月至2016年6月在我们机构接受内镜下颅底肿瘤手术的所有患者进行了回顾性研究。所有手术均使用Aquamantys®系统。共识别出45例病例。
所有病例均成功止血，平均估计失血量（EBL）为46毫升（范围10 - 250毫升）。无术中并发症。与手枪式双极镊子相比，单轴设计便于操作。热能提供了良好的径向覆盖范围，且不会广泛穿透到存活的垂体组织中。
据我们所知，这是记录Aquamantys®系统在颅底手术中应用的最大系列研究。该设备在内鼻通道内易于移动且高效，应成为神经内镜医生的工具之一。随机对照试验对于比较Aquamantys®与标准双极电灼的EBL将是有用的。
