Suzuki Tomoyuki, Kawamoto Shunsuke, Nakagawa Atsuhiro, Endo Toshiki, Tominaga Teiji, Akiyama Masatoshi, Adachi Osamu, Kumagai Kiichiro, Saiki Yoshikatsu
Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aoba-ku, Sendai, Miyagi, Japan.
Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
J Artif Organs. 2018 Jun;21(2):247-253. doi: 10.1007/s10047-017-1008-z. Epub 2017 Nov 16.
Actuator-driven pulsed water-jet (ADPJ) dissection is an emerging surgical method for dissecting tissue without heat and mechanical injury to vessels. We elucidated the mechanical properties of the piezo ADPJ and evaluated its usefulness and safety in coronary artery bypass grafting procedures. The relationship between the input voltage (10-100 V) and peak pressure of the pulsed water jet was evaluated. The tissue strengths of swine internal thoracic and coronary arteries and the surrounding tissues were measured to assure tissue-selective dissection. Internal thoracic arteries were harvested by conventional electric cautery and the water jet in four swine, and eight coronary arteries surrounded by myocardium were attempted to be exposed with the water jet. The dissected specimens were histologically evaluated. The peak pressure of the pulsed water jet was positively correlated with the input voltage (R = 0.9984, P < 0.001). The breaking strengths of the target vessels (internal thoracic and coronary arteries) and the surrounding tissues were significantly different (P = 0.002 and P < 0.001, respectively). Histologic examination revealed that internal thoracic arteries were isolated with less heat damage using the pulsed water jet (P = 0.002) compared with electric cautery, and coronary arteries also were dissected without apparent histologic damage. ADPJ has the possibility of assuring tissue selectivity among the internal thoracic and coronary arteries. The results also indicated that the use of ADPJ may enhance safe procedures to harvest grafts during coronary artery bypass grafting.
actuator驱动的脉冲水刀（ADPJ）解剖是一种新兴的手术方法，用于在不产生热损伤和对血管无机械损伤的情况下解剖组织。我们阐明了压电ADPJ的力学性能，并评估了其在冠状动脉旁路移植手术中的实用性和安全性。评估了输入电压（10 - 100V）与脉冲水刀峰值压力之间的关系。测量了猪胸廓内动脉和冠状动脉及其周围组织的组织强度，以确保组织选择性解剖。在4头猪中，用传统电灼法和水刀采集胸廓内动脉，并尝试用水刀暴露8条被心肌包围的冠状动脉。对解剖后的标本进行组织学评估。脉冲水刀的峰值压力与输入电压呈正相关（R = 0.9984，P < 0.001）。目标血管（胸廓内动脉和冠状动脉）及其周围组织的断裂强度有显著差异（分别为P = 0.002和P < 0.001）。组织学检查显示，与电灼相比，使用脉冲水刀分离胸廓内动脉时热损伤较小（P = 0.002），冠状动脉解剖后也无明显组织学损伤。ADPJ有可能确保胸廓内动脉和冠状动脉之间的组织选择性。结果还表明，在冠状动脉旁路移植术中使用ADPJ可能会提高采集移植物的安全性。
