Hamasaki Azumi, Uchida Tetsuro, Kuroda Yoshinori, Sadahiro Mitsuaki
Second Department of Surgery Yamagata University Faculty of Medicine Yamagata, Japan.
Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.
Multimed Man Cardiothorac Surg. 2019 Nov 18;2019. doi: 10.1510/mmcts.2019.037.
Until now, scissors, clips and electrocautery have been used to harvest the gastroepiploic artery (GEA) for grafting. Because this artery has many branches and large fragile satellite veins tangled around it, conventional methods are not suitable for quick harvesting without bleeding. In order to harvest the GEA easily and efficiently, a skeletonized technique using an ultrasonic scalpel was developed, but the blade of this device was not well designed for fine tissue dissection. In order to address this problem, we have developed an alternative harvesting technique using a hybrid bipolar/ultrasonic energy device. This hybrid device integrates both electrical bipolar energy and ultrasonic frictional heat energy and is thus more versatile than traditional energy devices. In addition, it achieves faster dissection speed while offering similar bursting pressure and acceptable thermal spread. Finally, our device has an improved blade design that is suitable for fine tissue dissection. This video tutorial demonstrates our use of this new hybrid energy device and shows how it enables the surgeon to harvest the GEA quickly, safely, with little bleeding, and with less instrument exchange.
到目前为止，一直使用剪刀、夹子和电灼来获取胃网膜动脉（GEA）用于移植。由于该动脉有许多分支，且周围缠绕着粗大且脆弱的卫星静脉，传统方法不适合在不出血的情况下快速获取。为了轻松、高效地获取GEA，开发了一种使用超声刀的骨骼化技术，但该设备的刀片在精细组织解剖方面设计不佳。为了解决这个问题，我们开发了一种使用混合双极/超声能量设备的替代获取技术。这种混合设备集成了双极电能和超声摩擦热能，因此比传统能量设备更通用。此外，它在提供相似爆破压力和可接受的热扩散的同时，实现了更快的解剖速度。最后，我们的设备改进了刀片设计，适合精细组织解剖。本视频教程展示了我们对这种新型混合能量设备的使用，并展示了它如何使外科医生能够快速、安全地获取GEA，出血少，且器械更换少。
