Shinmura Kensuke, Ikematsu Hiroaki, Kojima Motohiro, Nakamura Hiroshi, Osera Shozo, Yoda Yusuke, Hori Keisuke, Oono Yasuhiro, Ochiai Atsushi, Yano Tomonori
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
BMC Gastroenterol. 2020 Jan 31;20(1):27. doi: 10.1186/s12876-020-1176-9.
Monopolar instruments are generally used in colorectal endoscopic mucosal resection (EMR). Bipolar instruments have previously been reported to be as safe as monopolar instruments. We sought to compare the safety of the monopolar and bipolar snare and hemostatic forceps in an animal model.
We created 5-mm, 10-mm, and 15-mm target lesions on an ex vivo porcine rectum. Two lesions of each size were resected via monopolar polypectomy (M-P), monopolar EMR (M-E), bipolar polypectomy (B-P), and bipolar EMR (B-E). We performed a pathological evaluation of the conditions of perforation and the effects of burning on the tissues. In addition, we burned the muscularis propria covered with submucosal layer using monopolar and bipolar hemostatic forceps and performed pathological evaluations.
Polypectomy and EMR were performed in a total of 24 target lesions. A perforation was found on histology in one case of M-P and one case of M-E after removing target lesions of 15 mm in diameter. There were no perforations during endoscopic resection using the bipolar snare. The thermal denaturation in B-P did not reach the muscularis propria layer regardless of the size of the target lesion. Although thermal damage after using monopolar hemostatic forceps was extensive, thermal denaturation was only seen on the surface of the submucosal layer when bipolar hemostatic forceps were used.
Bipolar instruments cause less damage to the tissue than monopolar instruments. Our results also suggest that bipolar instruments may be safer than monopolar instruments in endoscopic procedures for colorectal lesions.
单极器械通常用于结直肠内镜黏膜切除术（EMR）。此前有报道称双极器械与单极器械一样安全。我们试图在动物模型中比较单极和双极圈套器及止血钳的安全性。
我们在离体猪直肠上制造了5毫米、10毫米和15毫米的目标病变。每种大小的两个病变分别通过单极息肉切除术（M-P）、单极EMR（M-E）、双极息肉切除术（B-P）和双极EMR（B-E）进行切除。我们对穿孔情况和组织烧灼效果进行了病理评估。此外，我们使用单极和双极止血钳烧灼覆盖有黏膜下层的固有肌层并进行病理评估。
总共对24个目标病变进行了息肉切除术和EMR。在切除直径为15毫米的目标病变后，组织学检查发现1例M-P和1例M-E出现穿孔。使用双极圈套器进行内镜切除期间未出现穿孔。无论目标病变大小如何，B-P中的热变性均未到达固有肌层。虽然使用单极止血钳后的热损伤广泛，但使用双极止血钳时仅在黏膜下层表面可见热变性。
双极器械对组织造成的损伤比单极器械小。我们的结果还表明，在结直肠病变的内镜手术中，双极器械可能比单极器械更安全。
