Hokkaido University, Sapporo, Hokkaido, Japan.
Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
Surg Innov. 2020 Oct;27(5):492-498. doi: 10.1177/1553350620904610. Epub 2020 Mar 18.
We analyzed the underlying principles of an unmodulated very-low-voltage (VLV) mode, designated as "soft coagulation" in hemostasis, and demonstrate its clinical applications. . While the advantage of the VLV mode has been reported across surgical specialties, the basic principle has not been well described and remains ambiguous. . Characteristics of major electrosurgical modes were measured in different settings. For the VLV mode, the tissue effect and electrical parameters were assessed in simulated environments. . The VLV mode achieved tissue coagulation with the lowest voltage compared with the other modes in any settings. With increasing impedance, the voltage of the VLV mode stayed very low at under 200 V compared with other modes. The VLV mode constantly produced effective tissue coagulation without carbonization. We have demonstrated the clinical applications of the method. The voltage of the VLV mode consistently stays under 200 V, resulting in tissue coagulation with minimal vaporization or carbonization. Therefore, the VLV mode produces more predictable tissue coagulation and minimizes undesirable collateral thermal tissue effects, enabling nerve- and function-preserving surgery. The use of VLV mode through better understanding of minimally invasive way of using electrosurgery may lead to better surgical outcomes.
我们分析了一种未调制的超低电压 (VLV) 模式的基本原理，该模式在止血中被指定为“软凝结”，并展示了其临床应用。虽然 VLV 模式在多个外科专业中都有优势，但基本原理尚未得到很好的描述，仍然存在模糊性。在不同的环境中测量了主要电外科模式的特性。对于 VLV 模式，在模拟环境中评估了组织效应和电气参数。VLV 模式在任何设置下都比其他模式以最低的电压实现组织凝结。随着阻抗的增加，VLV 模式的电压保持在 200V 以下，而其他模式的电压则保持在 200V 以下。VLV 模式持续产生有效的组织凝结，而不会碳化。我们已经展示了该方法的临床应用。VLV 模式的电压始终保持在 200V 以下，从而实现了最小化汽化或碳化的组织凝结。因此，VLV 模式产生更可预测的组织凝结，并最大限度地减少不理想的附带热组织效应，从而实现神经和功能保留手术。通过更好地理解电外科的微创使用方式，使用 VLV 模式可能会带来更好的手术效果。
