CETOC-CHUM Endoscopic Tracheobronchial and Oesophageal Center, Division of Thoracic Surgery, Department of Surgery, University of Montréal, Montréal, QC, Canada.
Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
Interact Cardiovasc Thorac Surg. 2020 Dec 7;31(6):847-852. doi: 10.1093/icvts/ivaa192.
Energy vessel-sealing devices are being increasingly utilized to seal pulmonary artery (PA) branches during lobectomy. Heat from these devices can potentially injure surrounding tissues. We evaluated heat production from devices in a live animal model.
PA branches were sealed in pigs with 4 energy vessel-sealing devices: 2 ultrasonic (US), 1 advanced bipolar or 1 mixed US and bipolar (mixed) device. Thermocouples were implanted in tissue surrounding the PA branch being sealed to measure tissue temperature. A thermal camera measured the sealing site and the temperatures of the instruments. Pathological analysis was performed on PA stumps to identify thermal damage.
A total of 37 PA branches were sealed in 4 pigs. Maximum tissue heat measured by the thermocouples for the 2 US, advanced bipolar and mixed devices was 42, 39, 42 and 46°C, respectively. The mean tissue temperatures at the site of the sealing measured with the thermal camera were 78, 75, 70 and 82°C (P = 0.834) and the mean instrument blade temperatures were 224, 195, 83 and 170°C (P = 0.000005) for the 2 US, advanced bipolar and mixed devices, respectively. The mean diameter of the region with tissue reaching 60°C or more measured with the thermal camera was between 4 and 6 mm for the 4 devices (P = 0.941). On pathological analysis, PA stumps had either thermal damage on the adventitia and external media (26/37) or transmural damage (11/37) at 1 mm from sealed site.
A 3-mm safety margin between the instrument blades and vital structures is recommended. Instrument blades can reach high temperatures that may cause tissue damage.
在肺叶切除术中，越来越多地使用能量血管封闭装置来封闭肺动脉（PA）分支。这些设备产生的热量可能会损伤周围组织。我们在活体动物模型中评估了设备产生的热量。
使用 4 种能量血管封闭装置（2 种超声（US）、1 种高级双极或 1 种混合 US 和双极（混合）装置）在猪的 PA 分支上进行密封。在正在封闭的 PA 分支周围的组织中植入热电偶以测量组织温度。使用热像仪测量密封部位和仪器的温度。对 PA 残端进行病理分析以识别热损伤。
在 4 只猪中总共封闭了 37 个 PA 分支。热电偶测量的 2 个 US、高级双极和混合装置的最大组织热量分别为 42、39、42 和 46°C。热像仪测量的密封部位的平均组织温度分别为 78、75、70 和 82°C（P=0.834），热像仪测量的仪器叶片平均温度分别为 224、195、83 和 170°C（P=0.000005）对于 2 个 US、高级双极和混合装置。热像仪测量的达到 60°C 或更高温度的组织区域的平均直径为 4 至 6mm，适用于 4 种装置（P=0.941）。在病理分析中，PA 残端在距密封部位 1mm 处要么有外膜和外膜的热损伤（26/37），要么有穿壁损伤（11/37）。
建议在仪器叶片和重要结构之间留出 3mm 的安全裕度。仪器叶片可以达到可能导致组织损伤的高温。
