Su Peiyi, Wrobel Bozena B, Zada Gabriel, Mack Wendy J, Ge Marshall, Kim Jee-Hong, Ference Elisabeth D
Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
Otolaryngol Head Neck Surg. 2021 Dec;165(6):899-904. doi: 10.1177/01945998211000372. Epub 2021 Mar 9.
Cauterization prevents hemorrhage and optimizes the surgical field during endoscopic sinus surgery but may cause injury to nearby structures. The objective of this study is to examine thermal conductance from cauterization equipment across the skull base.
Cadaver and animal model.
Surgical skills laboratory of an academic tertiary medical institution.
A pilot study was conducted with a deidentified cadaver head and expanded to a goat head animal model. Endoscopic dissection was performed to expose the lamina papyracea, ethmoid roof, sphenoid roof, and frontal sinus. Cautery was applied to the frontal sinus of goat heads, and temperatures were measured via thermocouple sensors placed along the intracranial skull base. Surgical instruments studied included monopolar, bipolar, and endoscopic bipolar devices at various power settings.
Temperature increase, as averaged across all cautery powers and measurement positions, was highest for the monopolar cautery (17.55 °C) when compared with the bipolar and endoscopic bipolar devices (<2 °C for bipolar, Endo-Pen, Stammberger, and Wormald; < .001). Monopolar cautery reached 30.86 °C at high power when averaged over all positions ( < .001) as compared with <3 °C for the other instruments. Temperatures rose as power of cautery was increased from low to medium and high. Temperatures decreased as the distance of the thermocouple sensor probe from the cautery origin increased.
Thermal conductance across the skull base varies depending on equipment and power of cautery, with monopolar resulting in the largest temperature increase. Choice and implementation of cauterization instruments have implications on inadvertent transmission of thermal energy during endoscopic sinus surgery.
在鼻内镜鼻窦手术中，烧灼可防止出血并优化手术视野，但可能会对附近结构造成损伤。本研究的目的是检测烧灼设备穿过颅底的热传导情况。
尸体和动物模型。
一所学术性三级医疗机构的外科技能实验室。
首先对一具身份不明的尸体头部进行了初步研究，然后扩展到山羊头部动物模型。进行内镜下解剖以暴露纸样板、筛窦顶、蝶窦顶和额窦。对山羊头部的额窦进行烧灼，并通过沿颅内颅底放置的热电偶传感器测量温度。所研究的手术器械包括不同功率设置的单极、双极和内镜双极设备。
与双极和内镜双极设备相比（双极、Endo-Pen、Stammberger和Wormald设备的温度升高<2℃），单极烧灼在所有烧灼功率和测量位置的平均温度升高最高（17.55℃；P<0.001）。与其他器械<3℃相比，单极烧灼在所有位置的高功率下平均温度达到30.86℃（P<0.001）。温度随着烧灼功率从低到中再到高而升高。随着热电偶传感器探头与烧灼源距离的增加，温度降低。
颅底的热传导因设备和烧灼功率而异，单极烧灼导致的温度升高最大。烧灼器械的选择和使用对鼻内镜鼻窦手术中热能的意外传递有影响。
