Morishita Y, Konishi I, Noda Y, Mori T
Gan To Kagaku Ryoho. 1987 May;14(5 Pt 2):1494-500.
Not infrequently, great difficulty is encountered in the operation for advanced cervical carcinoma of the uterus in dissecting cancerous tissues and controlling incidental bleeding. The CUSA is a major achievement of modern ultrasonic technology, and has been used by us to overcome such difficulties in 6 cases of total pelvic exenteration, 4 of anterior pelvic exenteration, 1 of posterior pelvic exenteration, 2 of cardinal ligament extirpation and 21 of radical hysterectomy. The handpiece of the CUSA contains a hollow titanium tip which vibrates longitudinally along its axis, driven by a magnetostrictive transducer. The vibration occurs with a frequency of 23 kHz and with an adjustable stroke of 0-300 microns. The tip of the device, placed in contact with the target tissues, destroys and emulsifies the cell membranes, which are irrigated and removed through a built-in suction tube. Since vessels larger than 0.5mm in diameter, nerves and fibrous tissue capsules contain much collagen, they rebound with the ultrasonic vibration waves emitted by the CUSA, and consequently they are left unimpaired by the procedure. It was noted in our operations that the larger the degree of tip excursion of the CUSA, the greater was the power added to fragment the target tissues. The effectiveness also depended upon the amount of water contained in the tissues. A very accurate sensation of the consistency of tissues was obtainable through the tip of the device in contact with them. This tactile feedback was quite helpful in enabling us to differentiate between target tissues. A clear visualization of detailed structures of vasculature and nerves in the pelvic cavity was attained as a result of sweeping dissection using the CUSA, and thereby extensive elimination of the cancerous tissues and lymph nodes was facilitated.
