Ewertowska Elzbieta, Casey Vincent J, Whiting Robert, Burke Micheal, Frey Laura, Sheridan Paul, Row Ben, Deeny Bryan, McNamara Laoise M
Mechanobiology and Medical Devices Research Group (MMDRG), Biomedical Engineering, National University of Ireland, Galway, Ireland.
CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland.
Int J Hyperthermia. 2024;41(1):2439549. doi: 10.1080/02656736.2024.2439549. Epub 2024 Dec 11.
Surgical cutting with electrosurgical tools facilitates tissue dissection and vessel sealing, preventing blood loss. The extent of tissue necrosis due to temperature elevations is dependent on the cutting technique, device design, coating properties and power settings, but the influence of these parameters is not fully understood. Here we conduct a comprehensive comparative analysis of thermal damage comparing (1) manual user-controlled and robotic electrosurgical cutting approaches for (2) varying electrodes and coatings, and power settings. We demonstrate that ceramic coating significantly enhanced cutting performance and cut quality and reduced lateral thermal damage, by 86.15% at 35 W and 65% at 50 W respectively. We provide quantitative assessment of the influence of surgical variability on thermal damage, comparing robotic and manual electrosurgical cutting. Robotic cutting with one ceramic electrosurgical coated device reduced thermal damage (midline - 47.42%, lateral - 33.06%), whereas for the other coated electrode the thermal spread increased (midline - 66.57%, lateral -245.72). Thus, thermal damage performance was strongly influenced by surgical variability and the specific characteristics of each device. Together, these results provide an enhanced understanding of potential mechanisms determining electrosurgical outcomes. Understanding of these interdependencies and mechanisms of action linked to a specific electrosurgical system is essential for successful tissue resection.
使用电外科工具进行手术切割有助于组织解剖和血管封闭，防止失血。由于温度升高导致的组织坏死程度取决于切割技术、设备设计、涂层特性和功率设置，但这些参数的影响尚未完全了解。在此，我们对热损伤进行了全面的比较分析，比较了（1）手动用户控制和机器人电外科切割方法，用于（2）不同的电极和涂层以及功率设置。我们证明，陶瓷涂层显著提高了切割性能和切割质量，并减少了侧向热损伤，在35W时分别减少了86.15%，在50W时减少了65%。我们提供了对手术变异性对热损伤影响的定量评估，比较了机器人和手动电外科切割。使用一种陶瓷电外科涂层设备进行机器人切割减少了热损伤（中线 - 47.42%，侧向 - 33.06%），而对于另一种涂层电极，热扩散增加了（中线 - 66.57%，侧向 - 245.72%）。因此，热损伤性能受到手术变异性和每个设备的特定特性的强烈影响。总之，这些结果增强了对决定电外科结果的潜在机制理解。了解这些相互依存关系和与特定电外科系统相关联的作用机制对于成功的组织切除至关重要。
