Vasquez J M, Eisenberg E, Osteen K G, Hickerson D, Diamond M P
Division of Reproductive Endocrinology, C-1100 MCN, C-FARR, Vanderbilt University and Medical School, Nashville, TN 37232-2515, USA.
J Am Assoc Gynecol Laparosc. 1993 Nov;1(1):36-42. doi: 10.1016/s1074-3804(05)80756-x.
Surgical modalities such as electrosurgery and lasers have been used for many years to treat endometriosis. They are relatively unselective with wide scatter, however, leading to the potential for significant tissue damage and injury. As an alternative, a technique for performing laparoscopic excision and adhesiolysis using a cavitational ultrasonic surgical aspirator (CUSA) was developed and studied in 15 patients. Endometriosis was removed using a prototype titanium probe developed for a 10-mm laparoscopic port. The ultrasonic laparoscopic probe consisted of an acoustic vibrator, a coupling device, a removable tip, and a protective flue. Vibrations from the acoustic vibrator (magnetostrictive device) were conveyed to the operating tip through a coupling piece. The magnetostrictive device consisted of nickel alloy laminations 10.8 cm in length that transformed electrical energy into mechanical motion at the hollow titanium tip, vibrating at a frequency of 23 kHz. The excursion of the tip (amplitude setting) was arbitrarily set, with a fixed stroke of 200 microm in all cases to remove tissue with a 1- to 2-mm radius of the vibrating tip. The tip was tapered to obtain greater amplitude and ablation efficiency. When placed in contact with the endometriotic implants and adhesions, it destroyed and emulsified the cell membranes, which were irrigated and removed through a built-in suction tube. The resulting debris and irrigating fluid were removed through the hollow central portion of the probe. The vibrating tip was moved over the surgical site in a back-and-forth motion to allow continuous, controlled removal. Vessels larger than 0.5 mm in diameter, nerves, and fibrous tissue capsules rebounded with the ultrasonic vibration waves emitted by the CUSA, and thus were unimpaired by the procedure. The consistency of tissues was sensed accurately when the tip of the device was in contact with them. This tactile feedback was helpful in enabling the surgeon to differentiate target tissues. The future application of this instrument awaits the outcome of research.
诸如电外科手术和激光等手术方式多年来一直用于治疗子宫内膜异位症。然而，它们的选择性相对较低，散射范围广，从而有可能造成严重的组织损伤。作为一种替代方法，开发了一种使用空化超声手术吸引器（CUSA）进行腹腔镜切除和粘连松解的技术，并在15名患者中进行了研究。使用为10毫米腹腔镜端口开发的原型钛探头切除子宫内膜异位症。超声腹腔镜探头由一个声学振动器、一个耦合装置、一个可移除尖端和一个保护烟道组成。声学振动器（磁致伸缩装置）产生的振动通过一个连接件传递到操作尖端。磁致伸缩装置由长度为10.8厘米的镍合金叠片组成，它在空心钛尖端将电能转化为机械运动，以23千赫的频率振动。尖端的偏移（振幅设置）可任意设定，在所有情况下固定行程为200微米，以切除振动尖端半径为1至2毫米范围内的组织。尖端呈锥形以获得更大的振幅和消融效率。当与子宫内膜异位植入物和粘连接触时，它会破坏并乳化细胞膜，这些细胞膜通过内置的吸管进行冲洗和清除。产生的碎片和冲洗液通过探头的空心中心部分排出。振动尖端在手术部位来回移动，以实现连续、可控的切除。直径大于0.5毫米的血管、神经和纤维组织包膜会随着CUSA发出的超声振动波反弹，因此该手术不会对其造成损伤。当设备尖端与组织接触时，可以准确感知组织的质地。这种触觉反馈有助于外科医生区分目标组织。该仪器的未来应用有待研究结果。
