Nduka C C, Poland N, Kennedy M, Dye J, Darzi A
Academic Surgical Unit, Imperial College School of Medicine at Saint Mary's, London, United Kingdom.
Surg Endosc. 1998 Aug;12(8):1031-4. doi: 10.1007/s004649900774.
Viable cancer cells may implant at distant sites and cause tumor recurrence. One possible mechanism is the inadvertent exfoliation of viable tumor cells during dissection. The ultrasonically activated scalpel (UAS) uses ultrasonic energy to disrupt tissues by cavitation and produces a dense cloud of cellular debris that may contain viable cells. This study aimed to investigate the viability of airborne cells released during cancer dissection using the UAS and electrosurgery.
Flank tumors (n = 8) measuring 1 cm3 were induced in male WAG rats by subcutaneous injection of 2 x 10(6) CC531s colon cancer cells. Dissection was performed in cutting mode using the maximum power output of the respective devices. Electrosurgery was performed using a standard monopolar electrosurgical unit and a needle probe, and ultrasonic dissection was performed with the Harmonic Scalpel utilising the open surgical handset and the hooked spatula tip. The smoke plume was aspirated by a vacuum pump and bubbled under Hank's balanced salt solution to trap particulate matter. The viability of the cellular material was blindly assessed with the trypan blue test and by in vitro culture. The morphology of the cellular debris was studied by examination of cytospin preparations.
Large quantities of cellular debris was trapped in the plume from both devices. However, no viable cells were isolated, nor did in vitro cell growth occur with either device. Examination of the debris from the UAS demonstrated a characteristic mixture of amorphous forms and very few morphologically intact cells. The cauterized tumor produced charred cells and tissue fragments.
In conclusion, this study demonstrates that viable airborne cancer cells are not released after tumor ablation with the UAS or electrosurgery.
存活的癌细胞可能会在远处着床并导致肿瘤复发。一种可能的机制是在解剖过程中存活的肿瘤细胞意外脱落。超声手术刀（UAS）利用超声能量通过空化作用破坏组织，并产生一团可能含有活细胞的密集细胞碎片云。本研究旨在调查使用UAS和电外科手术进行癌症解剖时释放的空气中细胞的活力。
通过皮下注射2×10⁶个CC531s结肠癌细胞，在雄性WAG大鼠中诱导出体积为1 cm³的侧腹肿瘤（n = 8）。使用各自设备的最大功率输出，以切割模式进行解剖。使用标准单极电外科设备和针状探头进行电外科手术，使用超声手术刀（Harmonic Scalpel）并配备开放式手术手柄和钩状刮铲尖端进行超声解剖。用真空泵抽吸烟雾，并使其在汉克平衡盐溶液下鼓泡以捕获颗粒物。通过台盼蓝试验和体外培养盲目评估细胞材料的活力。通过检查细胞涂片制剂研究细胞碎片的形态。
两种设备产生的烟雾中都捕获了大量细胞碎片。然而，未分离出活细胞，两种设备也均未出现体外细胞生长。对UAS产生的碎片进行检查发现，其呈现出无定形形式的特征性混合物，且形态完整的细胞极少。烧灼的肿瘤产生了烧焦的细胞和组织碎片。
总之，本研究表明，使用UAS或电外科手术进行肿瘤切除后，不会释放存活的空气中癌细胞。
