Lantis JC I I, Durville F M, Connolly R, Schwaitzberg S D
Surgical Research Laboratory, New England Medical Center, Boston, Massachusetts, USA.
J Laparoendosc Adv Surg Tech A. 1998 Dec;8(6):381-94. doi: 10.1089/lap.1998.8.381.
The increase in laparoscopic surgery has resulted in an increased need for a safe and reliable method of obtaining minimally invasive operative hemostasis. Because the traditional "open" methods of controlling bleeding (pressure, tying, and suture ligating) are not as easily applied in the laparoscopic arena, a heavy reliance on forms of tissue and vessel coagulation is necessary. To better assess these forms, we compare monopolar, bipolar, and ultrasound energy, in addition to laser energy used in a novel application. In the first part, 20 rabbit mesenteric arteries that measured 1 to 1.5 mm in diameter were coagulated using each of the technologies. We measured the time to coagulation, the efficacy of hemostasis, lateral tissue damage, and local tissue temperature of the vessels when exposed. Part 2 consisted of a survival study using 12 New Zealand white rabbits. In each of these two groups splenectomies were performed. A laser-heated forceps was compared to a monopolar electrosurgery device for the speed of the operation, blood loss, and adhesion grade at necrosectomy. In addition, the speed to cauterization of the iliac vessels and the amount of tissue damage was measured. These vessels were also examined for the extent of microscopic damage. Bipolar electrosurgery was much slower than the other modalities, while monopolar electrosurgery caused significantly more tissue damage and elevation in lateral tissue temperature. The ultrasound technology and the laser-heated forceps were equally safe and efficacious instruments. There was no significant difference in the ability of the laser-heated forceps or the monopolar cautery to perform the splenectomy safely. However, the forceps cauterized the iliac vessels faster and with less lateral thermal injury than the ultrasound device. Although each instrument has its place in the surgical armamentarium, the ultrasound technology appears to be the safest and most efficacious commercially available device for obtaining hemostasis. The laser, as it is applied in this setting, was also highly effective, but still a prototype device.
腹腔镜手术的增加使得对一种安全可靠的微创术中止血方法的需求也随之增加。由于传统的“开放”止血方法（压迫、结扎和缝合结扎）在腹腔镜领域不易应用，因此严重依赖各种组织和血管凝固方法成为必要。为了更好地评估这些方法，我们比较了单极、双极和超声能量，以及一种新型应用中使用的激光能量。在第一部分中，使用每种技术对20条直径为1至1.5毫米的兔肠系膜动脉进行凝固。我们测量了凝固时间、止血效果、侧向组织损伤以及血管暴露时的局部组织温度。第二部分是一项使用12只新西兰白兔的生存研究。在这两组中分别进行脾切除术。将激光加热钳与单极电外科设备在手术速度、失血量和坏死切除时的粘连等级方面进行比较。此外，测量了髂血管的烧灼速度和组织损伤量。还检查了这些血管的微观损伤程度。双极电外科手术比其他方式慢得多，而单极电外科手术造成的组织损伤明显更多，侧向组织温度升高也更明显。超声技术和激光加热钳是同样安全有效的器械。激光加热钳或单极烧灼器在安全进行脾切除术的能力上没有显著差异。然而，与超声设备相比，激光加热钳烧灼髂血管的速度更快，侧向热损伤更小。尽管每种器械在手术器械库中都有其用途，但超声技术似乎是目前可获得的用于止血的最安全、最有效的设备。在这种情况下应用的激光也非常有效，但仍是一种原型设备。
