Tao Gao1, Bik Ee Lau2, Tadashi Yamaguchi3, Naoyuki Hanari1, Hisashi Gunji1, Masayuki Kano1, Hisahiro Matsubara1, Hideki Hayashi4,5. 1. Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. 2. Graduate School of Engineering, Chiba University, Chiba, Japan. 3. Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba, 263-8522, Japan. 4. Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. hhayashi@faculty.chiba-u.jp. 5. Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba, 263-8522, Japan. hhayashi@faculty.chiba-u.jp.
Abstract
PURPOSE: Recently, the incidence of postoperative pancreatic leakage has been reported to have significantly increased after laparoscopic gastrectomy for gastric cancers in comparison to open surgery. Although their lateral thermal spread has been shown to be smaller than that of other electrosurgical devices, ultrasonically activated surgical devices (USADs) have been suggested as one of the causes. We therefore hypothesized that cavitation generated by USADs could cause injuries to pancreatic tissue. Our retrospective study showed that the amylase activity in the drainage fluid of patients in whom surgery was performed using a USAD with a curved blade was significantly higher than that in patients in whom surgery was performed using a USAD with a straight blade. We therefore focused on the effects of straight and curved USAD blades. METHODS: The distribution of microbubbles generated in degassed water, which produce mechanical and biological tissue destructive forces, was measured and compared between the two types of USAD. RESULTS: More microbubbles were found to be generated from the side aspect of the curved blade, and the mechanical and biological destructive forces were found to be significantly higher than those generated by the side aspect of the straight blade. CONCLUSIONS: These findings strongly suggest that cavitation generated by USADs could injure pancreatic tissues in the clinical cases. Surgeons should be aware of these properties of devices to achieve safe and secure surgeries.
PURPOSE: Recently, the incidence of postoperative pancreatic leakage has been reported to have significantly increased after laparoscopic gastrectomy for gastric cancers in comparison to open surgery. Although their lateral thermal spread has been shown to be smaller than that of other electrosurgical devices, ultrasonically activated surgical devices (USADs) have been suggested as one of the causes. We therefore hypothesized that cavitation generated by USADs could cause injuries to pancreatic tissue. Our retrospective study showed that the amylase activity in the drainage fluid of patients in whom surgery was performed using a USAD with a curved blade was significantly higher than that in patients in whom surgery was performed using a USAD with a straight blade. We therefore focused on the effects of straight and curved USAD blades. METHODS: The distribution of microbubbles generated in degassed water, which produce mechanical and biological tissue destructive forces, was measured and compared between the two types of USAD. RESULTS: More microbubbles were found to be generated from the side aspect of the curved blade, and the mechanical and biological destructive forces were found to be significantly higher than those generated by the side aspect of the straight blade. CONCLUSIONS: These findings strongly suggest that cavitation generated by USADs could injure pancreatic tissues in the clinical cases. Surgeons should be aware of these properties of devices to achieve safe and secure surgeries.
Entities:
Keywords:
Energy device; Laparoscopic gastrectomy; Pancreatic injury
Authors: Victor B Tsirline; Kelvin N Lau; Ryan Z Swan; Paul N Montero; David Sindram; John B Martinie; David A Iannitti Journal: Surg Innov Date: 2013-01-08 Impact factor: 2.058