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Radcliff K, Vijay P, Sarris RF, Speltz M, Vose JG. Preclinical Comparison of Thermal Tissue Effects from Traditional Electrosurgery and a Low-Temperature Electrosurgical Device during Anterior Cervical Discectomy and Fusion. Int J Spine Surg 2018; 12:483-489. [PMID: 30276109 DOI: 10.14444/5059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Exposure of the anterior cervical spine requires dissection in proximity to critical neurovascular structures. Monopolar electrosurgical (ES) devices generate heat in contacted tissues, resulting in thermal damage and temperature change. This study examined depth of thermal injury and temperature change associated with use of a low-temperature electrosurgical device (LTD) compared to traditional electrosurgery during a cadaveric anterior cervical discectomy and fusion (ACDF) dissection. Methods ACDF was performed, using ES or LTD, on cervical spines (C3-4 and C4-5) from 2 fresh human cadavers with intact neck soft tissues and no history of surgery. Cadavers were maintained at 22-23°C, and fiber-optic temperature sensors (Neoptix, Québec City, Québec, Canada) were placed near relevant structures to measure changes during dissection. Depth of thermal injury was assessed by hematoxylin and eosin and Masson's trichrome histology of fixed tissue specimens. Results Use of the LTD resulted in a statistically significant reduction in temperature change at platysma (3.0 ± 1.04 vs. 11.41 ± 3.10°C, P = .003), carotid sheath (7.32 ± 1.13 vs. 15.57 ± 2.56°C, P = .007), and longus colli (6.11 ± 1.32 vs. 12.9 ± 3.62°C, P = .016) compared to ES. Temperature change at the trachea was similar between groups (6.06 ± 1.99 vs. 4.96 ± 1.89°C, P = .528). Histology showed that LTD produced less mean and maximal depth of thermal injury compared to ES (mean: 0.5 vs. 1.2 mm; max: 0.9 vs. 1.8 mm; P < .05). Conclusions The results of this pilot study demonstrate that anterior cervical spine exposure using an LTD reduces tissue temperature change and depth of thermal injury compared to ES. Clinical Relevance Although exploratory, these results suggest that use of an LTD during ACDF may reduce the extent of thermal tissue injury during dissection. Future studies in live animal models are warranted to determine if thermal injury is a potential cause of common exposure-related complications, such as dysphagia and dysphonia.
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Affiliation(s)
- Kris Radcliff
- Departments of Orthopedic Surgery and Neurological Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Ruba F Sarris
- Medtronic Advanced Energy LLC, Portsmouth, New Hampshire
| | - Molly Speltz
- Medtronic Physiologic Research Laboratories, Coon Rapids, Minnesota
| | - Joshua G Vose
- Medtronic Advanced Energy LLC, Portsmouth, New Hampshire
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Zheng L, Wan J, Long Y, Fu H, Zheng J, Zhou Z. Effect of high-frequency electric field on the tissue sticking of minimally invasive electrosurgical devices. ROYAL SOCIETY OPEN SCIENCE 2018; 5:180125. [PMID: 30109069 PMCID: PMC6083695 DOI: 10.1098/rsos.180125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/04/2018] [Indexed: 06/08/2023]
Abstract
Generally minimally invasive surgery is performed using an endoscope and other instruments including electrosurgical units (ESUs), and the adhesion of tissue to electrodes is a major concern. The mechanism governing this tissue sticking, especially the influence of high-frequency electric field, is still unclear. In this study, the effect of high-frequency electric field on the tissue sticking upon electrodes was investigated. The electrosurgical cutting test was performed on ex vivo fresh porcine liver under blend mode using a monopolar ESU. A heat-adherence test without electric field was used as a control. For the control group, the electrode was heated and maintained at a certain temperature and directly in contact with porcine liver. Both sticking tissues obtained from these two tests are partially carbonized porcine liver tissue, but their microstructure and bonding with electrode are obviously different. The sticking tissue formed just under heat is composed of biggish nanoparticles of different sizes which are loosely aggregated and has a weak bonding with the electrode, while the sticking tissue from the electrosurgical cutting test consists of tightly packed fine nanoparticles of equable size as a result of thermo-electric coupling and has a strong bonding with the electrode. Obviously, high-frequency electric field plays an extremely important role in the formation of the sticking tissue. It is the thermo-electric coupling that underlies the function of minimally invasive electrosurgical devices, and the effect of high-frequency electric field cannot be ignored in the tissue sticking study and anti-sticking strategies.
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Affiliation(s)
- Liang Zheng
- Tribology Research Institute, Key Laboratory of Advanced Technologies of Materials, Ministry of Education of China, Southwest Jiaotong University, Chengdu 610031, People's Republic of China
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu 610031, People's Republic of China
| | - Jianfei Wan
- Tribology Research Institute, Key Laboratory of Advanced Technologies of Materials, Ministry of Education of China, Southwest Jiaotong University, Chengdu 610031, People's Republic of China
| | - Yunjiang Long
- Tribology Research Institute, Key Laboratory of Advanced Technologies of Materials, Ministry of Education of China, Southwest Jiaotong University, Chengdu 610031, People's Republic of China
| | - Helin Fu
- Tribology Research Institute, Key Laboratory of Advanced Technologies of Materials, Ministry of Education of China, Southwest Jiaotong University, Chengdu 610031, People's Republic of China
| | - Jing Zheng
- Tribology Research Institute, Key Laboratory of Advanced Technologies of Materials, Ministry of Education of China, Southwest Jiaotong University, Chengdu 610031, People's Republic of China
| | - Zhongrong Zhou
- Tribology Research Institute, Key Laboratory of Advanced Technologies of Materials, Ministry of Education of China, Southwest Jiaotong University, Chengdu 610031, People's Republic of China
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Marangi GF, Pallara T, Lamberti D, Perrella E, Serra R, Stilo F, De Caridi G, Onetti Muda A, Persichetti P. An electrical plasma dissection tool for surgical treatment of chronic ulcers: Results of a prospective randomised trial. Int Wound J 2018; 15:717-721. [PMID: 29600828 DOI: 10.1111/iwj.12915] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/08/2018] [Accepted: 02/12/2018] [Indexed: 12/01/2022] Open
Abstract
Cutaneous ulceration is a difficult medical problem and a major source of morbidity for patients. In the surgical treatment of ulcers, debridement is the first step, and it can be carried out using several surgical tools. Recently, new surgical devices have emerged using plasma-mediated electrical discharges with a lower peak temperature. A prospective single-blind trial was conducted on chronic ulcers not responsive to common non-surgical management. Patients were randomly separated into 2 groups: Group A received surgical debridement with conventional electrocautery, and Group B received surgical debridement using the plasma-mediated device. Histological samples were collected intraoperatively to evaluate the thermal damage during the surgical procedure and 2 weeks after surgery to evaluate the inflammatory response and collagen deposition. The width of coagulation necrosis at the incision margins in Group B was significantly shorter compared with Group A (P = .001). The inflammatory cell infiltration showed a cellular distribution percentage that was quite equal between the 2 groups. The granulation tissue showed an abundant deposition of dense and mature collagen in Group B, compared with Group A, where the mature collagen appeared in small quantities (P < .001). Microbial culture showed a lower incidence of postoperative infections in Group B compared with the control group (P < .05). The study demonstrated, based on the results, that the new technology with the use of a lower temperature electrosurgical device represents an effective therapeutic weapon for the surgical treatment of skin ulcers, both vascular and extravascular types.
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Affiliation(s)
- Giovanni F Marangi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
| | - Tiziano Pallara
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
| | - Daniela Lamberti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
| | - Eleonora Perrella
- Department of Pathology, Campus Bio-Medico of Rome University, Rome, Italy
| | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Francesco Stilo
- Vascular Surgery Unit, Campus Bio-Medico of Rome University, Rome, Italy
| | | | - Andrea Onetti Muda
- Department of Pathology, Campus Bio-Medico of Rome University, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
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Lin CC, Lin HJ, Lin YH, Sugiatno E, Ruslin M, Su CY, Ou KL, Cheng HY. Micro/nanostructured surface modification using femtosecond laser pulses on minimally invasive electrosurgical devices. J Biomed Mater Res B Appl Biomater 2016; 105:865-873. [DOI: 10.1002/jbm.b.33613] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/06/2015] [Accepted: 12/27/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Chia-Cheng Lin
- Department of Dentistry; Shin Kong Wu Ho-Su Memorial Hospital; Taipei Taiwan
- School of Dental Technology, College of Oral Medicine, Taipei Medical University; Taipei Taiwan
| | - Hao-Jan Lin
- School of Dentistry, College of Oral Medicine, Taipei Medical University; Taipei Taiwan
- Research Center for Biomedical Devices and Prototyping Production, Taipei Medical University; Taipei Taiwan
| | - Yun-Ho Lin
- Research Center for Biomedical Devices and Prototyping Production, Taipei Medical University; Taipei Taiwan
- School of Medical Technology and Biotechnology, Taipei Medical University; Taipei Taiwan
| | - Erwan Sugiatno
- Research Center for Biomedical Devices and Prototyping Production, Taipei Medical University; Taipei Taiwan
- Department of Prosthodontic; Faculty of Dentistry, Universitas Gadjah Mada; Yogyakarta Indonesia
| | - Muhammad Ruslin
- Research Center for Biomedical Devices and Prototyping Production, Taipei Medical University; Taipei Taiwan
- Department of Oral and Maxillofacial Surgery; Faculty of Dentistry, University of Hasanuddin; Makassar Indonesia
| | - Chen-Yao Su
- Department of Pharmacology College of Medicine; Taipei Taiwan
- Department of Dentistry; National Yang-Ming University; Taipei Taiwan
- Department of Microbiology and Immunology College of Medicine; School of Medical Laboratory Science and Biotechnology; Taipei Taiwan
| | - Keng-Liang Ou
- School of Dentistry, College of Oral Medicine, Taipei Medical University; Taipei Taiwan
- Research Center for Biomedical Devices and Prototyping Production, Taipei Medical University; Taipei Taiwan
- Research Center for Biomedical Implants and Microsurgery Devices, Taipei Medical University; Taipei Taiwan
- Department of Dentistry; Taipei Medical University-Shuang Ho Hospital; New Taipei City Taiwan
| | - Han-Yi Cheng
- Research Center for Biomedical Devices and Prototyping Production, Taipei Medical University; Taipei Taiwan
- Research Center for Biomedical Implants and Microsurgery Devices, Taipei Medical University; Taipei Taiwan
- Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University; Taipei Taiwan
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Effect of Anti-Sticking Nanostructured Surface Coating on Minimally Invasive Electrosurgical Device in Brain. Ann Biomed Eng 2015; 43:2383-93. [PMID: 25851468 DOI: 10.1007/s10439-015-1304-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
Abstract
The purpose of the present study was to examine the extent of thermal injury in the brain after the use of a minimally invasive electrosurgical device with a nanostructured copper-doped diamond-like carbon (DLC-Cu) surface coating. To effectively utilize an electrosurgical device in clinical surgery, it is important to decrease the thermal injury to the adjacent tissues. The surface characteristics and morphology of DLC-Cu thin film was evaluated using a contact angle goniometer, scanning electron microscopy, and atomic force microscopy. Three-dimensional biomedical brain models were reconstructed using magnetic resonance images to simulate the electrosurgical procedure. Results indicated that the temperature was reduced significantly when a minimally invasive electrosurgical device with a DLC-Cu thin film coating (DLC-Cu-SS) was used. Temperatures decreased with the use of devices with increasing film thickness. Thermographic data revealed that surgical temperatures in an animal model were significantly lower with the DLC-Cu-SS electrosurgical device compared to an untreated device. Furthermore, the DLC-Cu-SS device created a relatively small region of injury and lateral thermal range. As described above, the biomedical nanostructured film reduced excessive thermal injury with the use of a minimally invasive electrosurgical device in the brain.
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Shen YD, Lin LH, Chiang HJ, Ou KL, Cheng HY. Research of electrosurgical unit with novel antiadhesion composite thin film for tumor ablation: Microstructural characteristics, thermal conduction properties, and biological behaviors. J Biomed Mater Res B Appl Biomater 2015; 104:96-105. [DOI: 10.1002/jbm.b.33363] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/04/2014] [Accepted: 11/18/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Yun-Dun Shen
- Department of Ophthalmology; Taipei Medical University-Shuang Ho Hospital; New Taipei City Taiwan
| | - Li-Hsiang Lin
- Research Center for Biomedical Devices and Prototyping Production; Taipei Medical University; Taipei 110 Taiwan
- School of Dentistry; College of Oral Medicine; Taipei Medical University; Taipei 110 Taiwan
| | - Hsi-Jen Chiang
- Research Center for Biomedical Devices and Prototyping Production; Taipei Medical University; Taipei 110 Taiwan
- School of Dentistry; College of Oral Medicine; Taipei Medical University; Taipei 110 Taiwan
- Department of Dentistry; Taipei Medical University-Shuang Ho Hospital; New Taipei City 235 Taiwan
| | - Keng-Liang Ou
- Research Center for Biomedical Devices and Prototyping Production; Taipei Medical University; Taipei 110 Taiwan
- Department of Dentistry; Taipei Medical University-Shuang Ho Hospital; New Taipei City 235 Taiwan
- Graduate Institute of Biomedical Materials and Tissue Engineering; Taipei Medical University; Taipei 110 Taiwan
- Research Center for Biomedical Implants and Microsurgery Devices; Taipei Medical University; Taipei 110 Taiwan
| | - Han-Yi Cheng
- Research Center for Biomedical Devices and Prototyping Production; Taipei Medical University; Taipei 110 Taiwan
- Graduate Institute of Biomedical Materials and Tissue Engineering; Taipei Medical University; Taipei 110 Taiwan
- Research Center for Biomedical Implants and Microsurgery Devices; Taipei Medical University; Taipei 110 Taiwan
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Hsiao WT, Lin LH, Chiang HJ, Ou KL, Cheng HY. Biomedical electrosurgery devices containing nanostructure for minimally invasive surgery: reduction of thermal injury and acceleration of wound healing for liver cancer. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:77. [PMID: 25631273 DOI: 10.1007/s10856-015-5416-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 11/01/2014] [Indexed: 06/04/2023]
Abstract
The aim of the present study was to investigate the thermal injury in the liver after a minimally invasive electrosurgery technique with a copper-doped diamond-like carbon (DLC-Cu) surface coating. To effectively utilize electrosurgery in a clinical caner setting, it is necessary to suppress the thermal injury to adjacent tissues. The surface morphologies of DLC-Cu thin films were characterized using scanning electron microscopy and transmission electron microscopy. Three-dimensional liver models were reconstructed using magnetic resonance imaging to simulate the electrosurgical procedure. Our results indicated that the temperature decreased significantly when minimally electrosurgery with nanostructured DLC-Cu thin films was used, and that it continued to decrease with increasing film thickness. In an animal model, thermography revealed that the surgical temperature was significantly lower in the minimally invasive electrosurgery with DLC-Cu thin film (DLC-Cu-SS) compared to untreated electrosurgery. In addition, DLC-Cu-SS created a relatively small thermal injury area and lateral thermal effect. These results indicated that the biomedical nanostructure coating reduced excessive thermal injury, and uniformly distributed temperature in the liver.
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Affiliation(s)
- Wen-Tien Hsiao
- Department of Diagnostic Radiology, Taipei Medical University Hospital, Taipei, 110, Taiwan
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Robertson SA, Rusby JE, Cutress RI. Determinants of optimal mastectomy skin flap thickness. Br J Surg 2014; 101:899-911. [DOI: 10.1002/bjs.9470] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2014] [Indexed: 02/01/2023]
Abstract
Abstract
Background
There is a limited evidence base to guide surgeons on the ideal thickness of skin flaps during mastectomy. Here the literature relevant to optimizing mastectomy skin flap thickness is reviewed, including anatomical studies, oncological considerations, factors affecting viability, and the impact of surgical technique and adjuvant therapies.
Methods
A MEDLINE search was performed using the search terms ‘mastectomy’ and ‘skin flap’ or ‘flap thickness’. Titles and abstracts from peer-reviewed publications were screened for relevance.
Results
A subcutaneous layer of variable thickness that contains minimal breast epithelium lies between the dermis and breast tissue. The thickness of this layer may vary within and between breasts, and does not appear to be associated with obesity or age. The existence of a distinct layer of superficial fascia in the breast remains controversial and may be present in only up to 56 per cent of patients. When present, it may not be visible macroscopically, and can contain islands of breast tissue. As skin flap necrosis occurs in approximately 5 per cent of patients, a balance must be sought between removing all breast tissue at mastectomy and leaving reliably viable skin flaps.
Conclusion
The variable and unpredictable thickness of the breast subcutaneous layer means that a single specific universal thickness for mastectomy skin flaps cannot be recommended. It may be that the plane between the subdermal fat and breast parenchyma is a reasonable guide for mastectomy flap thickness, but this may not always correspond to a subcutaneous fascial layer.
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Affiliation(s)
- S A Robertson
- University Hospital Southampton, Cancer Research UK Clinical Centre, Southampton General Hospital, Southampton, UK
| | | | - R I Cutress
- University Hospital Southampton, Cancer Research UK Clinical Centre, Southampton General Hospital, Southampton, UK
- University of Southampton, Cancer Research UK Clinical Centre, Southampton General Hospital, Southampton, UK
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