Feil / Dallemagne / Degueldre Ultrasonic Energy for Cutting, Coagulating, and Dissecting

1. Auflage 2004
ISBN: 978-3-13-258120-3
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 240 Seiten, ePub

Reihe: Thieme

Ultrasonic energy can be applied to surgical instruments for cutting, dissecting, and coagulating vessels and/or tissue. This book presents the use of ultrasound energy as it is used in UltraCision products, for use in surgery on many parts of the body. Principles of UltraCision technology: The instruments are attached to a hand piece, which is connected to a generator. The ultrasonic system is situated inside the hand piece and transforms the electric energy into mechanical movement, producing in this way longitudinal vibrations of the blades at approx. 55 kHz per second. The movement of the blades causes collagen molecules to vibrate inside the tissues, thus forming a coagulum upon their denaturation. This method is especially useful in parenchymatous organs, where dissection can be performed cleanly and with little or no bleeding. Among the applications of UltraCision are: esophageal surgery; reflex surgery; gastrectomy; colorectal surgery for Crohn's disease, diverticulitis, and cancer; laparoscopic cholecystectomy - hepatic resection; pancreatic surgery; adrenalectomy; thyroid surgery; hysterectomy and other gynecologic surgery; and much more! For the general surgeon becoming acquainted with this highly effective new surgical tool, this book represents an ideal introduction, including a step-by-step guide to operative sequences, and tips provided by those who have already gained experience in the modality.

Wolfgang Feil

Zielgruppe

Ärzte

Autoren/Hrsg.

Feil, Wolfgang

Dallemagne, Bernard

Degueldre, Michel

Kauko, Minna

Löhlein, Dietrich

Walther, Bruno

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Bildgebende Verfahren, Nuklearmedizin, Strahlentherapie Sonographie, Ultraschall

Inhaltsverzeichnis

1 UltraCision: System and Instruments
2 Principles of Ultrasonic Energy for Cutting and Coagulation
3 UltraCision Scalpel and Other Energy Modalities
4 Education, Training, and Personal Experience
5 Esophageal Resection with the UltraCision Blade and Shears
6 Reflux Surgery (Nissen and Toupet)
7 Esophageal Myotomy for Achalasia
8 Total Radical Gastrectomy
9 Laparoscopic Assisted Right Hemicolectomy for Crohn's Disease
10 Open Colorectal Surgery
11 Laparoscopic Treatment of Left Colon Diverticulitis
12 Laparoscopic Colorectal Surgery for Cancer
13 Laparoscopic Cholecystectomy using the 10 mm UltraCision Blade (DH 010)
14 Laparoscopic Cholecystectomy using the 5 mm UltraCision Curved Shears (LCSC 5)
15 Hepatic Resection with the UltraCision 10 mm Shears with Rotating Blade for Open Surgery (CS 150 Pistol Grip or CS 6S Needle-Holder Grip) and the UltraCision Blade (DH 010)
16 Hepatic Surgery with the UltraCision Blade for Open Surgery (DH 105)
17 Laparoscopic Splenectomy with the 5 or 10 mm UltraCision Shears (LCSC 5 or LCS 15)
18 Laparoscopic Splenectomy with the 10 mm UltraCision Shears (LCS 15 Pistol Grip or LCS 6S Needle-Holder Grip) with Rotating Blade
19 Pancreatic Resection with the 10 mm UltraCision Shears for Open (CS 6S) and Laparoscopic Surgery (LCS 15)
20 Laparoscopic Adrenalectomy with the 10 mm UltraCision Shears (LCS 15 Pistol Hand Grip or LCS 6S Needle Hand Grip)
21 Thyroid Surgery with the UltraCision Blade
22 Minimally Invasive Thyroid Surgery with the UltraCision Shears (CS 14C)
23 Thyroid Surgery with the 10 mm UltraCision Shears (CS 150 Pistol Grip or CS 6S Needle-Holder Hand Grip) for Open Surgery
24 Laparoscopic Hysterectomy: with or without Ophorectomy
25 Laparoscopic Myomectomy
26 Resection of Deep Infiltrating Endometriosis
27 The UltraCision Shears in Major Breast Surgery
28 Axilliary Lymphatic Node Dissection in Breast Surgery
29 Tonsillectomy with the UltraCision Scalpel
30 Tonsillectomy and UltraCision
31 Orthopedic Exposure for Total Hip Replacement
32 Miscellaneous Knee and Spine Surgery
33 Anterior Endoscopic Approach for the Spine
34 The UltraCision Scalpel in Thoracic Surgery
35 Radical Laparoscopic Prostatectomy

Leseproben

1 UltraCision: System and Instruments

W. Feil

The UltraCision system utilizes ultrasonic energy to enable hemostatic cutting and/or coagulation of soft tissue. The system consists of an ultrasonic generator (Fig. 1.1), a footswitch, an optional hand-switching adapter, a hand piece, and a variety of open and minimally invasive instruments.

Fig. 1.1 UltraCision Generator 300 with cart.

Fig. 1.2 Footswitch with two pedals: the right pedal is fixed to level 5; the left pedal can be changed from levels 1 to 5, but preferably is set to level 2 or 3.

The UltraCision instruments vibrate longitudinally at 55 500 Hz. This ultrasonic vibration enhances the blade's cutting ability and coagulates blood vessels as tissues are incised. Hemostasis occurs when tissues are coupled with the instrument. This coupling causes collagen molecules within the tissue to vibrate and become denatured, thus forming a coagulum.

The UltraCision system is indicated for soft tissue incisions when bleeding control and minimal thermal injury are desired. The instruments can be used as an adjunct to or substitute for electrosurgery, lasers, or steel scalpels.

The generator is connected to a regular power supply. It supplies the hand piece with electrical energy and facilitates the selection of power levels, system monitoring, and system diagnosis. The footswitch (Fig. 1.2) has two pedals to activate the ultrasound application. For the left pedal, ultrasound energy can be chosen from five levels (25 to 100 µm longitudinal extension of vibration) on the generator. The right pedal is set to level 5 (100 µm) solely.

Generator

There are two types of generators: first and second generation.

The first-generation generator (Fig. 1.3) is connected to the local alternating current supply. The electrical connector and the cooling air source connector from the silicon tube are connected to the generator. The electrical connector provides the power supply for the ultrasonic transducer in the hand piece and allows continuous monitoring of ultrasonic function by the generator's electronics. Irregularities of ultrasonic vibration in any part of the system will result in an acoustic signal and immediate shutdown of the system.

After switching the system on, the device performs a brief system test and is then ready for use. The standby mode on the generator is intended for use during assembly or during the change of assembled instruments.

The second-generation generator (Fig. 1.4a) provides only one connector for the cable leading to the hand piece.

The generator delivers two power levels: minimum (Min) and maximum (Max). The minimum power level may be adjusted by the user from level 1 to level 5. The maximum power level is always level 5. With all instruments except the ball coagulator, use a higher generator power level for higher tissue cutting speed, and a lower generator power level for greater coagulation. For the ball coagulator, higher generator power levels will provide greater coagulation. The amount of energy delivered to the tissue and resultant tissue effects are a function of many factors, including the power level selected, instrument characteristics, grip force (when applicable), tissue tension, tissue type, pathology, and surgical technique.

Fig. 1.3 First-generation generator.

Fig. 1.4a Second-generation generator (Generator 300). b Operation of the Generator 300 (front panel). c Operation of the Generator 300 (back panel).

The front panel (Fig. 1.4b) of the generator has all the controls needed for the practical use of the system.

1. Ready: When this indicator is green, the system is ready for activation.
   Note: In the Ready mode, for self-diagnostic purposes, the system sends a low-amplitude signal to the blade, causing the blade to vibrate slightly. This vibration does not pose a risk to the user.
2. Standby: Push this button to enter or exit the Standby mode. In Standby mode, all power is removed from the hand piece. Both the footswitch and hand switch are disabled. Upon power-up, the system defaults to Standby. The system is ready for TEST in the Standby mode. When the generator is on standby, the indicator is orange.
3. Increase/Decrease Power: Push this button to increase or decrease the minimum (Min) power setting to the desired level (from 1 to 5). The level chosen will be shown on the graphic display. The power level may be adjusted when the generator is in the Ready or Standby modes.
4. Power: This switch controls the main electrical power to the generator.
5. Volume: Turn this knob to adjust the volume of the activation tones. A tone will sound demonstrating the volume level selected.
6. Min: Indicates the user-settable minimum power level setting. When this power level is activated, the Min indicator will flash. On power-up the system defaults to Min level 3. Refer to the instruments’ package inserts for the recommended Min power level.
7. Max: Indicates the maximum power level setting (level 5). When this power level is activated, the Max indicator will flash.
8. Alarm Indicator: This red indicator only appears if a system alarm occurs in response to a component or generator problem.
9. Hand Piece Receptacle: This receptacle is used to connect the hand piece to the generator.
10. Hand Activation: When the indicator is green, hand activation on the hand switching adapter is enabled. To disable the Hand Activation mode, press the button. Upon power-up, the system defaults to Hand Activation mode disabled.
    Note: If the footswitch is installed, the footswitch is always enabled.
11. Test: Pressing this button initiates the Test mode. This mode is used during troubleshooting. The generator will emit a tone when the Test mode is active and “test in progress” will appear on the display.
12. Graphic Display: In the Ready or Standby modes, this display indicates the minimum (user-settable level 1 to 5) and maximum (level 5) power levels. If a system or component problem exists, error codes will appear on this display.
    The back panel of the generator (Fig. 1.4c) bears connectors and fuse holders.
13. Footswitch Receptacles: For the user's convenience, identical receptacles allow connection of one or two footswitch assemblies. If only a single footswitch is to be used, it may be connected to either receptacle.
14. Potential Equalization Terminal: This terminal provides a means for connection to a Potential Equalization Conductor.
15. Fuses: Refer to the “replacement parts” drawings in the back of the manual for additional fuse locations and fuse type.
16. Power Cord Receptacle: This receptacle is used to attach the power cord to the generator. For power cord requirements, refer to the manual's chapter 10, System Specifications.

Audible Signals: The generator delivers audible tones to signal activation, test, and alarm states. The user may choose from three activation tone pitches.

Silicon Tube/Cable and Hand Piece with Ultrasonic Transducer

The hand piece contains an acoustic transducer that converts the electrical energy supplied by the generator to mechanical motion. The transducer is connected to an ultrasonic wave guide/amplifier that amplifies the motion produced by the transducer and relays it to the instrument.

There are three types of silicon tubes/cables connecting the instruments and the generator. The 3 m long silicon tube of the basic equipment has two attachments for connection to the first-generation generator (Fig. 1.5). The silicon tube carries the air stream for cooling the ultrasound system and holds the electric supply for the ultrasonic transducer, which is situated in the hand piece at the other end of the silicon tube.

Fig. 1.5 Hand piece with ultrasonic transducer.

Editor's tip: The silicon tube can be secured to the drapes with the two clamps. In every case, ensure when fixing the silicon tube to the operating table that no adhesive materials are used and that the cooling air stream is not reduced through kinking.

The hand piece contains the ultrasonic transducer and the ultrasonic amplifier (Fig. 1.6). Electrical energy is converted to ultrasonic energy through a piezoelectric ceramic system.

The 3 m long silicon cable of the revised system (Fig. 1.7a) connects to the electric plug of the firstgeneration generator and has a stopcock to deactivate the cooling air supply when the old generator is used. The new cable is slim and supple, thus promoting ergonomic surgical work.

Fig. 1.6 Electrical energy is converted into ultrasonic vibration in a Piezoelectric ceramic system. Energy is transferred to the blade systems by an acoustic mount coupled to the housing of the hand piece.

Fig. 1.7a Silicone tube with one connector for the generator, and a stopcock to deactivate the cooling air supply on one side and the acoustic mount with the ultrasonic transducer on the other side. b Silicon cable for the Generator 300.

The revised cable and hand piece provide major benefits and will replace the standard equipment stepwise.

The new cable (Fig. 1.7b) bears only one connector for the Generator 300 and may also be used with the hand-activation adapter. The silicon cable, either...

Über Autor(innen)

Wolfgang Feil