- 期刊
Utility of the PlasmaKinetic™ Bipolar Forceps for Control of the Renal Artery in a Porcine Model
運用PlasmaKinetic™雙極切割夾來切割凝結腎動脈之動物實驗
摘要
研究目的：評估plasmaKinetic雙極切割夾使用在切割凝結豬隻腎動脈的有效性。 材料與方法：選擇8隻體重介於20-30公斤的豬隻，施要經腹腔腹腔鏡腎臟切除手術。在腎動脈及靜脈的部分，利用plasmaKinetic雙極切割夾來凝結並切斷動脈和靜脈，剛不使用任何的血管夾。在安全地將腎切除後，改用傳統開腹手術，截取一段約十公分包含腎動脈斷端裂主動脈，將兩條Polyethylene管子經由兩個連接於主動脈旁的動脈分支分別置入管腔內，將其餘的動脈分支及這節主動脈的兩端用３－０絲線綁緊，使這段主動脈成為密閉空間。將這兩條管子分別接上液體灌注器及壓力測定器，把水經灌注器灌入主動脈腔內，灌注的速度依空腔內壓力來調整，使其壓力慢慢增加，如此一來便可測量出腎動脈斷端凝結區所能承受的壓力臨界點。 結果：共有五隻動物完成了這驗，平均的腎動脈直徑為4.8±0.2毫米，兩個失敗的例子是發生在術中的大出血，一個是夾子在切割完要與動脈分離時，因為沾黏的緣故拉扯到凝結區而失敗，另一個則可能是凝結區不夠緊密，當夾子分立時即出血。總共有六例成功地完成了腹腔鏡腎臟切除手術，其中有一例在壓力測量前凝結區自動分開而無法進行實驗。其餘的順利完成實驗者，平均的壓力臨界點為215.8±17.5毫米汞柱。 結論：在八例中有六例順利的將動脈凝結分離，仍然有兩例在術中因器械緣搶而出血，將這組器械利用在臨床的腎動脈凝結與分割是可行的，但仍須進一步評估其安全性。
並列摘要
OBJECTIVE: To evaluate the effectiveness of the PlasmaKinetic Cutting Forceps in coagulating and dividing the renal artery in a porcing model. MATERIALS AND METHODS: Eight domestic pigs underwent a transperitoneal laparoscopic nephrectomy with 3 trocars. The renal artery was laparoscopically sealed and severed without clipping or stapling using a novel bipolar cauterization deice, which has an incorporated cutting function (Cutting Forceps, PlasmaKinetic,Berkshire, UK). A segment of the aorta, with an average length of 10 cm including the renal artery stump, was harvested by open laparotomy. Both ends of the aorta and its small branches were ligated with 3-0 silk sutures. Two polyethylene tubes were placed into the aorta lumen: 1 tube was connected to an infusion pump, and the other to a pressure monitor. Water was used to fill the aorta, and the pumping speed was promptly adjusted, so that the bursting pressure of the renal artery stump could be measured. RESULTS: The experiment was completed in 5 subjects. The average diameter of the renal artery stump was 4.8±0.2 mm. Two failures occurred due to stump bleeding immediately after the renal artery was cut with the Cutting Forceps. When the surface of the blade was detached from the renal artery stump, adhesion between the tissue and the instrument occurred in 1 case. It tore the sealed stump, and led to massive bleding. In the other case, the arterial stump did not seal. The renal artery was successfully controlled in 6 of 8 (75%) animals. The maximal intraluminal pressure at bursting was 215.8±17.5 mmHg. CONCLUSIONS: The renal arterial stump was successfully sealed using only the Plasmakinetic cutting Forceps in 6 of 8 animals. However, further refinement of the instrument to prevent tissue adhesion by he blade is required before the PlasmaKinetic Cutting Forceps can safely be used clinically or control of the renal artery without clipping.