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Operating room hemostasis equipment - ultrasonic scalpel (Part 1)

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Update time : 2023-11-11 12:00:00
With the increasing development of science and technology, the scalpel is no longer a simple instrument cutting knife, in order to achieve the purpose of fast and accurate cutting and hemostasis. In recent decades, high-frequency electrosurgery, ultrasonic scalpel, etc. have come out one after another. Today I will mainly explain the ultrasonic scalpel.
1. What is ultrasound?
Ultrasound scalpel is one of the electrosurgical instruments that replaces mechanical scalpels for tissue cutting. It uses the thermal effect, air effect and high-frequency mechanical vibration of ultrasound to change the structure and state of biological tissues, complete the cutting, separation and destruction of tissues to achieve the purpose of treatment. It is mainly used for cutting and disconnecting soft tissues in surgical operations, and has a certain hemostatic effect.
 
The ultrasonic scalpel system consists of a host machine, a handle, an ultrasonic scalpel head, and a foot-controlled switch.
2. Which surgeries are suitable for ultrasonic scalpel? How does it work to stop bleeding?
Ultrasonic scalpel can cut soft tissue while controlling bleeding and minimizing thermal damage. It is widely used in laparoscopic and traditional open surgeries in general surgery, thoracic surgery, urology, gynecology, pediatric surgery and other departments.
3. Clinical development history of ultrasonic scalpel
Ultrasound surgery uses an ultrasonic knife instead of an ordinary scalpel to crush, separate and remove diseased tissues or organs of the human body to achieve the purpose of surgical treatment.
Ultrasonic scalpel appeared in the 1950s and began to be used clinically in the 1980s. After the 1980s, ultrasonic surgery suddenly emerged internationally, pushing it into a new era of vigorous development. In 1995, Robbins and Ferland performed the first laparoscopic hysterectomy using ultrasound energy. In recent years, it has been widely used in surgical procedures in developed countries such as Europe, the United States, and Japan, and the market saturation is relatively high. In China, it is only half of that in Europe and the United States.
Main categories
At present, ultrasonic scalpels are mainly used for: cataract emulsification (phacoemulsification), hepatobiliary tumor suction (phacoemulsification), liposuction beauty (phacoemulsification), bone cutting (ultrasonic osteotome), cutting and coagulation (soft tissue ultrasonic scalpel), Debridement (ultrasonic debridement knife), etc. What is commonly known as ultrasonic scalpel in clinical practice usually refers to the ultrasonic scalpel that cuts coagulated soft tissue. Wide range of clinical applications.
Product performance comparison
Soft tissue ultrasonic scalpel is often compared with scalpels, electrosurgical scalpels, laser scalpels and other instruments.
At present, the development trend of surgical technology is becoming more and more minimally invasive, and laparoscopic surgery is an important component of minimally invasive surgery. It has the advantages of small surgical trauma, fast postoperative recovery, significantly shortened hospitalization time, and postoperative pain. Slight; advantages include reduced chance of surgical blood loss and lower cost. However, laparoscopic surgery requires high anatomical accuracy, strong ability to effectively handle blood vessels, and high requirements for surgical instruments.
Traditional electrosurgery (monopolar electrosurgical or bipolar electrocoagulation) cannot solve the problems of too wide heat conduction range (easily causing side damage to important organs), inability to effectively treat blood vessels, large smoke affecting the field of vision, etc., which seriously restricts the cavity. Expansion of scope of endoscopic surgery.
Until the birth of the ultrasonic cutting hemostat in 1996, laparoscopic technology developed rapidly, making minimally invasive surgical technology, mainly laparoscopic surgery, widely used in various surgical fields.
4. Main advantages of ultrasonic scalpel
1. Only small water droplets are produced without smoke, and the surgical field of view is clear;
2. The thermal effect is small, and the operating heat is 80°C ~ 100°C; the thermal damage is small, and the area around the damage is 3mm;
3. It has the functions of tissue cutting, coagulation and separation, and can accurately control the cutting and coagulation range, shortening the operation time and reducing intraoperative bleeding;
4. No possibility of electrical damage;
5. Less tissue adhesion, less eschar formation, and fewer postoperative complications;
6. Postoperative adhesion is less and the incision heals quickly;
7. Rapid oscillation has a self-purifying effect, and the adhesion between the knife and the tissue will not occur;
8. Suitable for patients with pacemakers;
9. Suitable for laparoscopic surgery during pregnancy;
10. It can be used to treat extensive adhesions of the omentum. The omental fat is severed without electrocoagulation contracture, the incision is neat, and the omental blood vessels are completely coagulated.
The main disadvantages of ultrasonic scalpel
1. Slow operation;
2. Expensive;
3. It is effective in coagulating blood vessels with a diameter less than 3 mm, but other methods are still needed to coagulate larger blood vessels;
4. Only the tissue that is in contact with and has a certain tension can be cut, and too much tissue cannot be cut at a time.
5. Working principle
Ultrasonic soft tissue cutting and hemostasis systems (hereinafter referred to as ultrasonic scalpels) usually consist of a host computer and accessories. The accessories usually include a transducer, an ultrasonic scalpel head (including handle, waveguide rod, cannula, etc.) and a foot switch (optional). The host provides energy for the transducer and the cutter head, and the foot switch and the manual control device on the cutter head are used to control the output energy of the host.
Unlike other medical ultrasounds, ultrasonic surgical equipment uses a relatively low driving frequency range (between 20kHz and 60kHz) and strong power; a dedicated ultrasonic handheld treatment head is used to focus and output ultrasonic energy.
The ultrasonic soft tissue cutting and hemostasis system can simultaneously cut and coagulate tissue by setting different output power levels. High power settings can cut tissue more quickly, while low power settings can coagulate tissue better.
The ultrasonic frequency current in the host is conducted to the transducer, and the transducer converts the electrical energy into the mechanical energy of back and forth vibration. Through the transmission and amplification of the cutter head, the end of the cutter head vibrates at a certain frequency (for example, 55.5kHz). The heat generated by friction causes The water in the tissue cells in contact with the blade vaporizes, the protein hydrogen bonds are broken, the cells disintegrate and re-fuse, and the tissue is coagulated and then cut; when cutting blood vessels, the blade comes into contact with tissue proteins and generates heat through mechanical vibration, causing internal damage to the tissue. The collagen structure is destroyed, causing the protein to coagulate, thereby sealing the blood vessels to stop bleeding.
The ultrasonic blade has two blades, one blade is the working blade that applies ultrasonic waves, and the other blade has a white toothed pad. The purpose of this white protective pad is to avoid noise and damage to the blade caused by direct contact of the ultrasonic blade with metal. It also helps the surgeon to better hold the tissue and enhance the coagulation effect. Its working blade can be used to cut directly like an electric knife. .
It should be noted that the high-frequency oscillation of the ultrasonic knife is transmitted from the piezoelectric ceramic to the cutter head jaw in the form of a longitudinal standing wave, so the root of the cutter head jaw is always at the node position, with the smallest amplitude and the smallest energy, so the cutting speed Slower; on the contrary, the tip of the cutter head is always at the antinode position, with the largest amplitude and energy, so the cutting speed is the fastest.
Ultrasonic scalpels can use frequency tracking and other related technologies to measure the resonant frequency of the blade head in real time, and adjust the host excitation frequency to be consistent with it in real time to achieve the best working condition. Tissue adaptation technology can be used to adjust the output energy of the host in real time so that the cutting or coagulation effects have similar performance on different types of tissues.
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