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Ultrasonic scalpel (2) Product application, selection and use points

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Update time : 2023-11-13 14:23:00
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.
1. Application of ultrasonic scalpel
The ultrasonic soft tissue cutting and hemostasis system (referred to as: ultrasonic scalpel) has few contraindications for clinical application and is suitable for hospital gynecology, urology, thoracic surgery, hepatobiliary surgery, gastrointestinal surgery, head and neck surgery, otolaryngology surgery, pediatric surgery, and breast surgery More than a dozen departments including surgery and vascular surgery cover dozens of surgical operations:
2. Ultrasonic scalpel product selection
According to the "Guiding Principles for Registration Technical Review of Ultrasonic Soft Tissue Cutting and Hemostasis Systems", the host of the ultrasonic soft tissue cutting and hemostasis system can be adapted to various types of cutter heads. Depending on the shape of the handle, there are clamp type, gun type, scissor type, etc., as shown in Figure 1 . According to the shape and structure of the tip tip of the blade, there are multi-purpose scissors, curved multi-purpose scissors, curved peeling knife, separation hook, hemostatic ball, etc.
The length of the cutter head usually comes in various specifications such as 14cm/23cm/36cm/45cm. The doctor selects the appropriate blade according to the specific conditions of the operation. At present, the mainstream use is the gun-type curved multi-purpose scissor combination cutter head, which has a wide range of applications.
When choosing an ultrasonic scalpel head, it is mainly distinguished whether it is used in endoscopic surgery or in open surgery. Usually, scissor-type blades or a clamp-type multi-purpose scissor combination blade of less than 23cm are used for open surgery, while blades of 36cm or above are often used for laparoscopic surgery to facilitate in-depth endoscopic operations.
3. Key points of ultrasonic scalpel operation
a. Reasonable power selection
Higher power results in faster cutting but poorer hemostasis. For blood vessels below 2 mm, the ultrasonic scalpel can be coagulated at the slow speed (Min speed), and then cut in situ at the fast speed (Max speed); for blood vessels with 2 to 3 mm, such as the superior rectal artery, the slow speed (Min speed) can be used to coagulate first, and then cut off in situ. Cutting with one knife position. Although the NMPA-certified ultrasonic scalpel can close blood vessels of 5 to 7 mm, for safety reasons, blood vessels of 3 to 5 mm should be clamped with hemostatic clips first and then coagulated and cut.
b. Appropriate cutting capacity
Because the ultrasonic scalpel has a long torque and weak clamping force, clamping large pieces of tissue may cause damage to the ultrasonic scalpel, and may also cause incomplete blood vessel coagulation. Clamping large pieces of tissue or excessively twisting or pulling the handle after clamping the tissue may cause damage to the ultrasonic scalpel. Not only that, large pieces of clamped tissue are aroused, the cutting speed is slow, bleeding is easy, and fog is produced, making it impossible to achieve fine dissection.
Therefore, when dealing with tissues with poor blood supply (such as thin mesangium), you should "walk quickly" with the front 1/3 of the ultrasonic knife head, and press the Max setting for rapid cutting. When dealing with ligaments with rich blood supply or coagulated blood vessels, according to the principle mentioned in the previous issue that the tip of the jaw has the largest energy and the fastest cutting speed, and the root of the jaw has the smallest energy and the slowest cutting speed, the blood vessel/blood vessel should be Place the abundant ligaments in the center of the jaws (within the code line) to achieve the best balance of cutting and hemostasis. Use the Min gear for cutting and hemostasis.
c. Appropriate tissue tension
Tissues that require sharp dissociation (such as thin peritoneum and mesangium, etc.) can be cut quickly, fire at a fast speed, use the front end of the knife head to gently hold the tissue, or cut with the back of the knife, increase the tension appropriately, the cutting speed is as fast as an electric knife, and the cutting speed is as fast as the electric knife. However, when dealing with blood vessels or ligaments with rich blood supply, excessive tension should be avoided to ensure sufficient ultrasonic energy action time to fully denature the blood vessel wall proteins and avoid bleeding caused by excessive cutting or pulling and tearing.
d. Proper grip strength
The strength of the grip can also determine the effectiveness of cutting and hemostasis. A firmer grip results in faster cutting but poorer hemostasis.
e. Accurate direction of force
Vertical cutting can minimize the section area, especially for blood vessels. For example, if a blood vessel with a diameter of 5mm is cut at 45 degrees, the diameter of the section will become 7mm.
f. Accurate tissue plane
The advantage of ultrasonic scalpel is that it
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