Surgical laparoscopy, endoscopy & percutaneous techniques · 2009
Closure of the cystic duct by ultrasonic energy: an electron-microscopic and biomechanical study in man.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Foschi Diego, Cellerino Paola, Corsi Fabio, Previde Paolo, Allevi Raffaele, Trabucchi Emilio
Аннотация
BACKGROUND: Ultrasonic activated devices are currently used both for sealing of blood vessels and dissection of parenchymal organs. Recently, ultrasonic energy has been used to seal the cystic duct during successful clip-less cholecystectomy, but no study examined the mechanisms of tissue welding by ultrasonic energy or the biomechanical properties of the seal. This was the aim of our investigations.
PATIENTS AND METHODS: Eight patients (7 women and 1 man, mean age 42+/-7 y) subjected to laparoscopic cholecystectomy had a cystic duct sealed and sectioned by Ultracision; after removal of the specimens, the distal end was processed for scanning electron microscopy and transmission electron microscopy, whereas the proximal end to the gallbladder was used for determination of the bursting pressure.
RESULTS: The bursting pressure of the cystic duct sealed by ultrasonic energy was 168+/-47 mm Hg, well above the maximal pressure of the common bile duct. At scanning electron microscopy, the end of the cystic duct was closed by an amorphous, bundled, dense substance. The section proximal to the end showed destruction of the epithelial layer with dense amorphous bridges connecting the opposite sites of the wall. When the lumen was observed, it was filled with bile microaggregates. At transmission electron microscopy, 2 different findings were evident: (1) coagulative necrosis in the sectioned area and (2) a combination of coagulative necrosis and collagen denaturation in the more distal sections. The connective tissue was characterized by attenuation of collagen birefringence and swelling of fibers and bundles due to shrinkage of collagen.
CONCLUSIONS: Ultrasonic energy can be applied to suitable tissues to obtain sealing of the walls with good biomechanical effects.
PATIENTS AND METHODS: Eight patients (7 women and 1 man, mean age 42+/-7 y) subjected to laparoscopic cholecystectomy had a cystic duct sealed and sectioned by Ultracision; after removal of the specimens, the distal end was processed for scanning electron microscopy and transmission electron microscopy, whereas the proximal end to the gallbladder was used for determination of the bursting pressure.
RESULTS: The bursting pressure of the cystic duct sealed by ultrasonic energy was 168+/-47 mm Hg, well above the maximal pressure of the common bile duct. At scanning electron microscopy, the end of the cystic duct was closed by an amorphous, bundled, dense substance. The section proximal to the end showed destruction of the epithelial layer with dense amorphous bridges connecting the opposite sites of the wall. When the lumen was observed, it was filled with bile microaggregates. At transmission electron microscopy, 2 different findings were evident: (1) coagulative necrosis in the sectioned area and (2) a combination of coagulative necrosis and collagen denaturation in the more distal sections. The connective tissue was characterized by attenuation of collagen birefringence and swelling of fibers and bundles due to shrinkage of collagen.
CONCLUSIONS: Ultrasonic energy can be applied to suitable tissues to obtain sealing of the walls with good biomechanical effects.