Name: a saline/bipolar radiofrequency energy device as an adjunct for hemostasis in solid organ injury/trauma
Uploaded: 2020-07-28T12:30:00
Description: Watch this Scientific Journal Video about A Saline/Bipolar Radiofrequency Energy Device As an Adjunct for Hemostasis in Solid Organ Injury/Trauma at JoVE.com

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卡尔加里大学动物护理委员会批准了涉及动物主题的程序，并遵循加拿大动物护理委员会设定的准则。委员会确保这项研究是合乎道德的，并且动物受到人道的待遇。
1. 模型准备
<ol><li>将50公斤重的成年雄猪在手术前1周在动物护理设施中，以使动物适应住房条件和处理者。在开始麻醉之前，将模型快速快速 6 小时。</li>
	<li>使用肌肉注射氯胺酮（33毫克/千克）、阿托平（0.04...

<ol>
	<li>Kauvar, D. S., Lefering, R., Wade, C. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+hemorrhage+on+trauma+outcome:+an+overview+of+epidemiology,+clinical+presentations,+and+therapeutic+considerations.">Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations.</a> Journal of Trauma and Acute Care Surgery. 60 (6), S3-S11 (2006).</li><li>Shrestha, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Damage-control+resuscitation+increases+successful+nonoperative+management+rates+and+survival+after+severe+blunt+liver+injury.">Damage-control resuscitation increases successful nonoperative management rates and survival after severe blunt liver injury.</a> Journal of Trauma and Acute Care Surgery. 78 (2), 336-341 (2015).</li><li>Kozar, R. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Trauma+Association/critical+decisions+in+trauma:+operative+management+of+adult+blunt+hepatic+trauma.">Trauma Association/critical decisions in trauma: operative management of adult blunt hepatic trauma.</a> Journal of Trauma and Acute Care Surgery. 71 (1), 1-5 (2011).</li><li>Peitzman, A. B., Richardson, J. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+treatment+of+injuries+to+the+solid+abdominal+organs:+a+50-year+perspective+from+the+Journal+of+Trauma.">Surgical treatment of injuries to the solid abdominal organs: a 50-year perspective from the Journal of Trauma.</a> Journal of Trauma and Acute Care Surgery. 69 (5), 1011-1021 (2010).</li><li>Aloia, T. A., Zorzi, D., Abdalla, E. K., Vauthey, J. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Two-surgeon+technique+for+hepatic+parenchymal+transection+of+the+noncirrhotic+liver+using+saline-linked+cautery+and+ultrasonic+dissection.">Two-surgeon technique for hepatic parenchymal transection of the noncirrhotic liver using saline-linked cautery and ultrasonic dissection.</a> Annals of surgery. 242 (2), 172-177 (2005).</li><li>Ball, C. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+a+novel+energy+technology+for+arresting+ongoing+liver+surface+and+laceration+hemorrhage.">Use of a novel energy technology for arresting ongoing liver surface and laceration hemorrhage.</a> Canadian Journal of Surgery. 57 (4), E146 (2014).</li><li>Ball, C. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+a+novel+saline/bipolar+radiofrequency+energy+instrument+as+an+adjunct+for+arresting+ongoing+solid+organ+surface+and+laceration+bleeding+in+critically+injured+patients.">Use of a novel saline/bipolar radiofrequency energy instrument as an adjunct for arresting ongoing solid organ surface and laceration bleeding in critically injured patients.</a> Injury. 47 (9), 1996-1999 (2016).</li><li>Ball, C. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+efficacy+of+a+novel+saline/bipolar+radiofrequency+energy+instrument+for+arresting+ongoing+solid+and+non-solid+organ+hemorrhage+in+a+swine+model.">The efficacy of a novel saline/bipolar radiofrequency energy instrument for arresting ongoing solid and non-solid organ hemorrhage in a swine model.</a> Injury. 47 (12), 2706-2708 (2016).</li><li>Swindle, M. M., Smith, A. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Best+practices+for+performing+experimental+surgery+in+swine.">Best practices for performing experimental surgery in swine.</a> Journal of Investigative Surgery. 26 (2), 63-71 (2013).</li><li>Cantle, P. M., Roberts, D. J., Holcomb, J. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Damage+Control+Resuscitation+Across+the+Phases+of+Major+Injury+Care.">Damage Control Resuscitation Across the Phases of Major Injury Care.</a> Current Trauma Reports. 3 (3), 238-248 (2017).</li><li>Gaarder, C., Naess, P. A., Buanes, T., Pillgram-Larsen, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Advanced+surgical+trauma+care+training+with+a+live+porcine+model.">Advanced surgical trauma care training with a live porcine model.</a> Injury. 36 (6), 718-724 (2005).</li><li>Harvin, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Control+the+damage:+morbidity+and+mortality+after+emergent+trauma+laparotomy.">Control the damage: morbidity and mortality after emergent trauma laparotomy.</a> The American Journal of Surgery. 212 (1), 34-39 (2016).</li></ol>

迅速有效地控制出血是现代损伤控制复苏十的重要组成部分。各种手术和辅助技术可用于在固体器官损伤3中控制出血。这些技术都没有被证明在实现性，或成功地实现性系统。此处描述的 SBRF 设备的初始体验是积极的6，7，8。该装置是实现复杂固体器官损伤快速有效的造物的一种宝贵辅助?...

由于固体器官损伤而不受控制的出血仍然是钝性创伤和穿透性创伤1的发病率和死亡率的主要原因。随着有效损伤控制复苏策略的出现，腹部外伤非手术管理率继续上升2.因此，需要手术管理的患者有越来越复杂的伤害和相关生理混乱。在这些患者中，早期控制出血是有效的损伤控制复苏和理想结果的重要组成部分。
固体器官损伤的手术管理仍然是创伤、急性护理和普通外科医生的主要能力。各种手术技术和这些损伤的止血辅助技术已描述3。处理固体器官出血的传统技术包括高压电烧凝固、局部止血剂的应用、缝合修复以及部分或全部器官切除。阿贡光束凝固也被描述为4。虽然每种技术在实现下到时都起着作用，但没有一种是普遍适用或成功的。
许多新的工具和止血疗法在选择性手术环境中被描述。这在肝胆外科领域尤为严重。随着对这些工具的熟悉程度的提高，许多工具在创伤的手术管理中也显示出了希望。其中一种装置利用点燃的盐水和双极射频能量的组合来控制出血。此外，它有能力同时密封肝脏6中的中小型胆管。这种工具在固体器官损伤管理中的积极经验，前文已描述6，7，8。,86,
本出版物旨在演示这种新型装置在猪模型中使用模拟固体器官损伤的潜在应用。

<table border="0" cellpadding="0" cellspacing="0" width="690">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:256px;">Aquamantys pump generator</td>
			<td style="width:173px;">Medtronic</td>
			<td style="width:173px;">40-402-1</td>
			<td style="width:88px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Aquamantys 6.0 bipolar sealer</td>
			<td>Medtronic</td>
			<td>23-112-1</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Electrosurgical pencil with tip</td>
			<td>Megadyne</td>
			<td>0039</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Porcine animal</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td colspan="2" height="21" style="height:21px;">Porcine ventilator/induction and anesthetic medications</td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">2 x 1 liter bags of 0.9% normal saline</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">2 x scalpels (#10)</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Belfour abdominal retractor</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Suction tubing</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Suction tip</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Suction device/wall connector</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Suction canister</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Debakey forceps</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Metz scissors</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Curved Mayo scissors</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Closing suture (1-0 Nylon)</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">20 x Laparotomy sponges</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">2 x Kelley clamps</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">2 x snap clamps</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

a saline/bipolar radiofrequency energy device as an adjunct for hemostasis in solid organ injury/trauma

固体器官（肝脏、脾脏和肾脏）出血通常危及生命，在危重病人中可能难以停止。阻止这种持续出血的传统技术包括高压电烧凝固、局部止血应用和点燃的砷气的输送。本研究/视频的目标是展示一种新能源装置对阻止持久性固体器官出血的疗效。利用双极射频（RF）能量的一种新型仪器，用于从简单的手提机点燃/沸腾滴液盐水，用于阻止猪模型中固体器官损伤的持续出血。该仪器是根据选择性肝切除术的经验推断的。猪模型中固体器官的一系列损伤将不断升级。接下来，这种新型能量装置将按顺序进行控制出血。还将采用标准吸气装置。这种简单的盐水/RF能量仪器有可能阻止持续的固体器官表面/帽性出血，以及与深度撕裂相关的中度出血。

此处描述的 SBRF 设备为各种固体器官损伤提供了有效的下半管。SBRF装置在猪模型中的功效在之前已经描述了8。经作者许可，本研究的结果将在这里重新发表。
使用猪模型，对四个单独的模型应用了日益严重的伤害。这些伤员被描述为表面斩首、表面撕裂、深度撕裂、穿透"穿过和穿过"导弹轨迹，以及完全转?...

Watch this Scientific Journal Video about A Saline/Bipolar Radiofrequency Energy Device As an Adjunct for Hemostasis in Solid Organ Injury/Trauma at JoVE.com

A Saline/Bipolar Radiofrequency Energy Device As an Adjunct for Hemostasis in Solid Organ Injury/Trauma

本出版物的目标是演示一种新型设备在猪模型中使用模拟固体器官损伤的潜在应用。

盐水/双极射频能量装置作为固体器官损伤/创伤中血侧体

Solid organ (liver, spleen, and kidney) hemorrhage is often life-threatening and can be difficult to stop in critically ill patients. Traditional ...

危及生命的固体器官出血可能极难控制。盐水双极射频仪的应用允许快速有效地调节显著的固体器官出血。这种技术是有效的控制出血，以及胆道泄漏。它简单易学，只需最少的正式培训，就可以快速有效地执行。这种技术的使用是直观的。它可以快速有效地应用，即使从业者缺乏广泛的经验，在设备或广泛的知识，介绍器官解剖学。当动物准备好时，打开根据制造商的规格准备的点燃的 SBRF 设备的手片，将手提片连接到发电机。然后将盐水流速设置为低，将射频功率设置为 160 瓦。建立适当接触感兴趣的固体器官，调动其他结构，并必要时插入缩回器。使用编号10的手术刀刀片，来回涂抹磨料，一至两毫米深，两平方厘米面积，表面力到肝胶囊诱导帽性出血。继续创建一厘米深，固体器官撕裂与手术刀越来越严重，从五厘米到整个长度的肝脏组织。然后，使用钝器（如 Kelly 钳）使用刺动，以产生部分到全厚度的穿透性伤害。模拟所有适当的实验损伤后，按下手提装置的按钮，启动 0.9% 盐水的同步流动和双极射频能量的传递。盐水将在应用现场沸腾。将设备尖端直接放在肝脏表面的原物上，放在肝脏本身的肤浅出血区域或缺陷区域，并根据需要从标准手术吸气器中同时吸气，将加热的盐水和能量直接送到持续出血区域。使用温和的来回运动，将组织加热到大约100摄氏度。三到五秒钟后会发生听觉弹出。表示刻录已完成。然后以有组织的方式将仪器移动到下一个目标站点，将精确定向的高压电烧与 SBRF 和吸气装置的应用结合使用，以便获得必要的吸液。当出血的所有位点都烧灼后，将装置的尖端涂抹在肝胆瘤的受伤边缘，以密封中小型胆管。在这个具有代表性的实验中，SBRF装置的组织穿透深度因目标器官而异。值得注意的是，当劣质的维纳卡瓦卡成为目标时，没有观察到组织凝固，很可能是由于大量血流的散热器效应，这进一步支持了大型血管结构周围的设备使用的安全性。盐水双极射频设备是外科医生的精湛仪器，他们必须停止在具有挑战性的领域持续出血。它们还有助于固体器官的原发性，而无需任何广泛的固体器官解剖学知识。

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