Medicine
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A Saline/Bipolar Radiofrequency Energy Device As an Adjunct for Hemostasis in Solid Organ Injury/Trauma
Chapters
Summary July 28th, 2020
The goal of this publication is to demonstrate the potential application of a novel device using simulated solid organ injuries in a porcine model.
Transcript
Life threatening solid organ hemorrhage can be extremely difficult to control. The application of a saline bipolar radio frequency instrument allows the rapid and effective regulation of significant solid organ hemorrhage. This technique is effective for the control of both bleeding, as well as biliary leakage.
It's simple to learn, and can be rapidly and effectively performed with minimal formal training. The use of this technique is intuitive. It can be rapidly and effectively applied, even if the practitioner lacks extensive previous experience with the device or extensive knowledge of intro organ anatomy.
When the animal is ready, open the hand piece of an ignited SBRF device prepared according to the manufacturer's specifications and connect the handpiece to the generator. Then set the saline flow rate to low and the radio frequency power setting to 160 watts. Establish an adequate exposure of the solid organs of interest, mobilizing other structures and inserting a retractor as necessary.
Using a number 10 scalpel blade, apply an abrasive back and forth, one to two millimeter deep, two square centimeter area, superficial force to the liver capsule to induce capsular bleeding. Continue to create one centimeter deep, solid organ lacerations of increasing severity with the scalpel, from five centimeters to the entire length of the liver tissue. Then, using a blunt device such as a Kelly clamp, use a stabbing motion to create penetrating injuries of a partial to full thickness.
After simulating all of the appropriate experimental injuries, depress the button of the handpiece to initiate the simultaneous flow of 0.9%saline and the delivery of bipolar radio frequency energy. The saline will boil at the site of application. Position the tip of the device directly onto the raw of the liver surface to superficial areas of bleeding or within defects in the liver itself, and apply concurrent suctioning from a standard surgical aspirator as needed to deliver the heated saline and energy directly to the areas of ongoing hemorrhage.
Using a gentle back and forth motion, heat the tissues to approximately 100 degrees Celsius. An auditory pop will occur after three to five seconds. Signifying that the burn is complete.
Then move the instrument in an organized manner to the next targeted site, applying precisely directed high voltage electrocautery in conjunction with the application of the SBRF and suction devices to obtain hemostasis as necessary. When all of the sites of the hemorrhage have been cauterized, apply the tip of the device across the injured edge of the liver parenchyma to seal the small to medium bile ducts. In this representative experiment, the depth of the tissue penetration by the SBRF device varied by target organ.
Notably, no tissue coagulation was observed when the inferior vena cava was targeted, likely due to the heat sink effect from significant blood flow, which further supports the safety of the device usage around large vascular structures. Saline bipolar radio frequency devices are superb instruments for surgeons who must stop ongoing hemorrhage in challenging areas. They also facilitate primary hemostasis in solid organs without requiring any extensive solid organ anatomy knowledge.
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