Document Detail


Surgical smoke management for minimally invasive (micro)endoscopy: an experimental study.
MedLine Citation:
PMID:  20339874     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The aim of this study was to investigate the use of surgical smoke-producing procedures such as laser ablation or electrosurgery in minimally invasive microendoscopic procedures. This study proposes a technical solution to efficiently remove surgical smoke from very small endoscopic cavities using microports as small as 20 G (0.9 mm) in diameter.
METHODS: The experimental laboratory study used small, rigid, transparent plastic cavity models connected with tubes and pressure sensors to establish an endoscopic in vitro laboratory model. A Kalium-Titanyl-Phosphate (KTP) laser with a 0.5-mm fiber optic probe was used to produce smoke from bovine scleral tissue in the cavity. Endoscopic gas insufflation into the model was generated by pressurized air and a microvalve. A laboratory vacuum pump provided smoke and gas suction via a microvalve. A self-built control and steering system was utilized to control intracavital pressure during experimental insufflation and suction.
RESULTS: Problems related to smoke-generating processes, such as laser vaporization or electrocautery, in small closed cavities were first analyzed. A theoretical and mechatronic laboratory model was established and tested. Intracavital pressure and gas flow were measured first without and then with smoke generation. A new construction design for the suction tube was proposed due to rapid obstruction by smoke particles.
CONCLUSIONS: Surgical smoke evacuation from endoscopic cavities that are as small as 2 cm in diameter via minimally invasive ports as small as 20 G (0.9 mm) in diameter may be safe and efficient if sufficient gas exchange is provided during smoke generation by laser or electrosurgical instruments. However, maintaining a low and constant pressure in the cavity during gas exchange and adopting a special construction design for the suction tube are essential to provide an excellent view during the surgical maneuver and to minimize potential toxic side effects of the smoke.
Authors:
Dietmar Mattes; Edah Silajdzic; Monika Mayer; Martin Horn; Daniel Scheidbach; Werner Wackernagel; Gerald Langmann; Andreas Wedrich
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Publication Detail:
Type:  In Vitro; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-03-26
Journal Detail:
Title:  Surgical endoscopy     Volume:  24     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-27     Completed Date:  2011-01-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  2492-501     Citation Subset:  IM    
Affiliation:
Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria. di.mattes@medunigraz.at
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MeSH Terms
Descriptor/Qualifier:
Animals
Electrosurgery* / adverse effects
Endoscopy / adverse effects*
Laser Therapy* / adverse effects
Microsurgery*
Models, Structural*
Smoke*
Surgical Procedures, Minimally Invasive
Chemical
Reg. No./Substance:
0/Smoke

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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