Features of the application of electrosurgical methods in pancreatic surgery
The specific features of resection interventions on the pancreas with the use of electrosurgical methods. The processes of tissue regeneration in the site of surgical interventions when applying these methods as compared with conventional surgical.
| Рубрика | Медицина |
| Вид | статья |
| Язык | английский |
| Дата добавления | 22.02.2021 |
| Размер файла | 6,6 M |
Отправить свою хорошую работу в базу знаний просто. Используйте форму, расположенную ниже
Студенты, аспиранты, молодые ученые, использующие базу знаний в своей учебе и работе, будут вам очень благодарны.
Размещено на http://www.allbest.ru/
Features of the application of electrosurgical methods in pancreatic surgery
Valikhnovska K.G., a postgraduate of Surgery and Transplantology Dpt., Shupyk National Academy of Postgraduate Education; Savytska I.M., Candidate of Medical Science, senior researcher, Department of Experimental Surgery, State Institute «Shalimov National Institute of Surgery and Transplantation», National Academy of Medical Sciences of Ukraine
Abstract
There have been investigated the specific features of resection interventions on the pancreas with the use of electrosurgical methods on experimental models of clinical operations. The processes of pancreatic tissue regeneration in the site of surgical interventions have been studied when applying these methods as compared with conventional surgical technique.
Key words: pancreas; electric welding of tissue; electrosurgery; monopolar welding; electrosurgical methods.
Surgical interventions on the pancreas have always been a challenge due to the features of the anatomical structure. Despite the latest developments in modern surgery, some issues still need addressing. High-frequency electrosurgical instruments are widely used in various branches of medicine. They are employed in gynecology and abdominal surgery, in proctology and thoracic surgery, in ophthalmology and urology [1, 2, 3, 4].
High frequency electric welding technology reduces the time of surgical intervention, does not require suture materials, not only minimizes the duration of bleeding, but also disinfects the wound surface [5, 6]. The use of electrosurgical instruments significantly reduces the time of surgical intervention and wound pain in the postoperative period [7].
However, there is limited data on changes that occur in the pancreatic tissue resulting from the use of electrosurgical instruments during resection interventions.
Materials and methods. The study was performed on 30 six-month old rats of the genus Rattus, (family Muridae), weighing 240-280 g.
Before the research, a veterinary examination was conducted and the animals had a group health passport with the necessary preventive measures. The animals were treated and anesthetized as required by the Law of Ukraine “On Protection of Animals from Cruel Handling” No. 1759-IV dated December 15, 2009, the Ordinance of the Cabinet of Ministers of Ukraine dated July 28, 2010 No. 1585 “On Approval of the List of Regulatory and Legal Acts Protecting Animals from
Ill-treatment”, and Scientific and Practical Guidance for Housing and Care of Laboratory Animals and Their Use issued by the National Pharmacological Centre, Ministry of Health of Ukraine (Protocol No. 8 dated June 22, 2012).
Aim of the study. To investigate the features of changes in the pancreatic tissue after resections using a conventional surgical technique and electrosurgical methods, including electric welding and monopole welding, to evaluate the possibilities and feasibility of the use.
The study objectives were as follows:
1. To investigate the features of interventions on the pancreas with the use of electrosurgical methods on the experimental models.
2. To compare the processes of the pancreatic tissue regeneration in the site of surgical intervention following the use of electrosurgical and conventional methods.
According to the assigned objectives, the animals were divided into three groups.
Animals of group I (n = 10) underwent the resection of part of the pancreas with the use of conventional surgical technique. These animals composed the control group.
In animals of the group II (n = 10), the resection of part of the pancreas was performed using the electrosurgical tool in a monopolar mode.
Animals of group III (n = 10) had a part of the pancreas resected employing Patonmed EKVZ-300 D device in a manual welding mode.
Operative interventions were performed under general intraperitoneal anesthesia (0.2 ml of 5% sodium thiopental and 0.4 ml of 1% propofol) under aseptic and antiseptic conditions. To prevent postoperative complications, a single injection of bicillin-5 at a dose of 1 million units per kg of body weight was administered.
To provide the analgesic effect within the first three postoperative days, dexketoprofen was injected subcutaneously (3-5 mg / kg of the body weight).
At three, seven and twenty-one days following resection the animals were euthanized with an intraabdominal overdose of 10% sodium thiopental. The pancreatic tissue in the resection site was investigated immediately after surgery and after 3, 7, 21 days.
To prepare samples for histological studies, the part of the pancreas was excised with the resection area, the sample was fixed for 24 hours in 10% neutral- buffered formalin, and then it was embedded in paraffin according to a routine protocol. Five-pm-thick tissue sections were stained with hematoxylin and eosin, azure-II-eosin, Van Gieson's picrofuchsin; the PAS- reaction and PAS-reaction with amylase control were conducted. The histological samples were studied using the Leica DM500 light optical microscope, the images were captured by the Leica ICC50 HD camera.
Statistical analysis and processing of the results were carried out using the IBM SPSS Statistics 20 Integrated Software Package. The non-parametric Kruskal-Wallis H test and the Mann-Whitney U test were employed as criteria for the reliability of the difference.
Results
Immediately after resection using a conventional technique, the blood vessels were dilated, the arteries were atonic. The blood clot with cell body fragments was loose; there were seen hemorrhages in the stroma (Fig. 1).
Fig. 1 White rat pancreas (under the resection site) following the surgical intervention by standard technique. Azure-II-eosin staining. Magnification x100.
In some areas under the resection area, multiple hemorrhages were merging into large fields, affecting the trophic support of the parenchyma, which had undergone dystrophic changes.
After three days, a necrotic focus arose in the resection site; granulation tissue began to form around it. Alongside with impaired vascular penetrability there was seen plasmorrhagia, diapedetic hemorrhages, and stromal edema even in the remote areas. Inflammation with abundant neutrophilic and lymphocytic infiltration of the stroma covered a significant part of the pancreas.
After seven days, a thick layer of granulation tissue with necrotic foci was formed in the resection site, the stroma was infiltrated mainly with neutrophils and lymphocytes, and under the resection area, edema was more pronounced. Dystrophic changes in pancreatocytes were particularly prominent in the resection site, and somewhat decreased in the remote areas.
After 21 days, the formation of adhesions with loops of the small intestine was mainly seen. Inflammatory manifestations were still observed in the tissues adjacent to the resection site. The areas of necrotic parenchyma were surrounded by a thick connective tissue capsule, the wall of which was mainly infiltered by neutrophils (Fig. 2).
Fig.2 The pancreas of the white rat 21 days after the conventional surgery. Azure-II-eosin staining. Magnification x100
In remote areas, the functional state of parenchymal cells somewhat recovered. Manifestations of the vascular response were less pronounced than in the prior time points.
Thus, after the use of the conventional surgical technique, in the resection site, there were seen alterations accompanied by circulatory disorders, the process became cascading with the formation of colliquative necrotic foci, which were surrounded by connective tissue capsules after seven days. Partial recovery of the functional state of parenchymal cells with a moderate decrease in the stromal inflammation and a microvascular response was observed after 21 days.
Immediately after monopolar welding, a layer of coagulation-altered tissue was formed on the resection surface. The underlying pancreatic tissue became compact due to the dehydration and compression; under this area, there was seen a loss of cellular communication in the parenchyma, in this area, there were isolated hemorrhages, blood vessels were thrombosed (Fig. 3).
Fig. 3 White rat pancreas in the resection site after monopole welding. Hematoxylin and eosin staining. Magnification x100.
The underlying vessels were dilated and plethoric.
After three days, around the thermal injuries in the parenchyma, there was formed a thin layer of fibroblasts and collagen fibers, which began to separate the damaged areas from the intact parenchymal areas. Pancreatocytes did not preserve the zonation around the damage area; they were undergoing dystrophic changes. Blood vessels under the resection area were dilated, the pancreatic stroma became swollen even in the remote areas.
After seven days, the necrotic pancreatic parenchyma was surrounded by a connective tissue capsule, the coagulation scab was divided into separate fragments due to the effect of tissue enzymes and macrophage activity. The separation of the pancreatic cytoplasm into homogeneous and zymogenic areas partially recovered in the areas remote from the affected site. Edema and a vascular response persisted.
After 21 days, there was seen a significant decrease in the severity of inflammatory response, in the areas remote from the resection site, pancreatocytes were recovering the functional activity as evidenced by the restoration of the cytoplasmic zonation. The manifestations of edema significantly decreased, vessels of the microcirculatory bloodstream were restoring. The cicatrix on the resected surface was formed by mature loose connective tissue, where there were noted clusters of tissue basophils with no signs of degranulation (Fig. 4).
Fig. 4 White rat pancreas in the resection site 21 days after monopole welding. 1 - a cluster of tissue basophils. Hematoxylin and eosin staining. Magnification x100.
As can be seen from the above, after three days, a thin connective tissue capsule was formed around the damaged parenchyma; after seven days, alongside with a reduction in the intensity of the inflammation, there were observed signs of functional restoration of the parenchyma; newly formed ducts participated in the compensatory processes in the granulation tissue on the resection surface. Twenty-one days after the resection using monopole welding, a more significant volume of connective tissue was formed and more pronounced signs of inflammation remained as compared with the use of electric welding.
After electric welding, on the resection surface, the coagulation scab was formed predominantly by coagulated plasma and fragments of cell bodies, it had clefts (Fig. 5). Under the scab, the pancreatic parenchyma became densified due to a reduced volume of cell bodies, liquid loss, intracellular coagulation and compression caused by the jaws of the electric instrument. Blood vessels were closed, compressed. There were small isolated hemorrhagic foci; there was a mosaic distribution of densified tissue areas among the areas of parenchyma with lost cellular communication.
Fig. 5 Pancreas of the white rat in the resection site after electric welding. Hematoxylin and eosin staining. Magnification x100.
After three days, in the resection site, the coagulation scab was partially fragmented and, along with the necrotic pancreatic parenchyma it was surrounded by a thin layer of fibroblasts. Under the resection site, in all sections of the microcirculatory bloodstream, there were changes, including stasis, detachment of the endothelial cells into the lumen of the vessels, hemorrhagic infiltration of the vascular walls and paravasal connective tissue.
After seven days, fragments of the coagulation layer and the necrotic pancreatic tissue were surrounded by a connective tissue capsule, where new ducts and blood vessels were formed. The functional status of pancreatic cells under the resection area partially recovered, but the blood vessels remained dilated.
After 21 days, on the surface of the resection site, there was formed mature and loose connective tissue containing new ducts and blood vessels. In this tissue, there were also seen fragments of coagulation scab. The remains of the coagulation scab were often rejected from the surface of the pancreas and seen in the abdominal cavity adherent to omentum (Fig. 6). The signs of inflammation almost faded in the newly formed tissue and in the surrounding parenchyma.
Fig. 6 The remains of coagulation scab 21 days after electric welding. Hematoxylin and eosin staining. Magnification x100.
To summarize, the tissue was densified in the resection area after electric welding. After three days, plastic functions were less manifested than after monopolar welding or the conventional technique. However, after seven days, a layer of granulation tissue was formed. After 21 days, signs of inflammation and edema of the stroma were significantly reduced, the necrotic area caused by the thermal exposure shrank in size due to the substitution by connective tissue and the resorption mainly by macrophages, the presence of newly formed ducts was indicative of the restoration of functional activity of the pancreas.
Discussion
When using electrosurgical methods, a hermetic layer formed on the resection surface, which ensured reliable hemostasis, contributing to a greatly reduced risk of bleeding and promoting the recovery processes in the postoperative period. The area of the thermally damaged tissue was less with the use of electric welding as compared with monopolar welding.
The site of the pronounced thermal damage was of heterogeneous structure and various volume, depending on the electrosurgical method. Visually, it was possible to distinguish three areas of changes: 1) a dense coagulation scab formed on the surface; 2) the parenchyma was densified, it was difficult to visualize the cellular boundaries, the nuclei diminished in volume and became hyperchromic; 3) pancreatic cells lost contact with each other.
The comparative analysis of independent data (groups II and III), using the non-parametric Kruskal Wallis H test, revealed statistically significant differences in such values as the width of the coagulation scab, the width of the densified area and the area with lost cellular communication between the two groups (p = 0.0001) (Table. 1). For the densified area width there was employed the non-parametric Mann-Whitney U test involving the analysis of two independent samples.
Table 1. Thickness of the thermal injuries after the pancreatic resection (?M)
|
Values |
Group II Monopolar welding |
Group ІІІ Electric welding |
|
|
Width of coagulation scab |
88.76 |
66.39* |
|
|
Width of the densified area |
328.26 |
236.11* |
|
|
Width of the area with lost cellular communication |
785.35 |
553.41** |
Note: * - the reliability of the difference between the groups according to the Kruskal-Wallis H test (p = 0.001);
** - the reliability of the difference between the groups according to the Mann-Whitney U test.
More pronounced damage to the pancreatic parenchyma during surgery with the use of monopolar welding slowed down the recovery processes asevidenced by the investigations at 3 and 7 days postoperatively, however, at 21 days, the difference between the injuries caused by both electrosurgical methods were somewhat smoothed out.
In the early stages after the use of the conventional surgical technique, there was seen a more pronounced inflammation, there occurred bleeding on the resection surface and hemorrhage in the stroma, the volume of newly formed connective tissue increased significantly.
Further, it could lead to postoperative bleeding, increase the duration of reparative processes, and cause the formation of a significant amount of cicatricial tissue.
pancreas resection electrosurgical regeneration
Conclusions
When using monopolar and electric welding, reliable hemostasis was observed due to the formation of coagulation scab on the resected surface and blood coagulation in the vessels under the resection area. The underlying vessels were markedly dilated, preserving patency. With the use of conventional technique there occurred bleeding on the resection surface and hemorrhage in the stroma.
Electric welding caused more considerable tissue compaction and liquid evaporation in the resection area than monopolar welding. However, the volume of the thermally damaged tissue was less, which significantly reduced the area of necrotic parenchyma.
In the early stages after the use of conventional surgical technique, there was a more pronounced inflammation with the dominance of neutrophil infiltration than after electrosurgical methods.
With the use of conventional surgical technique the volume of newly formed connective tissue increased faster than after electric welding, which further could lead to the formation of a considerable amount of cicatricial tissue.
The cicatrices formed in the resection site at 21 days both after electric and monopole welding were moderately thin and did not cause the deformation of the pancreas.
The use of electric and monopolar welding allowed reducing the time of surgery, lessened the risk of bleeding, promoted more compact connection on the resection surface, and did not affect recovery processes in the investigated periods.
References
1. Meeuwsen F.C., Guйdon A.C.P., Arkenbout E.A., Van der Elst M., Dankelman J., Van den Dobbelsteen J.J. The art of electrosurgery: trainees and experts. Surg Innov. 2017 Aug;24(4): 373-378.
2. Hainer BL. Fundamentals of electrosurgery. J Am Board Fam Pract. 1991 Nov-Dec;4(6):419-26.
3. Taheri A., Mansoori P., Sandoval L.F., Feldman S.R., Pearce D., Williford P.M. Electrosurgery: part II. Technology, applications, and safety of electrosurgical devices. J Am Acad Dermatol. 2014 Apr;70(4):607.e1- 607.e12.
4. Advincula AP, Wang K. The evolutionary state of electrosurgery: where are we now? Curr Opin Obstet Gynecol. 2008 Aug;20(4):353-8.
5. Morris ML, Tucker RD, Baron TH, Song LM. Electrosurgery in gastrointestinal endoscopy: principles to practice. Am J Gastroenterol. 2009 Jun;104(6):1563-74.
6. Sukhin I.A., Khudetskyi I.Yu., Kachan S.H., Bilylovets O.M. Investigation of influence on parenchymatous organs of high-temperature methods of tissue dissection and coagulation in the experiment. Clin. surgery. 2013;(1):76-8.
7. Linchevskyy O., Makarov A., Getman V. Lung sealing using the tissue-welding technology in spontaneous pneumothorax. Eur J Cardiothorac Surg. 2010 May;37(5):1126-8.
8. Shapovalova Y.A.. Criterions of efficacy of the soft tissues electric welding for the hemostasis guaranteeing in laparoscopic operations. Klin Khir. 2015;(8):17-20. [In Ukrainian]
9. Alkatout I., Schollmeyer T., Hawaldar N.A., Sharma N., Mettler L. Principles and safety measures of electrosurgery in laparoscopy. JSLS. 2012 Jan20
10. Huschak G., Steen M., Kaisers U.X. Principles and risks of electrosurgery. Anasthesiol Intensivmed Notfallmed Schmerzther. 2009 Jan; 44(1):10-3.
11. Aird L.N., Brown C.J. Systematic review and meta-analysis of electrocautery versus scalpel for surgical skin incisions. Am J Surg. 2012 Aug;204(2):216-21.
Размещено на Allbest.ru
...Подобные документы
Structure of a clinical term. The suffixes and prefixes. The final combining forms partaining to diagnostic methods, therapy, pathology, surgical interventions. Pharmaceutical term structure. The forms of medicines. Chemical, botanical terminology.
методичка [458,1 K], добавлен 29.03.2012The main features of uterine fibroids. The development of a tumor from the "embryonic growth site" and a microscopic nodule without signs of cellular differentiation to a macroscopic nodule. Study of surgical and conservative treatment of leiomyoma.
презентация [1,4 M], добавлен 31.10.2021The major pathogens and symptoms of cholera - an acute intestinal anthroponotic infection caused by bacteria of the species Vibrio cholerae. Methods of diagnosis and clinical features of disease. Traditional methods of treatment and prevention of disease.
презентация [1,0 M], добавлен 22.09.2014Body Water Compartments. The main general physico-chemical laws. Disorders of water and electrolyte balance. Methods bodies of water in the body, and clinical manifestations. Planning and implementation of treatment fluid and electrolyte disorders.
презентация [1,1 M], добавлен 11.09.2014The characteristic features of the two forms of eating disorders: anorexia nervosa and bulimia. Description body dysmorphic disorder syndrome as a teenager painful experiences of his "physical disability." Methods of treatment and prevention of disease.
курсовая работа [17,9 K], добавлен 31.03.2013Risk Factors. The following symptoms may indicate advanced disease. A barium contrast study of the small intestine. Surgical removal is the primary treatment for cancer of the small intestine. The association of small bowel cancer with underlying.
презентация [4,1 M], добавлен 28.04.2014The endocrine system is a control system of ductless glands that secrete hormones within specific organs. Exocrine function of pancreas. Ferments and secretion of digestive juice. Mixed endocrine and exocrine glands are the pancreas, ovaries and testes.
презентация [5,4 M], добавлен 22.11.2015Different classification schemes for dementias. His reasons. Risk Factors for Dementia. Dementia is diagnosed by using many methods such as patient's medical and family history, physical exam, neurological evaluations, cognitive and neuropsychological.
презентация [775,8 K], добавлен 10.06.2013Tachycardia is a heart rate that exceeds the normal range. Symptoms and treatment methods of tachycardia. An electrocardiogram (ECG) is used to classify the type of tachycardia. It's important to get a prompt, accurate diagnosis and appropriate care.
презентация [596,2 K], добавлен 20.11.2014Churg-Strauss syndrome, microscopic polyangiitis as one of the basic types of the small vessel vasculitis. Specific features of differential diagnosis of pulmonary-renal syndrome. Characteristics of the anti-neutrophil cytoplasmic autoantibodies.
презентация [8,2 M], добавлен 18.10.2017Areas with significant numbers of malaria cases: Africa, the Middle East, India, Southeast Asia, South America, Central America and parts of the Caribbean. Etiology, symptoms and diagnosis of the disease, methods of treatment and antimalarial immunity.
презентация [286,9 K], добавлен 02.10.2012The development of modern medicine. The creation of internal organs, implants. The use of modern orthopaedics mechanical devices. The replacement of lost parts of the human body by means of surgical operations. Bridge denture. The use of prostheses.
презентация [5,0 M], добавлен 31.05.2016Methods of making Herbal Oils. Pain Herbs For Natural Relief. Salicin, Olive, Almond Oil, Lavender oil, Castor Oil, Jojoba oil, Safflower oil, Grapeseed oil, Hemp seed oil. Healing herbal oils. Herbal teas, tinctures, extracts and topical pain relievers.
презентация [800,0 K], добавлен 06.03.2013The concept and the internal structure of the lungs, the main components and their interaction. Functional features of the lungs in the human body, their relationship with other anatomical systems. Existing pathology of respiratory organ and control.
презентация [2,5 M], добавлен 12.02.2015Introduction to the functionality of the most important internal organs. The main causes of supraventricular and ventricular tachycardia. Features of the structure and basic functions of the human heart. The study of the three phases of the heart.
презентация [3,8 M], добавлен 12.05.2013Orderliness (methodical) of the general inspection. The patient's position in bed. Constitution types - set of congenital and acquired the morphological and functional characteristics of the organism. Distinctive features of the constitutional types.
презентация [2,1 M], добавлен 22.02.2015Features of the structure and anatomy of the heart, it's main functions and tasks in the body. Changes taking place in the human heart in the course of his life from birth to aging. Age-related disorders in the blood supply system and the heart.
презентация [725,8 K], добавлен 16.10.2016Frequency of distribution of a pseudo erosion of neck of uterus. Stydying of clinico–morphological types of pseudo erosion of neck of uterus. Stydying of a age features. Damages at abortion or at the time of delivery, infections transmittable sexual ways.
реферат [2,5 M], добавлен 13.10.2013Acromegaly as an rare syndrome that result when the anterior pituitary gland produces excess growth hormone. Signs and symptoms, etiology and pathogenesis. The complications of acromegaly. Treatment: Hormone therapy, surgery on the pituitary gland.
презентация [827,4 K], добавлен 28.12.2015Study of method of determining the amount of osteocyte lacunar and estimation of specific numerical closeness of lacunes by a three-dimensional impartial expecting method at the analysis of anisotropy of types of the vascular ductings of human bone.
реферат [8,6 K], добавлен 01.12.2010
