Novel high-intensity focused ultrasound clamp--potential adjunct for laparoscopic partial nephrectomy.
Novel high-intensity focused ultrasound clamp--potential adjunct for laparoscopic partial nephrectomy.
复制标题
新型高强度聚焦超声钳——腹腔镜肾部分切除术的潜在辅助手段。
DOI：
10.1089/end.2012.0107
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发表时间：
2012
影响因子：
2.7
通讯作者：
Crum,LawrenceA
中科院分区：
文献类型：
--
作者：
Harper,JonathanD;Shah,Anup;Mitchell,StuartB;Wang,Yak-Nam;Starr,Frank;Bailey,MichaelR;Crum,LawrenceA
背景和目的：部分肾切除术(PN)在技术上具有挑战性，尤其是在以微创方式进行的情况下。虽然超声波技术已经被证明具有治疗能力，包括组织消融和止血，但它还没有在PN环境中获得临床应用。本研究的目的是评估高强度超声钳在肾脏内形成消融平面的能力，以提供潜在的止血，从而可能有助于腹腔镜下的PN。方法：使用腹腔镜Padron内窥镜暴露牵引器制作一种新的器械。在牵引器的两侧设计了超声波元件，以在夹具的两侧之间提供高强度的超声波能量。将这种高强度聚焦超声(HIFU)夹放置在距10个猪肾脏上下极2~2.5 cm处，以评估其在不同能量传递水平和持续时间下的效果。PN横断术通过夹闭边缘的远端部分进行。干预后和PN后评估肾脏，并通过在缺损处放置称量纱布来估计出血量。苏木精-伊红染色和烟酰胺腺嘌呤二核苷酸染色进行组织学分析，以评估组织的活力和热扩散。结果：大体实质改变在处理和未处理组织之间有明显的分界。增加超声暴露时间(10vs5和2 分钟)，即使在较低功率设置下，也更有效地导致组织的破坏和坏死。在暴露10分钟后，四个肾单位中的三个实现了跨壁消融，失血量显著减少(<；2 gvs30-100 g)。无活性组织经组织学证实。结论：在猪的初步评估中，一种新型的高强度聚焦超声夹子止血并在肾脏内形成了一个消融平面。这项技术可以作为未来腹腔镜式PN的一个有用的辅助手段，潜在地消除对肾门夹闭的需要。
Background and Purpose:Partial nephrectomy (PN) can be technically challenging, especially if performed in a minimally invasive manner. Although ultrasound technology has been shown to have therapeutic capabilities, including tissue ablation and hemostasis, it has not gained clinical use in the PN setting. The purpose of this study is to evaluate the ability of a high-intensity ultrasound clamp to create an ablation plane in the kidney providing hemostasis that could potentially aid in laparoscopic PN.Methods:A new instrument was created using a laparoscopic Padron endoscopic exposing retractor. Ultrasound elements were engineered on both sides of the retractor to administer high-intensity ultrasound energy between the two sides of the clamp. This high-intensity focused ultrasound (HIFU) clamp was placed 2 to 2.5 cm from the upper and lower poles of 10 porcine kidneys to evaluate its effectiveness at different levels and duration of energy delivery. PN transection was performed through the distal portion of the clamped margin. Kidneys postintervention and after PN were evaluated and blood loss estimated by weighing gauze placed at the defect. Histologic analysis was performed with hematoxylin and eosin and nicotinamide adenine dinucleotide staining to evaluate for tissue viability and thermal spread.Results:Gross parenchymal changes were seen with obvious demarcation between treated and untreated tissue. Increased ultrasound exposure time (10vs5 and 2 min), even at lower power settings, was more effective in causing destruction and necrosis of tissue. Transmural ablation was achieved in three of four renal units after 10 minutes of exposure with significantly less blood loss (<2 gvs30–100 g). Nonviable tissue was confirmed histologically. There was minimal thermal spread outside the clamped margin (1.2–3.2 mm).Conclusion:In this preliminary porcine evaluation, a novel HIFU clamp induced hemostasis and created an ablation plane in the kidney. This technology could serve as a useful adjunct to laparoscopic PN in the future and potentially obviate the need for renal hilar clamping.