Takao Toshima, Ryuichi Kumashiro, Norifumi Harimoto, Youichi Yamashita, Toru Ikegami, Tomoharu Yoshizumi, Yuji Soejima, Ken Shirabe, Yoshihiko Maehara, Tetsuo Ikeda
Kyushu University, Fukuoka, Japan.
What kind of instrument is the “Silicon Jacket Irrigator”?: The Silicone Jacket Irrigator (SJI) is coated with silicone that is not denatured or degraded at 200°C and can be applied to a variety of bipolar electrosurgery devices like a jacket. It allows the tips of bipolar electrosurgery devices to be irrigated with saline through narrow canals (1.0 × 0.3 mm in diameter). The SJI has been developed for use with endoscopic surgical instruments of 3 mm and 5 mm external diameter. When applied to 5 mm endoscopic surgical instruments, the external diameter becomes 6.3 mm, so that it can still be used in a port with a 7 mm internal diameter.
How efficient is the SJI?: When connected to an infusion pump, the SJI can supply saline at a constant flow rate of 50–200 ml/h to the tip of instrument. As a result, the tissue in contact with the bipolar blade is maintained below 100°C, which is still sufficient to coagulate tissue. Blood is washed away so that tissues do not carbonize, the blade does not stick and proteins congeal smoothly.
Why are such instruments required for endoscopic surgery?: Approximately 40,000 patients suffer electrosurgical-related injuries each year. Many of these accidents occur in monopolar electrosurgery using a return electrode. Bipolar electrosurgery and ultrasonic surgery those current does not flow into the patient’s body are considered safer. However, the blades of bipolar needs to be in contact with tissue and high current concentrations confined between blades. The presence of blood which has high electrical conductivity, current flows preferentially in blood and coagulated. Coagulated blood and tissue stick to the blades and impairs the function of bipolar electrosurgery. Ultrasound is a device that generates heat in the tissue by vibration, It takes more time to heat tissue, the cavitation occurs at the tip by vibration and the coagulation power also is inferior.
Experimental and clinical experience with SJI: We have confirmed the utility and safety of the device in animal experiments. The maximum temperature during continuous use was 85°C. On histological analysis, tissue damage was less than standard bipolar diathermy. Blood vessels had been occluded by thrombosis. Rupture pressure of the bile duct after dissection of the liver parenchyma exceeded 100 mmHg. We have already used the device in endoscopic subtotal esophagectomy, gastrectomy, rectal resection and hepatectomy. Bipolar electrosurgery with irrigation proved to be an effective and safe means of mobilizing organs, dissecting lymph nodes and hepatic parenchyma and transecting vascular structures without burns. The material cost savings per case are approximately 70,000 Japanese yen.
Conclusions: SJI can be attached to standard reusable bipolar electrosurgery equipment and is effective and safe in a variety of endoscopic surgical procedures. The device reduces the requirements of other disposable surgical equipment, so it is also is economical. SJI was protected by patent in Japan in January 2013 and will sell for about 7,000 Japanese yen.
Session: Poster Presentation
Program Number: ETP051
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