Background

During esophagectomy for esophageal cancer, meticulous attention is needed to prevent thermal injury to the vital organs, such as the recurrent laryngeal nerve (RLN) and tracheobronchus. In order to clarify the novel mechanism behind thermal injury induced by energy devices, we investigated the temperature of steam with the use of two different devices under wet and dry conditions.

Methods

An ultrasonic device (Sonicision™) and a vessel sealing device (Ligasure™) were studied. We evaluated the temperature at the tip of the devices and the steam when the devices were activated under different grasping ranges, under four different combinations of device and muscle, and under four different wet/dry conditions (dry–dry, dry–wet, wet–dry, and wet–wet).

Results

Although the maximum temperature of the devices was significantly higher with Sonicision™ than with Ligasure™, the maximum temperature of the steam was significantly higher with Ligasure™ than with Sonicision™ in almost all situations. At 1 mm away from Sonicision™, the critical temperature more than 60 °C was observed only when used with one-third grasping range under the wet–dry or the wet–wet conditions. In case of Ligasure™, high-temperature steam was observed when used with one-third grasping under the wet–dry or the wet–wet condition and two-third grasping under the dry–wet, the wet–dry, or the wet–wet condition. Under the wet condition, the emission of steam from the non-grasping part of Ligasure™ caused a spike in temperature that exceeded the critical temperature.

Conclusion

We demonstrated that the use of energy devices under a wet condition generates steam from the non-grasping part of the devices. The temperatures of steam from Ligasure™ were significantly higher than that from Sonicision™. To prevent thermal injury to the vital organs, a very attentive and meticulous surgical technique is imperative considering the characteristics of each device.

中文翻译：

---

在潮湿条件下激活能量设备而产生的蒸汽可能会造成热伤害

背景

在食管癌食管切除术期间，需要认真注意防止热损伤诸如喉返神经和气管支气管等重要器官。为了阐明由能量装置引起的热损伤背后的新机制，我们在潮湿和干燥条件下使用两种不同的装置研究了蒸汽温度。

方法

研究了超声设备（Sonicision™）和容器密封设备（Ligasure™）。我们评估了在不同抓握范围，四种不同的器械和肌肉组合以及四种不同的干/湿条件（干-干，干-湿，湿，湿）下激活设备时，设备尖端和蒸汽温度的变化。 –干湿湿）。

结果

尽管使用Sonicision™的设备的最高温度明显高于使用Ligasure™的设备，但在几乎所有情况下，使用Ligasure™的蒸汽最高温度都明显高于使用Sonicision™的设备。在距离Sonicision™1毫米的位置，只有在干湿或湿湿条件下以三分之一的抓地力使用时，才能观察到超过60°C的临界温度。如果使用Ligasure™，则在湿-干或湿-湿条件下抓握三分之一时会观察到高温蒸汽，而在干-湿，湿-干或湿-湿条件下抓到三分之二时会观察到高温蒸汽。潮湿的条件。在潮湿条件下，Ligasure™的非抓握部分释放的蒸汽导致温度峰值超过临界温度。

结论

我们证明了在潮湿条件下使用能源设备会从设备的非夹持部分产生蒸汽。Ligasure™的蒸汽温度明显高于Sonicision™的蒸汽温度。为了防止对重要器官造成热损伤，考虑到每种设备的特性，必须采取非常细致而细致的外科手术技术。