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Multi-Stream Saline-Jet Dissection Using a Simple Irrigation System Defines Difficult Tissue Planes

机译:使用简单的灌溉系统进行多流盐水喷射解剖确定了困难的组织平面

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Introduction: Single-stream hydro-jet dissection is increasingly used in various laparoscopic procedures, but its use requires special equipment. We describe a simple method for using an irrigation system for saline-jet tissue dissection as a useful adjunct prior to adhesiolysis. Material and Methods: Intraabdominal adhesions prolong laparoscopic procedures, because tissue planes are difficult to identify. We performed multi-jet saline dissection (MSSJ) between 2000 and 2009 in more than 500 patients during laparoscopy involving hernias, gallbladders, appendices, and intestinal obstructions. We use a standard suction irrigation probe, which is attached to a 1-liter saline bag with an inflatable cuff around to create a pressure of 250mm Hg to 300mm Hg. In effect, this is the standard setup generally used for irrigation. After using saline dissection, tissue planes can be better defined and the structures can then be separated. Result and Discussion: Using this method, we have successfully identified tissue planes in spite of dense adhesions, and our conversion rates to open have been reduced dramatically. This method is relatively safer than other modalities of tissue dissection, such as diathermy, ultrasonic, blunt or sharp dissection. The disadvantage is that with tissues saturated with saline it becomes more difficult to use diathermy hemostasis. Care has to be exercised in monitoring the temperature and volume of the fluid used.
机译:简介:单流水力喷射解剖越来越多地用于各种腹腔镜手术,但其使用需要特殊的设备。我们描述了使用冲洗系统进行盐水喷射组织解剖的简单方法,作为粘连前的有用辅助手段。材料和方法:由于难以识别组织平面,因此腹腔内粘连延长了腹腔镜手术时间。在2000年至2009年之间,我们对500例涉及疝气,胆囊,阑尾和肠梗阻的腹腔镜手术患者进行了多射流盐水解剖(MSSJ)。我们使用标准的抽吸灌溉探头,该探头连接到1升盐水袋上,周围带有可充气的袖带,可产生250mm Hg至300mm Hg的压力。实际上,这是通常用于灌溉的标准设置。使用盐水解剖后,可以更好地定义组织平面,然后可以分离结构。结果与讨论:使用这种方法,尽管粘连紧密,我们仍成功地识别了组织平面,并且我们的开放转化率大大降低。这种方法比其他组织解剖方法(例如透热,超声,钝性或尖锐解剖)相对安全。缺点是组织充满盐水后,很难进行透热止血。在监视所用流体的温度和体积时必须格外小心。

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