The Acute And Sub-Acute Effects Of Electrosurgical And Ultrasonic Surgical Devices On The Neurophysiologic Changes Of Sciatic Nerve Function

摘要

THE ACUTE AND SUB-ACUTE EFFECTS OF ELECTROSURGICAL AND ULTRASONIC SURGICAL DEVICES ON THE NEUROPHYSIOLOGIC CHANGES OF SCIATIC NERVE FUNCTION Since the dawn of medicine, blood loss during surgeries has been one of the major concerns for the surgeons. Iatrogenic blood loss can have several harmful effects on the patient condition. With the rapid development in technology, the blood loss can now be significantly minimized by using a variety of vessel sealing devices that use several energy sources to seal the blood vessels or tissue bundles instead of traditional sutures and clips. These devices can be used in several general, colorectal, gynecological and urological surgical procedures.The two types of vessel sealing techniques accepted worldwide are based on electrosurgical and ultrasonic technology. The electrosurgical technique uses electric energy while the ultrasonic technique uses ultrasonic energy to seal the blood vessels and simultaneously cut and coagulate tissues.In 2009, more than 17.5 million electrosurgical procedures were performed in US alone. Also, ultrasonic devices have been used for over 10 million procedures worldwide. However, it is not clear to if these devices can cause nerve injury when applied near the nerve tissue. The safe distance to apply these devices from nerves has not been profoundly investigated.In the current study, a set of electrosurgical and ultrasonic devices were surgically tested in a rat model. These devices were applied on the muscle tissue at specific distances from the sciatic nerve. The consequent change in the nerve conduction function was neurophysiologically assessed and analyzed. Also, a developmental study was performed to determine a feasible surgical technique to use these devices to minimize nerve injury in the acute as well as sub-acute phase. The sensory nerve function was assessed by means of behavioral changes in the sub-acute phase.It was seen that electrosurgical devices produced a significant nerve dysfunction as compared to the ultrasonic devices. The ultrasonic devices appeared to be more safe, convenient and efficient during surgical applications close to the nerve tissue.