双极电凝钳LiNAPowerBlade

LiNA PowerBlade 双极电凝钳,By Ang Boon HawMarketing Manager,Select Your Energy选择适合您的能量,What to Achieve with Coagulation?以什么来实现电凝呢？,Hemostasis (Haemostasis)止血Greek: heme, blood + stasis, halt = halt of the blood. 希腊语：血红素，血液+凝固，停止=止血,Energy-Based Techniques To Ensure Hemostasis & Limit Damage During Laparoscopy以能量为基础的技术在腹腔镜检查中确保止血和减少伤害,Incomplete hemostasis or incision of an active vascular core can occur even with ideal application即使操作理想，也会发生不完全的止血或者切开活动的核心血管Hemostasis during laparoscopy: 用于腹腔镜检查术中的止血：monopolar electrosurgery 单极电刀bipolar electrosurgery 双极电刀ultrasonic energy 超声刀Etc. 等等,Protocol To Minimize Risk 医疗方案：将风险降到最低,The art of surgical hemostasis: 外科止血的艺术：To prevent vascular trauma with least-possible collateral tissue damage. 保护血管的创伤和最少可能减少附带组织的损害When bleeding is encountered, the surgeons ability to attain hemostasis using a particular modality depends largely on how well he or she understands its technical aspects.当遇到出血的情况，外科医生能使用一种特殊模式来止血，这很大程度取决于他/她对这器械的技术问题了解程度。,Bipolar Electrosurgery双极电刀,Mechanism of action 作用机理Bipolar electrosurgery consolidates an active electrode and return electrode into an instrument with 2 small poles. 双极电刀巩固一个活跃的电极和返回电极到一个有2个小极的器械These poles can be the tines of a forceps, blades of a scissors, or an electrode matched to a more proximal conductive collar separated by an insulator. 这两极可能是一个钳的尖叉、剪刀的刀片、或是一个电极匹配到更近的导电圈由绝缘体隔开。The output typically used is the low-voltage “cut” current.通常用于输出的是低电压“切割”电流。,Bipolar Electrosurgery双极电刀,Advantages of bipolar energy 双极电流能量的优点Localization of current between the poles offers distinct advantages. Thermal damage is generally limited to a discrete volume of tissue. 两极之间的局部电流具有明显的优势。热损伤一般仅限于离散量的组织。A bipolar forceps can be used to coapt and thermally weld blood vessels. 双极抓钳可用来电凝和热焊接血管。The concentrated current and small distance between the poles also make it possible to desiccate tissue that is immersed in fluid. 两极之间的集中电流和小距离也可能使浸泡在液体中的组织失水。,LiNA PowerBladeLiNA 双极切割电刀,Targeted Procedures 目标手术程序,Gynaecology 妇科LAVH腹腔镜辅助经阴道子宫切除术LSH腹腔镜筋膜内子宫切除术Myomectomy子宫肌瘤剔除术Ectopic preg, 子宫妊娠异位Salpingetomy输卵管切除术Oophorectomy卵巢切除术 Ovarian cysts卵巢囊肿切除术,General Surgery 普外科Nissen FundoplicationNissen胃底折叠术Appendectomy阑尾切除术 Colon Resection结肠切除术Gastric by-pass胃旁路手术Cholecystectomy 胆囊切除术,Urology 泌尿科Cystectomy膀胱切除术Prostectomy前列腺电切术Nephrectomy肾切除术,Grasping, Dissecting, Coagulating and Cutting with safe bipolar energy all in one安全的双极能量：抓、分离、电凝和切割四合一Saves costly stapling devices/clips and reduces the number of instruments needed节省设备/钳子的费用和减少了手术器械的需要数量LiNA PowerBlade may save 10-30 minutes at longer procedures like e.g. LAVH使用双极电凝钳在例如LAVH手术过程可以节省10-30分钟For use with all bipolar generators适用于全部双极发生器,LiNA PowerBlade,Uniquely bipolar Uniquely safe 独特的双极非常安全The LiNA PowerBlade uses bipolar electrosurgical current to obtain safe coagulation of tissue, vessels and arteries before cutting. 双极电凝钳利用双极电流能量，在组织、血管和动脉在切割之前作安全的电凝。LiNA PowerBlade applies bipolar energy when transecting tissue. 双极电凝钳提供双极能量来横切组织。By activating the bipolar generator with “coag” or “cut” after coagulation and advancing the cutting electrode for transection, the bipolar poles of the forceps automatically switch to become one pole and the cutting electrode the other pole. 当激活双极发生器的“电凝”或“切割”，电凝后切割电流作用作横切，钳子的双极电极自动转换成单极切割。bipolar electrosurgical cut with coagulation along the surface of the cutting electrode thus ensuring that no bleeding occurs if prior coagulation was insufficient.双极电凝切割是沿着切割的表面同时电凝，因此确保了不会如果先前的电凝不够而使切割时出血。No problems of blunt cutting blades不用担心切割刀片是钝的Safe and effective cut each time每次切割保证安全和有效的,LiNA PowerBlade,Unique LiNA PowerBlade独特的双极电凝钳,Straight jaws直型钳口,Curved jaws弯型钳口,LiNA PowerBlade,LiNA PowerBlade,Real active bipolar cut (LiNA International patent)真正双极切割（LiNA 国际专利）The only coag/cut device with real bipolar cut in the market! 只有电凝/切割设备，在市场上是真正的双极切割Coagulation of vessel walls during whole cutting procedure在整个切割手术程序中，同时电凝血管组织No risk of blunt knife during long procedures即使长时间的手术也不会因为刀头钝了而出现风险情况。,Two finger trigger with ergonomic and light weight handle两根手指就可操作，而且很轻手柄,For grasping 抓,For cutting 切割,LiNA PowerBlade,LiNA PowerBlade,Targeted Procedures 目标手术程序,Gynaecology 妇科LAVH腹腔镜辅助经阴道子宫切除术LSH腹腔镜筋膜内子宫切除术Myomectomy子宫肌瘤剔除术Ectopic preg, 子宫妊娠异位Salpingetomy输卵管切除术Oophorectomy卵巢切除术 Ovarian cysts卵巢囊肿切除术,General Surgery 普外科Nissen FundoplicationNissen胃底折叠术Appendectomy阑尾切除术 Colon Resection结肠切除术Gastric by-pass胃旁路手术Cholecystectomy 胆囊切除术,Urology 泌尿科Cystectomy膀胱切除术Prostectomy前列腺电切术Nephrectomy肾切除术,Sun Tzu The Art of War孙子孙子兵法,So it is said that if you know your enemies and know yourself, you will fight without danger in battles.所以有人说，如果你知道你的敌人和了解你自己，你将会在战场上战无不胜。If you only know yourself, but not your opponent, you may win or may lose.如果你只了解你自己，但对对手一无所知，你可能会赢或者输掉。If you know neither yourself nor your enemy, you will always endanger yourself. 如果你对你自己和对手都不了解，你将会危害到你自己。,Fundamental of Competition Energy Based Vs End Point Results基本竞争能源基础 vs 终点结果,Development of newer generators and innovative instrumentation aimed at delivering appropriate amount of energy to obtain the desired effect 新发生器的发展和创新器械目的在于提供适当的能源量以获得理想的效果Smart generators were introduced 推广巧妙的发生器The basis of all of them is the use of energy to better seal vessels. 在所有这些的基础是能源的使用，以便更好地闭合血管Classic bipolar energy has been used for hemostasis and to coagulate blood vessels for many years经典双极电流能量已被用于止血和电凝血管多年了。One of the major area targeted by new Energy is the lateral spread of thermal energy, as well as charring and sticking of instruments with eschar disruption针对开发新能源的主要领域之一是热能横向扩散，以及炭化和器械与焦痂中断的粘连,Whos out there?谁在那里？,Bipolar devices: 双极设备LigaSure 结扎速PK Cutting Forceps PK电刀SurgRx EnSealTM Laparoscopic Vessel Fusion SystemSurgRx 安速刀TM腹腔镜血管融合系统Erbe BiClamp 爱尔博 BiClamp钳 Ultracision devices: 超声刀设备Ethicon Harmonic Scalpel/ACE (new) 爱惜康 超声波手术刀/酶抑制剂 (新) Tyco AutoSonix Ultrasonic System泰科 AutoSonix超声波系统,Valleylab The Ligasure System Valleylab The Ligasure 系统,Combination of pressure and energy to create vessel fusion. 压力和能量的结合，产生血管的融合Melting the collagen and elastin in the vessel walls and reforming it into a permanent, plastic-like seal熔化血管壁的胶原蛋白和弹性蛋白，以及重整它转化为永久的、像塑料类闭合Also using the fundamental of BIPOLAR ENERGY 也是使用基本双极电流能量A feedback-controlled response system automatically discontinues energy delivery when the seal cycle is complete, eliminating guesswork and minimizing thermal spread to approximately 2 mm for most LigaSure instruments当闭合周期完成，反馈控制的响应系统自动中止能源的传递，为多数LigaSure结扎速器械消除猜测和降低热传导约2毫米。This unique energy output results in virtually no sticking or charring, and the seals can withstand 3 times normal systolic blood pressure. 这独特的能量输出几乎没有导致粘连或炭化，以及密封可以承受的3倍正常血管收缩压。This system also requires a designated generator that works with several different instruments designed by the company.这个体系也要求特定的发生器，与工厂指定的几种不同的器械一起工作。,Valleylab The Ligasure System,Advantages:Vessel sealing up to 7mmStrong burst strength359 rotation applicationInstant Response technology Huge sales force,Disadvantages:Normally twice the price of PowerBladeExpensive LigaSure generator neededMechanical knife (may turn blunt)No visibility of cutting knife during cut procedureHeavy - Weight = 212g (PB 99g)Tissue stick in jaws can affect auto coag, functionNo curved jaws,Valleylab The Ligasure SystemValleylab Ligasure体系,优点:可闭合至7mm静脉血管强烈的爆发力359 旋转程式即时反应 技术强大的销售团队,缺点:通常为双极切割电刀两部的价钱需要配套昂贵的LigaSure发生器机械刀（可能会变钝）切割刀在切割程序时没有视程净重 = 212g (外围缓冲器 99g)组织置在钳口可影响自动电凝功能没有弯型钳口,Gyrus Medical PK Cutting Forceps佳乐 医疗器械PK 切割钳,Unique technology called Vapor Pulse Coagulation (VPC), which produces faster, more uniform results with pulsed energy instantly delivered in a controlled manner. 一种叫蒸气脉冲电凝(VPC)的特殊技术，其生产速度更快，更均匀的即时与控制的方式提供脉冲能量的结果。VPCs pulse-off periods allow tissue to cool and moisture to return to the targeted area, greatly reducing hot spots and coagulum formation. VPC的脉冲时间使组织冷却和水分回到目标区域，大大减少热点和凝块的形成。This technology also results in evenly coagulated target tissue, minimal thermal spread, less sticking, and enhanced hemostasis.这种技术也导致均匀凝固靶组织，减少的热传导，少粘连，和增强止血能力。Specific generator required, which works in tandem with the Gyrus PK instruments.要求特殊的发生器，与佳乐的PK电刀器械串联工作,Advantages: 优点：Complete range of PK Bipolar products PK双极电刀产品齐全Auto-coagulation with bip sound from generator自动电凝时，发生器产生很大的声音Well established in US market not as strong in Europe成功成立于美国市场没有欧洲市场的强大Disadvantages: 缺点：Expensive, normally 20-50 % higher than PowerBlade 昂贵，通常高于双极电凝钳Powerblade 20-50%Expensive Plasma Kinetic Gyrus generator needed需要有Gyrus昂贵的等离子体动力学发生器Mechanical cutting blade (can turn blunt during proc,) 机械切割刀片（可能会变钝）No curved jaws 没有弯型钳口设计,Gyrus Medical PK Cutting Forceps佳乐 医疗器械PK 切割钳,ACMI (Gyrus) Tripolar Ultra ForcepsACMI(佳乐)三极超钳,SurgRx EnSeal Laparoscopic Vessel Fusion System SurgRx 安速刀腹腔镜血管融合系统,Smart Electrode Technology. 巧妙的电极技术EnSeal adjust and dose energy simultaneously to various tissue types in a tissue bundle each with its own impedance characteristics. 调整闭合电凝能量，同时对各种类型组织进行捆绑，每个组织有它的阻抗特性。 The electrode consists of millions of nanometer-sized conductive particles embedded in a temperature-sensitive material. 双极是由数以百万计的纳米大小的导电粒子嵌入一个对温度敏感的材料中。Each particle acts like a discrete thermostatic switch to regulate the amount of current that passes into the tissue region with which it is in contact, thereby generating heat within it.每个粒子的行为像一个独立的恒温开关，调节控制电流传递到与它接触的区域组织中，从而产生热量。,To keep temperature from rising to potentially damaging levels, each conductive nanoparticle interrupts current flow to a specific tissue region engaged by the electrode region. 为了使温度防止上升到潜在的损害水平，各传导的纳米电粒子在电极区域内中断电流流向特定组织区域。 When temperature dips below the optimal fusion level, the individual particle switches back on, reinstating current flow and heat deposition. 当温度骤降低于最优融合水平时，个别电颗子开关激活，恢复电流和升温。 The process continues until the entire tissue segment is uniformly fused without charring or sticking. 这个过程一直持续到整个组织的部分是均匀熔合而无炭化或粘合。 Less heat is required to accomplish fusion, as the tissue volume is minimized through compression; energy is focused on the captured segment; and the vessel walls are fused through compression, protein denaturation, and then renaturation.较少的热量需要完成融合，因为组织是通过减少压缩数量，能源是聚焦于被占领的部分，以及血管壁通过压缩后熔合，蛋白质变性，然后复原。,Advantages: 优点：Uniform sealing of complete tissue grip 统一完整密封的组织抓Auto-coagulation with less char 自动电凝少烧焦Vessel sealing up to 7mm 可闭合至7mm静脉血管Disadvantages: 缺点：Expensive typically double price of PowerBlade 昂贵的一般为双极电凝钳Powerblade的两倍价钱RF controller unit necessary (investment) 必须有RF能量发生器（需投资）Mechanical cutting blade 机械切割刀片No curved jaws 没有弯型钳口设计,Enseal + ERBE VIO安速刀 +爱尔博 VIO,ERBE VIO + ERBE BICLAMP,The BiClamp is an instrument used for safe thermofusion of vessels and vascularized tissue structures. In gynecology these properties are used to seal uterine tissue structures before separation and mobilization of the uterus during transvaginal hysterectomy. The cervix and parametrium are safely thermofused with the bipolar BiClamp procedure so that the surgeon does not need to use sutures or clips to treat the vessels,Aesculap, Adtec Combi Multifunctional Instrument Bipolar,AdTec comBi - BIPOLAR MULTIFUNCTIONAL INSTRUMENTSALE ONLY IN: Germany, Italy, Switzerland, UK, GreeceCombination of bipolar forceps and mechanical scissorsGrasp, dissect, coagulate and cut with one instrumentFine instrument tips for precise preparation and coagulationNo current leakage thanks to bipolar technologyCompatible to all electrosurgical units,Aesculap, Adtec Combi Multifunctional Instrument Bipolar,AdTec comBi - BIPOLAR MULTIFUNCTIONAL INSTRUMENT4-in-1CoagulationDissectingGraspingCutting,BOWA NightKnife,BOWA NightKnife,FOR SURGERY, UROLOGY AND GYNAECOLOGYReusable, 20 times?5 seconds sealing on average and stops automatically when finished“The sealing process is having the correct effect when the translucent white coagulation zone can be seen, within which the tissue can then be safely cut. In some individual cases it might be worthwhile creating two seals a short distance apart and making the incision between them.” possible to carry out bipolar sealing up to a vessel diameter of approximately 10 mmIt is endorsed for use up to 7 mmbursting pressure in more than 90% of cases was at more than 400 mm Hg (up to 900 mm Hg) generally well above blood pressure values observed in clinical practice.,Martin Marseal,“MarSeal” the Reusable, Bipolar Sealing SystemDissect seal cut. This is exactly where the new, reusable marSeal sealing system from KLS Martin excels. Only available 10mm,Ethicon Harmonic Scalpel,Ethicon (J&J) Harmonic Scalpel/ACE爱惜康（强生公司） -超声刀/酶抑制剂,Ultrasonic energy is mechanical in nature and works at much lower temperatures. 超声波能量的机械性质，可在很低的温度下工作。 Electrosurgery and lasers coagulate by burning (obliterative coagulation) at higher temperatures (150 C to 400 C). 在较高温度下（150至400）利用高频电凝燃烧（闭塞性凝血）。 Blood and tissue are desiccated and oxidized (charred), forming eschar that covers and seals the bleeding area. Rebleeding can occur when blades removed during electrosurgery stick to tissue and disrupt the eschar.血液和组织的干涸和氧化（烧焦），形成焦痂覆盖和百合出血面积。当刀片离开的过程中，电刀会粘着组织和中断焦痂，就会发生再次出血。The HARMONIC SCALPEL technology (Ethicon Endo-Surgery, Inc., Cincinnati, Ohio) controls bleeding by coaptive coagulation at low temperatures ranging from 50 C to 100 C. 超声刀技术（爱惜康内镜外科公司，辛辛那提市，俄亥俄州）控制出血是在50 C至100 C的低温范围内凝血。,Ethicon (J&J) Harmonic Scalpel/ACE爱惜康（强生公司） -超声刀/酶抑制剂,Vessels are coapted (tamponaded) and sealed by a protein coagulum. 血管的接合（压塞）和蛋白质凝固闭合。 Coagulation occurs by means of protein denaturation when the blade, vibrating at 55,500 Hz, couples with protein, denaturing it to form a coagulum that seals small coapted vessels. 凝血发生在蛋白质发生变性时，即当刀片在55,500赫兹振动，与蛋白质连接，使其变性，形成凝固闭合连接小血管。 When the effect is prolonged, secondary heat is produced that seals larger vessels. 当效果持续很久，二次加热可产生闭合较大的血管动脉。 One of the major downsides of this technology has been the inability to coapt larger vessels. 对这种技术的主要缺点之一是无法接合大的血管静脉。 Post-op Bleeding? 术后出血？,Harmonic Scalpel VS Electrosurgery超声刀 VS 电刀,超声刀,电刀/激光手术,蛋白质破坏而形成凝固物,水分气化，组织失水,当组织燃烧产生焦痂,Advantages: 优点：Coagulation at low temp, ranging from 50C to 100C 低温电凝，范围从50C至100CLess surgical smoke 少手术烟雾Disadvantages: 缺点：Aerosols spread (low, temp) gives higher risk of infectious spread 气溶胶传播（低温）以致高风险传染病的传播Vessel sealing only on up to 5mm只可闭合血管至5mmSlow coagulation 缓慢电凝Expensive double price of PowerBlade昂贵两个双极电凝钳Powerblade的价钱Expensive ultrasound generator needed 需要昂贵的超声发生器Post-op bleeding? 术后出血？,Ethicon (J&J) Harmonic Scalpel/ACE,Comparison Chart: PowerBalde, Ligasure, Harmonic Scalpel 比较图