ligasuretm的临床应用PPT课件

1、Energy Based Tissue and Vessel Fusion 第1页/共43页Vessel ligation is a critical component of all surgical dissection.血管的结扎是所有外科手术分离中的关键部分第2页/共43页Vessel and Tissue LigationWhat are your choices?第3页/共43页Ligation TechniquesManufacturers Recommended Range of Vessel Size for Application (mm)0.51.01.52.02.53.

2、03.54.04.55.05.56.06.57.07.58.08.59.09.5 10.0Suture Clips Staples Monopolar ES Bipolar ES Ultrasonic Coag Vessel Sealing *3 sizes of clips and appliersVascular Staples 第4页/共43页Vessel and Tissue Fusion脉管和组织融合技术Pressure and Energy压力和能量压力和能量To Create a Fusion Zone产生一个融合带产生一个融合带第5页/共43页Tissue and Vessel

3、 Fusion an advance in a unique electrosurgical technology that combines pressure and energy to create a fusion zone一种先进电外科技术将压力和能量结合从而产生融合带Developed in response to surgeon requests for an additional option to current vessel ligation methods根据外科医生的需求发展的技术，从而提供目前血管结扎手段以外的方法。第6页/共43页Vessel Fusion Syste

4、m脉管闭合系统 Generator 主机 Bipolar instrument configuration 双极工作模式 Low Voltage - 180V 低电压180V High Current - 4A 高电压4A Tissue Response 组织反馈技术 Instruments 器械 High pressure 高钳口压力 Open (reposable and single use) 开放器械（可重新组装的和一次性使用的） Laparoscopic (single use) 腔镜器械（一次性使用）第7页/共43页System Operation Applies optimal

5、pressure to vessel/tissue bundle 在血管/组织束上施加最佳的压力 Energy delivery cycle: 能量输送周期： Measures initial resistance of tissue and chooses appropriate energy settings 测量组织的最初电阻并选择适当的能量设定 Delivers pulsed energy with continuous feedback control 输送能量脉冲同时进行持续的反馈控制 Pulses adapt as the cycle progresses 随循环周期的进行调整能

6、量脉冲 Senses that tissue response is complete and stops the cycle 监测组织反馈当闭合完成时停止能量输送第8页/共43页Fusion Characteristics融合带的特性 Intimal layers of vessel walls fused 融合血管壁的内膜 Does not rely on a proximal thrombus 不依赖于近端血栓 Permanent 永久性闭合第9页/共43页Tissue Effects of Coagulation Versus Vessel Fusion凝血和脉管闭合技术的组织效果的比

7、较Coagulation relies on vessel shrinkage and a proximal thrombus for vessel occlusion.凝血依赖于血管的收缩和近端血栓凝血依赖于血管的收缩和近端血栓堵塞血管堵塞血管Vessel fusion fuses the intimal walls of the vessel, completely obliterating the lumen.脉管闭合技术融合了血管壁的内膜，从脉管闭合技术融合了血管壁的内膜，从而完全封闭管腔。而完全封闭管腔。*Porcine Model第10页/共43页Fusion Characteri

8、stics Plastic-like consistencydue to collagen remodeling 由于胶原蛋白的重塑，闭合带均一而且富有弹性。 Distinctive, possibly translucent fusion zone 独特的透明闭合带 Withstands greater than three times normal systolic pressure 可承受3倍以上的正常收缩压第11页/共43页Tissue Selection Criteria选择组织的标准 Veins and arteries up to and including 7mm 达到并包括7

9、mm的静脉和动脉 Tissue bundles containing vessel(s) or lymphatics 包含有血管或淋巴管的组织束 Lymphatics up to and including 7 mm 达到并包括7mm的淋巴管第12页/共43页ResultsHigh burst strength seals exhibited the following properties: 高破裂压的闭合带具有以下特性： Thin, translucent, plastic-like seal site 薄的透明弹性闭合带 seal zone significantly compresse

10、d 被压缩的扁平闭合带 intimal layers of vessel walls fused 融合血管壁内膜 lateral thermal damage 2mm 外侧热损伤2mmH & E stained longitudinal section of sealed porcinerenal arteryH & E染色的猪肾动脉闭合带的纵切面The seal zone. Note the fused lumen of the vessel walls.闭合带；注意血管壁已被融合在一起，内腔消失。第13页/共43页Burst Strength Study ResultsPe

11、rcent success of fusion zone withstanding 3 times normal systolic pressure (360mmHg)0%20%40%60%80%100%1.0-1.9mm 2-3.9mm4-7mmUltrasonics超声刀超声刀Bipolar双极双极Vessel Fusion脉管闭合技术脉管闭合技术Vessel sizes第14页/共43页Comparison Study Results Probability of seal failure below 400 mmHg: 在400mmHg压力下闭合带破裂的概率：lUltrasonic c

12、oagulator 超声凝血95.0% lStandard bipolar 标准双极 28.0% lClips* 金属夹金属夹 0.4%lVessel sealer*脉管闭合技术脉管闭合技术 0.2%lLigatures* 缝线缝线 0.0% Probability of failure for ultrasonics and standard bipolar is significantly higher than other methods 超声刀和标准双极的闭合失败概率明显高于其他方法。 Other methods (*) not statistically different from

13、 each other 其他的方法（*）之间没有明显区别。第15页/共43页Healing process A comparison* of the healing process following ligation with sutures and vessel sealing system have been studied at 7, 14 and 28 days.缝线结扎和血管闭合技术的愈合过程中第7、14和28天比较At 7 days, both LigaSure and suture sites exhibited gross signs of inflammation.第7天：

14、“LigaSure 和缝线的部位都有炎症的表现”At 14 days, numerous adhesions were noted at the suture sites whereas the LigaSure seals did not affect any of the surrounding tissue第14天：“在缝线部位有许多的粘连，而LigaSure闭合带与周围组织没有粘连”At 28 days : “ numerous evolved adhesions were present at the suture sites. The LigaSure sites were dif

15、ficult to locate.”第28天：“缝线部位有许多粘连形成，而LigaSure 闭合部位已经难以确认”The potential for seals composed of the patients native tissue reduce the inflammatory response and improves healing process .闭合带由患者自身的组织构成，从而减少了炎症反应，促进了愈合过程。* Comparison of Healing Process Following Ligation with Sutures and Bipolar Vessel Se

16、aling PETERSON, STRANAHAN, SCHMALTZ, MIHAICHUK, COSGRIFF Surgical Technology International Sutures at 28 daysLigaSure at 28 days第16页/共43页Vessel Fusion Technology Ensures: Fusion strengths higher than other energy based techniques 闭合强度高于其他的能量技术 Fusion strengths comparable to existing mechanical based

17、 techniques 闭合强度与现存的机械闭合技术相当第17页/共43页Vessel Fusion Technology Ensures: Reliable, consistent, permanent vessel wall fusion 可靠的、一致的、永久性血管壁融合 Minimal thermal spread 最小的热传导 Reduced sticking and charring 较少的粘连和焦痂第18页/共43页第19页/共43页第20页/共43页第21页/共43页Surgical specialties with experience in vessel fusion tec

18、hnology Surgical Applications第22页/共43页LigaSureTM Clinical ApplicationsGeneral surgery普外科Gynaecological surgery妇产科Urological surgery泌尿外科Thyroid surgery甲状腺手术第23页/共43页General Surgery Gastrectomy 胃切除术 Gastrojejunostomy 胃空肠吻合术 Gastric Bypass 胃旁路手术 Mastectomy 乳房切除术 Axillary Dissection 腋窝淋巴结清扫 Liver Resect

19、ion 肝切除 Living Door Liver Transplant 活体肝移植手术 Splenectomy 脾切除术Thyroidectomy 甲状腺切除术Lap Nissen 腔镜Nissen手术 Esophagectomy 食道切除术Bowel Resection 小肠切除术 Abdominal Perineal Resection 经腹会阴联合切除术 Low Anterior Resection 低位前切除Colectomy 结肠切除术Hemorrhoidectomy 痔切除术 Whipple 胰十二指肠切除术 Omentectomy 网膜切除术 Ileo-anal Pull-th

20、rough 拖出式回肠肛管吻合术 Rectal Prolapse 直肠脱垂手术 Adrenalectomy 肾上腺切除术Lap Colectomy 腔镜结肠切除术第24页/共43页Gynaecology妇产科第25页/共43页uAnatomy解剖解剖uVaginal Hysterectomy经阴道子宫切除术经阴道子宫切除术 uTAH经腹子宫切除术经腹子宫切除术 uLAVH腔镜辅助的经阴道子宫切除术腔镜辅助的经阴道子宫切除术 uSupracervical Hysterectomy子宫颈上子宫切除术子宫颈上子宫切除术第26页/共43页子宫解剖子宫解剖第27页/共43页腹腔镜子宫切除术腹腔镜子宫切除

21、术第28页/共43页Study by: Barbara Levy, MDClinical Assistant Professor of OB/GYN, U of WA Seattle, WASealableNot recommendedVaginal Hysterectomy经阴道的子宫切除术 84 patients 共84例患者 Blood loss decreased in all cases compared to average expected loss 所有病例的失血量均少于平均预期失血量 5 cases suture used on one side, vessel fusion

22、 used on the other 5例在一侧使用缝线，另一侧使用脉管闭合技术 Operative time consistently decreased 10 -20 minutes 手术时间平均下降1020min第29页/共43页Study by: Robert McLellan, MDDepartment of GynecologyLahey Clinic, Burlington, MATotal Abdominal Hysterectomy 50 patients (randomized vessel fusion/suture) 50例患者（随机使用血管闭合技术/缝线） Proce

23、dure time (abdominal incision to closure of vaginal cuff with satisfactory hemostasis 手术时间（从做腹部切口到关闭阴道袖并得到满意的止血效果） Vessel fusion 30.6 min. (18-62) 使用血管闭合技术：30.6min(1862) Suture 48.2 min. (30-109) 使用缝线：48.2min(30109) Blood loss 失血量 Vessel fusion 32 - 50cc Suture 25 - 250ccSealableNot recommended第30页/

24、共43页结肠解剖结肠解剖第31页/共43页第32页/共43页Right Hemicolectomy右半结肠切除术右半结肠切除术第33页/共43页Transverse Colectomy横结肠切除术横结肠切除术第34页/共43页Left Colectomy左半结肠切除术左半结肠切除术第35页/共43页Sigmoid Colectomy乙状结肠切除术乙状结肠切除术第36页/共43页Low Anterior Resection低位前切除低位前切除第37页/共43页Laparoscopic Assisted Colectomy腔镜辅助的结肠切除术IndicationsColon carcinoma 结肠癌 Rectosigmoid cancers 直乙结肠癌Rectal cancer直肠癌 Benign colon polyps良性结肠息肉 Diverticulitis憩室 Volvulus肠扭转 Cr