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Comparative Study
. 2012 Feb 23:12:3.
doi: 10.1186/1471-2482-12-3.

Ultrasonic scalpel causes greater depth of soft tissue necrosis compared to monopolar electrocautery at standard power level settings in a pig model

Kia Homayounfar  1 , Johanna Meis, Klaus Jung, Bernd Klosterhalfen, Thilo Sprenger, Lena-Christin Conradi, Claus Langer, Heinz Becker
Affiliations
Comparative Study

Ultrasonic scalpel causes greater depth of soft tissue necrosis compared to monopolar electrocautery at standard power level settings in a pig model

Kia Homayounfar et al. BMC Surg. .

Abstract

Background: Ultrasonic scalpel (UC) and monopolar electrocautery (ME) are common tools for soft tissue dissection. However, morphological data on the related tissue alteration are discordant. We developed an automatic device for standardized sample excision and compared quality and depth of morphological changes caused by UC and ME in a pig model.

Methods: 100 tissue samples (5 × 3 cm) of the abdominal wall were excised in 16 pigs. Excisions were randomly performed manually or by using the self-constructed automatic device at standard power levels (60 W cutting in ME, level 5 in UC) for abdominal surgery. Quality of tissue alteration and depth of coagulation necrosis were examined histopathologically. Device (UC vs. ME) and mode (manually vs. automatic) effects were studied by two-way analysis of variance at a significance level of 5%.

Results: At the investigated power level settings UC and ME induced qualitatively similar coagulation necroses. Mean depth of necrosis was 450.4 ± 457.8 μm for manual UC and 553.5 ± 326.9 μm for automatic UC versus 149.0 ± 74.3 μm for manual ME and 257.6 ± 119.4 μm for automatic ME. Coagulation necrosis was significantly deeper (p < 0.01) when UC was used compared to ME. The mode of excision (manual versus automatic) did not influence the depth of necrosis (p = 0.85). There was no significant interaction between dissection tool and mode of excision (p = 0.93).

Conclusions: Thermal injury caused by UC and ME results in qualitatively similar coagulation necrosis. The depth of necrosis is significantly greater in UC compared to ME at investigated standard power levels.

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Figures

Figure 1
Figure 1
Automatic device for soft tissue dissection. Self-constructed apparatus fixed at the operating table and loaded with ultrasonic scalpel. The instrument can be moved engine-driven into two directions (aluminium tracks).
Figure 2
Figure 2
Schematic illustration of tissue sample and excision planes. a) epidermal layer, b) corium, c) subcutaneous fatty tissue, d) vertical excision lines performed by steel scalpel, e) horizontal excision line performed by either ultrasonic scalpel (UC) or monopolar electrocautery (ME).
Figure 3
Figure 3
Elastic-Van Gieson (EvG) staining. Representative EvG staining results with deep red necrosis (a), more superficial necrosis with closure of a capillary (b) and deep necrosis with closure of a larger vessel (c) all caused by UC and necrosis with closure of small vessels caused by ME (d) (magnification a and d ×200; c and d × 400).
Figure 4
Figure 4
Morphometric measurement. Representative tissue section (HE staining) at ×100 magnification displaying the morphometric measurement with 7 different measuring points.
Figure 5
Figure 5
Box-plot for correlation between depht of necrosis, method and device. Distribution of the depth of necrosis according to method and device.
See this image and copyright information in PMC

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