Evaluation of Bone Wax Coated Bipolar Coagulation Forceps: Performance and Safety Assessment.

Jichun Shi,Yu Feng,Jianjian Zhang,Chenguang Jia,Haobin Ren,Zhen Wang,Lixin Dong,Jincao Chen,Zhengwei Li,Xiang Li,Kaixin Huang,Wei Wei

doi:10.3389/fsurg.2021.816295

Jichun Shi, Yu Feng + Show 10 more

Open Access

https://doi.org/10.3389/fsurg.2021.816295

Copy DOI

Abstract

BackgroundImproving the performance of bipolar coagulation forceps is crucial for safer and more accurate neurosurgery. In our department, we found that bone wax (BW) melted by thermal effect of bipolar electrocoagulation can achieve more efficient hemostasis and reduce the amount of BW in neurosurgical procedures associated with bleeding from emissary and diploic veins. Nevertheless, relevant studies are still lacking to verify our finding.ObjectiveThe study objectives were to evaluate the performance and safety in electrocoagulation: (1) compare the performance of BW coated bipolar coagulation forceps and the conventional anti-stick forceps in vivo, and (2) assess the safety of electrocoagulation with BW coated bipolar coagulation forceps in rat primary motor cortex.MethodsTissue adhesion was evaluated by comparing the wetting tension and the amount of protein adhered to the forceps tips after electrocoagulation. Thermal damage was assessed by analyzing the thermography and H&E staining of coagulated rat brain tissues. The hemostatic efficiency was reflected by the number of electrocoagulation until complete hemostasis and the condition of damaged common carotid arteries. The safety of BW coated forceps in electrocoagulation was assessed by evaluating the inflammation of coagulated rat primary motor cortex and the motor functions at the 7th day postoperatively.ResultsBone wax coated forceps had a significantly higher contact angle and adhered less coagulum. Thermography was acquired at 3 s, 6 W units in rat primary motor cortex in vivo. The highest temperature recorded during BW coated tips application was significantly lower than the uncoated. In addition, there was a relatively smaller tissue injury area produced by the BW coated forceps. Additionally, BW coated forceps improved the hemostatic efficiency and caused fewer injuries on the damaged arteries (3 s, 10 W units). More importantly, electrocoagulation with BW coated forceps led to no significant motor function impairments and less glial and microglia responses.ConclusionThis study reveals that BW coated bipolar coagulation forceps can provide a convenient, cost-efficient, safer, and more efficient way for hemostasis. More research is needed to evaluate the electrocoagulation with BW in the long term and verify our finding in human beings.

Highlights

Intraoperative hemorrhage is likely to be the most severe situation arising in neurosurgical procedures, associated with severe morbidity and mortality [1]
We developed a novel bipolar coagulation method, bipolar forceps coated with a small amount of bone wax (BW), which led to better intraoperative coagulation while minimizing the tissue charring, stickiness, thermal damage, and improving the hemostatic efficiency, potentially improving outcomes for neurosurgical procedures
We further evaluate the safety of electrocoagulation in M1 area of rats, which demonstrated that application of small amount of BW in rat brain parenchyma was safe for 7 days postoperatively

Summary

Introduction

Intraoperative hemorrhage is likely to be the most severe situation arising in neurosurgical procedures, associated with severe morbidity and mortality [1]. All drawbacks above will make the operative process less accurate and more time-consuming [5] To overcome these drawbacks, approaches, such as irrigation and new tip technologies have been developed to improve the electrocoagulation performance [5,6,7]. Approaches, such as irrigation and new tip technologies have been developed to improve the electrocoagulation performance [5,6,7] These approaches solved only part of the problem and themselves created new problems. For dealing with difficult hemostasis situations, cost-effective, better performing, and safe improvements for electrocoagulation forceps should be an important matter for earnest development. We found that bone wax (BW) melted by thermal effect of bipolar electrocoagulation can achieve more efficient hemostasis and reduce the amount of BW in neurosurgical procedures associated with bleeding from emissary and diploic veins. Relevant studies are still lacking to verify our finding

Methods

Results

Discussion

Conclusion