Cavitational Ultrasonic Surgical Aspirator Research Articles

Non-dysraphism intradural cervical lipoma

Intradural spinal lipomas not associated with spinal dysraphism account are rare entity. The pure cervical intradural lipomas are rarer and only eleven cases have been reported in the literature. The median age at diagnosis was 35 (8m-52y) years old and the ratio of men to female was 1.4:1. The possible risk factor included weight increase or rapid metabolic change. Only one case had recurrent condition during follow-up period. Here, we reported a 32-year-old male who presented with posterior neck pain and radiating numbness from neck to bilateral upper extremities. The radiograph of cervical spine showed a widening spinal canal diameter. Further study confirmed a pure cervical intradural intramedullary lipoma without spinal dysraphism. For preventing the neurologic deficit, early diagnosis and adequately surgical decompression were needed. Subtotal removal with cavitational ultrasonic surgical aspirator has been widely use as it minimizes any traction on already compromised neural tissues.

Intraoperative changes in transcranial motor evoked potentials and somatosensory evoked potentials predicting outcome in children with intramedullary spinal cord tumors

Intraoperative dorsal column mapping, transcranial motor evoked potentials (TcMEPs), and somatosensory evoked potentials (SSEPs) have been used in adults to assist with the resection of intramedullary spinal cord tumors (IMSCTs) and to predict postoperative motor deficits. The authors sought to determine whether changes in MEP and SSEP waveforms would similarly predict postoperative motor deficits in children. The authors reviewed charts and intraoperative records for children who had undergone resection for IMSCTs as well as dorsal column mapping and TcMEP and SSEP monitoring. Motor evoked potential data were supplemented with electromyography data obtained using a Kartush microstimulator (Medtronic Inc.). Motor strength was graded using the Medical Research Council (MRC) scale during the preoperative, immediate postoperative, and follow-up periods. Reductions in SSEPs were documented after mechanical traction, in response to maneuvers with the cavitational ultrasonic surgical aspirator (CUSA), or both. Data from 12 patients were analyzed. Three lesions were encountered in the cervical and 7 in the thoracic spinal cord. Two patients had lesions of the cervicomedullary junction and upper spinal cord. Intraoperative MEP changes were noted in half of the patients. In these cases, normal polyphasic signals converted to biphasic signals, and these changes correlated with a loss of 1-2 grades in motor strength. One patient lost MEP signals completely and recovered strength to MRC Grade 4/5. The 2 patients with high cervical lesions showed neither intraoperative MEP changes nor motor deficits postoperatively. Dorsal columns were mapped in 7 patients, and the midline was determined accurately in all 7. Somatosensory evoked potentials were decreased in 7 patients. Two patients each had 2 SSEP decreases in response to traction intraoperatively but had no new sensory findings postoperatively. Another 2 patients had 3 traction-related SSEP decreases intraoperatively, and both had new postoperative sensory deficits that resolved. One additional patient had a CUSA-related SSEP decrease intraoperatively, which resolved postoperatively, and the last patient had 3 traction-related sensory deficits and a CUSA-related sensory deficit postoperatively, none of which resolved. Intraoperative TcMEPs and SSEPs can predict the degree of postoperative motor deficit in pediatric patients undergoing IMSCT resection. This technique, combined with dorsal column mapping, is particularly useful in resecting lesions of the upper cervical cord, which are generally considered to be high risk in this population. Furthermore, the spinal cord appears to be less tolerant of repeated intraoperative SSEP decreases, with 3 successive insults most likely to yield postoperative sensory deficits. Changes in TcMEPs and SSEP waveforms can signal the need to guard against excessive manipulation thereby increasing the safety of tumor resection.

Editorial: Use of intraoperative monitoring in children

The holy grail of intraoperative monitoring is accurate correlation of electrophysiological changes and postoperative neurological changes. Ideally, feedback provided to the surgeon in real time would allow for an alteration in technique and thus the opportunity to prevent or reverse neurological deficits. While intraoperative neuromonitoring modalities continue to evolve, the perfect predictive value of this tool remains elusive. Intraoperative spinal cord monitoring is essentially the standard of care for adults harboring intramedullary tumors.5–7 Less information is available in the pediatric population, perhaps given the rarity of these lesions.2–4 Cheng et al.1 report on their experience using both transcranial motor evoked potentials (TcMEPs) and somatosensory evoked potentials (SSEPs) in a retrospective series of 12 patients. Overall, they found that intraoperative electrical changes predicted postoperative neurological outcomes. They correlated changes in TcMEP and SSEP monitoring with specific intraoperative maneuvers, including traction on the spinal cord and tumor resection via the cavitational ultrasonic surgical aspirator. They also used dorsal column mapping to accurately predict where to perform a midline myelotomy, novel information in the pediatric population. Several patients in the series had intraoperative changes in their monitoring, which correlated with new postoperative deficits. Not all of these deficits resolved, and the correlation between intraoperative changes and postoperative dysfunction was not perfect. While the use of intraoperative monitoring in children undergoing intramedullary spinal cord tumor resection appears to be useful, the results of this study must be interpreted with some caution. The study is retrospective in nature with only 12 patients, 5 of whom did not undergo dorsal column mapping. Data were collected over a period of 8 years, and the last patient in the series underwent surgery a decade ago. Moreover, D-wave monitoring,8–10 a more recent advance in the intraoperative assessment of motor function, was not utilized. Nevertheless, the data contribute to our understanding of spinal cord tumor resection in the pediatric population. The authors noted that raising the blood pressure above normal was not helpful in reversing SSEP changes and that releasing traction proved the most reliable maneuver for correcting the first SSEP change. Finally, the provided data offer some guidance in the intraoperative balancing act faced by every surgeon regarding how aggressive the tumor resection should be to avoid tumor recurrence, while doing no harm in preserving neurological function. (http://thejns.org/doi/abs/10.3171/2013.9.PEDS13439)

Tensile Strength of Human Pericardium Treated with Glutaraldehyde

We have reconstructed aortic valves using autologous pericardium treated with glutaraldehyde since April 2007. However, the strength of the human pericardium has not been confirmed. We compared tensile strength between glutaraldehyde-treated human pericardium and aortic valve leaflets with various degrees of calcification to determine their suitability for use in aortic valve reconstruction. We measured the ultimate tensile strength and elasticity of samples of glutaraldehyde-treated pericardia (n = 8), non-calcified (n = 12), calcified (n = 9) and decalcified (n = 21) aortic leaflets collected from 23 patients who underwent aortic valve surgery. Aortic valves were decalcified using a cavitational ultrasonic surgical aspirator. The pericardium was immersed in 0.6% buffered glutaraldehyde for 10 minutes and then rinsed three times for 6 minutes each in normal saline. The ultimate tensile strength of the glutaraldehyde-treated human pericardium, non-calcified, calcified and decalcified leaflets was 10, 2.8, 1.0 and 0.8 MPa, respectively. The ultimate tensile strength of glutaraldehyde-treated human pericardium was 4 times higher than non-calcified leaflets, indicating its suitability for application to aortic valve reconstruction. Calcified leaflets were slightly stronger than decalcified leaflets. Thus, calcification can be removed without altering the tensile strength of valve materials.

Surgical Management of the Subdiaphragmatic Mass: A Sequential Combined Approach With Laparoscopy Followed by Posterior Thoracotomy

Recurrent ovarian cancer in the upper abdomen involving the liver parenchyma and diaphragmatic muscle traditionally requires a major abdominal surgical procedure; this involves pubis to xyphoid incision and complete mobilization of the liver. We present a strategy for evaluating 4 cases with apparently isolated recurrence to the diaphragm and liver approached by a sequential 2-phase procedure, involving diagnostic laparoscopy and subsequent posterior lateral thoracotomy. Preliminary diagnostic laparoscopy was performed to distinguish candidates for either definitive laparoscopic treatment or posterior thoracotomy. Two patients with disease confined to the diaphragm were successfully treated by laparoscopy alone, whereas full-thickness diaphragmatic resection and liver metastasis excision with cavitational ultrasonic surgical aspirator was performed in the other 2 patients. Argon beam coagulation was used to control local hemostasis and to fulgurate any possible residual tumor at the margin of resection. This is a multidisciplinary approach that is technically feasible and safe, requiring a short hospital stay.

Laser Ablation of Surgical Margins After Excisional Partial Vulvectomy for VIN

This paper presents the results of a retrospective review of all patients of a single gynecologist (n = 33) who underwent surgical treatment for vulvar intraepithelial neoplasia (VIN) 2 or 3 from 1994 through 2002. Four different surgical techniques were used. The size, location, and extent of the lesion influenced the choice of surgical technique. Sixteen patients (48.5%) underwent a laser and excisional partial vulvectomy in which all gross disease was excised, and the surgical margins were ablated an additional 4 mm laterally with a colposcopically directed CO2 laser. The excision was then closed with interrupted 2.0 polyglactin 910 sutures. Ten (30.3%) patients had a laser partial vulvectomy, which involved laser ablation of colposcopically visible disease to the basement membrane. An excisional partial vulvectomy used a traditional scalpel to excise all disease with 0.5- to 1.0-cm margins (n = 6). One additional patient was treated with a cavitational ultrasonic surgical aspirator. The median age of patients was 46 years (range, 31–80 years). Twenty-one women were smokers, 2 were using immunosuppressive medications, 12 had a history of infection with human papilloma virus, and 4 had previous nonvulvar intraepithelial neoplasia. None were positive for human immunodeficiency virus. Nine patients had undergone previous surgical treatment for VIN. The preoperative biopsy was VIN 3 in 30 of the 33 patients. Fourteen patients had multifocal lesions. The lesions were located on the posterior fourchette (n = 19), the right or left labium majus (n = 13 each), and the right or left labium minus (n = 11 and 9, respectively). With an average follow up of 20 months, 12 (36.4%) of the 33 patients had recurrent disease, including 7 of 10 women who had laser partial vulvectomy, 3 of 6 who had excisional partial vulvectomy, and the one patient treated with a cavitational ultrasonic surgical aspirator. Only one of the 16 patients who underwent laser/excisional partial vulvectomy had a recurrence of disease (P = .0016). Seven of the 14 patients with multifocal disease and 6 of the 21 who smoked recurred. Of the 6 patients who had excisional partial vulvectomy, 4 had positive surgical margins, one had negative, and one was unknown. The 3 patients in this group who recurred included one each with positive, negative, and unknown margins. Seven years 9 months after treatment, an invasive squamous cell carcinoma on the skin over the coccyx was diagnosed in a patient who was taking immunosuppressive medications after a combined kidney and liver transplant.

A novel treatment for early gastrointestinal carcinoma by ultrasonic endoscopic mucosal stripping.

The aim of this study was to clarify the indications for a new endoscopic mucosal resection (EMR) technique that employs a cavitational ultrasonic surgical aspirator (CUSA). Endoscopic mucosal resection has proved an effective technique for treating early mucosal gastrointestinal cancer. However, resecting a lesion larger than 2 cm en bloc requires special devices and a long processing time; and it engenders the risk of bleeding, perforation, and other complications. We investigated application of the CUSA for detaching the mucosa from the muscularis propria of extracted porcine stomachs and then clarified the specification of an endoscopic ultrasonic scalpel for endoscopic mucosal resection by investigating characteristics of two original, handmade prototype cavitational ultrasonic surgical aspirators. Use of a cavitational ultrasonic surgical aspirator should improve the ease and safety of detaching the mucosa. A small, high-power ultrasonic cylindrical vibrator should be developed to make possible a probe-type scalpel with a piezoelectric vibrator mounted in the tip of a catheter. An ultrasonic transmission-type scalpel could lead to the development of a new endoscopic mucosal resection device for clinical use. The CUSA should enable us to develop a safer, simpler, time-saving scalpel for endoscopic mucosal resection, although some resolvable technical problems remain. The CUSA might enable us to diagnose carcinoma invasion into the submucosa in aspirated specimens and then aspirate out the entire invading submucosal carcinoma.

Ultraradical debulking of epithelial ovarian cancer with the ultrasonic surgical aspirator: A prospective randomized trial

OBJECTIVE: Our purpose was to evaluate the effectiveness, benefits, and potential side effects of the use of the cavitational ultrasonic surgical aspirator for cytoreduction of advanced ovarian cancer. STUDY DESIGN: Forty patients with stage IIC to IV ovarian carcinoma were randomized to undergo ultraradical cytoreductive surgery with (group 1, 20 patients) or without (group 2, 20 patients) the use of the CUSA 200 cavitational ultrasonic surgical aspirator (Valleylab, Boulder, Colo.). Preoperative and postoperative information and follow-up data were collected prospectively and compared between both groups. RESULTS: The amount of residual tumor after debulking surgery, the duration of the operation, and the rate of perioperative complications were comparable in both study groups. The amount of perioperative blood loss was significantly lower (1450 ml vs 1650 ml, p = 0.02) in group 1. These patients had less morbidity ( p < 0.05), and could be discharged from the hospital significantly sooner (14 days vs 16 days, p = 0.031). CA 125 levels 1 and 2 months after surgery were significantly lower in the group with cavitational ultrasonic surgical aspirator ( p < 0.01 and p < 0.01, respectively), suggesting more successful cytoreduction. However, this is not reflected in a better disease-free or overall survival. CONCLUSION: Cavitational ultrasonic surgical aspirator - assisted cytoreductive surgery of advanced ovarian carcinoma is more effective in eradicating disease, reduces morbidity, and is cost beneficial. (A M J O BSTET G YNECOL 1996;174:943-50.)

Laparoscopic ablation of endometriosis using the cavitational ultrasonic surgical aspirator

Surgical modalities such as electrosurgery and lasers have been used for many years to treat endometriosis. They are relatively unselective with wide scatter, however, leading to the potential for significant tissue damage and injury. As an alternative, a technique for performing laparoscopic excision and adhesiolysis using a cavitational ultrasonic surgical aspirator (CUSA) was developed and studied in 15 patients. Endometriosis was removed using a prototype titanium probe developed for a 10-mm laparoscopic port. The ultrasonic laparoscopic probe consisted of an acoustic vibrator, a coupling device, a removable tip, and a protective flue. Vibrations from the acoustic vibrator (magnestostrictive device) were conveyed to the operating tip through a coupling piece. The magnetostrictive device consisted of nickel alloy laminations 10.8 cm in length that transformed electrical energy into mechanical motion at the hollow titanium tip, vibrating at a frequency of 23 kHz. The excursion of the tip (amplitude setting) was arbitrarily set, with a fixed stroke of 200 μm in all cases to remove tissue within a 1- to 2-mm radius of the vibrating tip. The tip was tapered to obtain greater amplitude and ablation efficiency. When placed in contact with the endometriotic implants and adhesions, it destroyed and emulsified the cell membranes, which were irrigated and removed through a built-in suction tube. The resulting debris and irrigating fluid were removed through the hollow central portion of the probe. The vibrating tip was moved over the surgical site in a back-and-forth motion to allow continuous, controlled removal. Vessels larger than 0.5 mm in diameter, nerves, and fibrous tissue capsules rebounded with the ultrasonic vibration waves emitted by the CUSA, and thus were unimpaired by the procedure. The consistency of tissues was sensed accurately when the tip of the device was in contact with them. This tactile feedback was helpful in enabling the surgeon to differentiate target tissues. The future application of this instrument awaits the outcome of research.

The cavitational ultrasonic surgical aspirator for cytoreduction in advanced ovarian cancer

International Journal of Gynecology & ObstetricsVolume 39, Issue 3 p. 251-251 Citations from the literature oncology The cavitational ultrasonic surgical aspirator for cytoreduction in advanced ovarian cancer PG Rose, PG RoseSearch for more papers by this author PG Rose, PG RoseSearch for more papers by this author First published: November 1992 https://doi.org/10.1016/0020-7292(92)90683-AAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume39, Issue3November 1992Pages 251-251 RelatedInformation

The cavitational ultrasonic surgical aspirator for cytoreduction in advanced ovarian cancer

The cavitational ultrasonic surgical aspirator is a newer surgical instrument that has been shown to be effective in tumor resection. The purpose of this study was to evaluate its usefulness for cytoreduction of advanced ovarian cancer. Over a 24-month period patients with advanced ovarian cancer (stage IIIC and IV or bulky recurrent disease) were studied to determine the frequency of use of the cavitational ultrasonic surgical aspirator and the sites of tumor resection. The blood loss and operative time for patients who underwent surgery with the cavitational ultrasonic surgical aspirator were compared by Student t test with those of patients who did not undergo surgery with the cavitational ultrasonic surgical aspirator. The cavitational ultrasonic surgical aspirator was utilized to effect optimal cytoreduction in 22 of 45 patients (48%). Of 52 sites of disease resected, 23 (44%) involved sites difficult to resect with standard operative techniques. These sites included the diaphragm, liver, spleen, and fixed retroperitoneal adenopathy. The cavitational ultrasonic surgical aspirator allowed resection from other sites, precluding procedures with potentially more morbidity. Of all 45 patients, 86% had cytoreduction to less than 2 cm and 44% to less than 0.5 cm. The blood loss and operative time were not different between cases in which the cavitational ultrasonic surgical aspirator was used and those in which it was not used. The cavitational ultrasonic surgical aspirator appears to contribute to cytoreduction in patients with advanced ovarian cancer.