The cadaveric brains were cut along the interhemispheric fissure to expose the ventricle wall. Subsequently, the animals were killed with an injection of potassium chloride and the whole brain was harvested. During the whole procedure, heart rate, oximetry, arterial blood pressure, and core temperature were monitored and maintained at physiological levels.įirst, procedures for other organs such as the liver and esophagus were performed. The animals received continuous ventilation appropriate to body weight. General anesthesia was maintained with isoflurane (1%–2%) or an intravenous infusion of propofol (2–5 mg/kg/hr). Subsequently, the animals were intubated with cuffed endotracheal tubes. Intravenous access was obtained using a catheter placed in the ear vein, and pentobarbital (10–20 mg/kg) was infused. Ten healthy 3-month-old domestic pigs were subjected to anesthesia induction with medetomidine hydrochloride (0.06 mg/kg) and midazolam (0.03 mg/kg). The present feasibility study investigated whether the ADPJ can maintain the efficacy of dissection properties and reduce the amount of water required when using the flexible neuroendoscope.Įvaluation of Dissection in Porcine VentriclesĪll animal procedures and protocols were approved by the institutional review board of the Center for Laboratory Animal Research of Tohoku University. Therefore, whether ADPJ can effectively dissect tissues immersed in fluids, and is safe for dissection of intraventricular lesions, remains unknown. 8, 10, 11 The ADPJ is useful for microscopic neurosurgery and submucosal dissection of the esophagus, 7, 8, 15 but no water jet device has been used in the ventricles with the flexible endoscope. 18 Initially, the ADPJ was applied in glioma and pituitary surgery, which achieved fine vessel preservation and increased resection rate. Our group has developed the actuator-driven pulsed water jet device (ADPJ) to dissect soft tissue. 1, 3 Although the possible usefulness of a water jet dissector with a neuroendoscope has been reported previously, 6 these characteristics can risk elevation of intracranial pressure (ICP) and obscuring of the neuroendoscopic view during ventricle wall dissection. 9, 12, 19, 20 However, the continuous-flow water jet device has several problems to be resolved, because a high volume of water supply is required for dissection, and the consequent water vortex tends to disperse tissue debris. 4, 5, 12–14 This technique initially used high-pressure continuous flow and could dissect tissue but preserve the vasculature, resulting in reductions in blood loss, operative time, and surgical complications. Water jet dissection has been used in liver and kidney surgery since the 1980s. Moreover, the lack of effective devices to control bleeding remains a problem with neuroendoscopic surgery, so that strategies to avoid bleeding are extremely important. Intraventricular lesions are often indicated for the neuroendoscopic approach, but tissue dissection performed using the flexible endoscope in the ventricles is still challenging because the number of instruments that can be used through the working channel is restricted. Neuroendoscopic surgery is now widely indicated for the surgical treatment of various diseases. M inimally invasive surgery is the goal of many recent advances in surgical devices.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |