Bipolar Radiofrequency-Based Hemorrhage Arrest in Solid Organ Injury: A Technique to Arrest Bleeding in Porcine Model With Liver Injury Using Electrosurgery
Transcript
When the animal is ready, open the handpiece of an ignited SBRF device prepared according to the manufacturer's specifications, and connect the handpiece to the generator. Then, set the saline flow rate to low and the radio frequency power setting to 160 watts. Establish an adequate exposure of the solid organs of interest, mobilizing other structures, and inserting a retractor as necessary.
Using a #10 scalpel blade, apply an abrasive, back and forth, 1 to 2-millimeter deep, 2-square centimeter area superficial force to the liver capsule, to induce capsular bleeding. Continue to create 1-centimeter deep solid organ lacerations of increasing severity with the scalpel from 5 centimeters to the entire length of the liver tissue.
Then, using a blunt device such as a Kelly clamp, use a stabbing motion to create penetrating injuries of a partial to full thickness. After simulating all of the appropriate experimental injuries, depress the button of the handpiece to initiate the simultaneous flow of 0.9% saline and the delivery of bipolar radiofrequency energy. The saline will boil at the site of application.
Position the tip of the device directly onto the raw of the liver surface to superficial areas of bleeding, or within defects in the liver itself, and apply concurrent suctioning from a standard surgical aspirator as needed, to deliver the heated saline and energy directly to the areas of ongoing hemorrhage. Using a gentle back-and-forth motion, heat the tissues to approximately 100 degrees Celsius. An auditory pop will occur after three to five seconds, signifying that the burn is complete.
Then, move the instrument in an organized manner to the next targeted site, applying precisely directed high-voltage electrocautery in conjunction with the application of the SBRF and suction devices, to obtain hemostasis as necessary. When all of the sites of the hemorrhage have been cauterized, apply the tip of the device across the injured edge of the liver parenchyma to seal the small to medium bile ducts.
