双极电凝钳 LiNA PowerBlade课件

1、LiNA PowerBlade 双极电凝钳By Ang Boon HawMarketing ManagerSelect Your Energy选择适合您的能量What to Achieve with Coagulation?以什么来实现电凝呢？Hemostasis (Haemostasis)止血Greek: heme, blood + stasis, halt = halt of the blood. 希腊语：血红素，血液+凝固，停止=止血Protocol To Minimize Risk 医疗方案：将风险降到最低The art of surgical hemostasis: 外科止血的艺术：

2、To prevent vascular trauma with least-possible collateral tissue damage. 保护血管的创伤和最少可能减少附带组织的损害When bleeding is encountered, the surgeons ability to attain hemostasis using a particular modality depends largely on how well he or she understands its technical aspects.当遇到出血的情况，外科医生能使用一种特殊模式来止血，这很大程度取决于

3、他/她对这器械的技术问题了解程度。Bipolar Electrosurgery双极电刀 Mechanism of action 作用机理Bipolar electrosurgery consolidates an active electrode and return electrode into an instrument with 2 small poles. 双极电刀巩固一个活跃的电极和返回电极到一个有2个小极的器械These poles can be the tines of a forceps, blades of a scissors, or an electrode matche

4、d to a more proximal conductive collar separated by an insulator. 这两极可能是一个钳的尖叉、剪刀的刀片、或是一个电极匹配到更近的导电圈由绝缘体隔开。The output typically used is the low-voltage “cut” current.通常用于输出的是低电压“切割”电流。Bipolar Electrosurgery双极电刀 Advantages of bipolar energy 双极电流能量的优点Localization of current between the poles offers di

5、stinct advantages. Thermal damage is generally limited to a discrete volume of tissue. 两极之间的局部电流具有明显的优势。热损伤一般仅限于离散量的组织。A bipolar forceps can be used to coapt and thermally weld blood vessels. 双极抓钳可用来电凝和热焊接血管。The concentrated current and small distance between the poles also make it possible to desic

6、cate tissue that is immersed in fluid. 两极之间的集中电流和小距离也可能使浸泡在液体中的组织失水。LiNA PowerBladeLiNA 双极切割电刀Grasping, Dissecting, Coagulating and Cutting with safe bipolar energy all in one安全的双极能量：抓、分离、电凝和切割四合一Saves costly stapling devices/clips and reduces the number of instruments needed节省设备/钳子的费用和减少了手术器械的需要数量L

7、iNA PowerBlade may save 10-30 minutes at longer procedures like e.g. LAVH使用双极电凝钳在例如LAVH手术过程可以节省10-30分钟For use with all bipolar generators适用于全部双极发生器LiNA PowerBladeUnique LiNA PowerBlade独特的双极电凝钳Straight jaws直型钳口Curved jaws弯型钳口LiNA PowerBladeTwo finger trigger with ergonomic and light weight handle两根手指

8、就可操作，而且很轻手柄For grasping 抓For cutting 切割LiNA PowerBladeLiNA PowerBladeTargeted Procedures 目标手术程序Gynaecology 妇科LAVH腹腔镜辅助经阴道子宫切除术LSH腹腔镜筋膜内子宫切除术Myomectomy子宫肌瘤剔除术Ectopic preg, 子宫妊娠异位Salpingetomy输卵管切除术Oophorectomy卵巢切除术 Ovarian cysts卵巢囊肿切除术General Surgery 普外科Nissen FundoplicationNissen胃底折叠术Appendectomy阑尾切除

9、术 Colon Resection结肠切除术Gastric by-pass胃旁路手术Cholecystectomy 胆囊切除术 Urology 泌尿科Cystectomy膀胱切除术Prostectomy前列腺电切术Nephrectomy肾切除术Sun Tzu The Art of War孙子孙子兵法So it is said that if you know your enemies and know yourself, you will fight without danger in battles.所以有人说，如果你知道你的敌人和了解你自己，你将会在战场上战无不胜。If you only

10、know yourself, but not your opponent, you may win or may lose.如果你只了解你自己，但对对手一无所知，你可能会赢或者输掉。If you know neither yourself nor your enemy, you will always endanger yourself. 如果你对你自己和对手都不了解，你将会危害到你自己。Fundamental of Competition Energy Based Vs End Point Results基本竞争能源基础 vs 终点结果Development of newer generat

11、ors and innovative instrumentation aimed at delivering appropriate amount of energy to obtain the desired effect 新发生器的发展和创新器械目的在于提供适当的能源量以获得理想的效果Smart generators were introduced 推广巧妙的发生器The basis of all of them is the use of energy to better seal vessels. 在所有这些的基础是能源的使用，以便更好地闭合血管Classic bipolar ener

12、gy has been used for hemostasis and to coagulate blood vessels for many years经典双极电流能量已被用于止血和电凝血管多年了。One of the major area targeted by new Energy is the lateral spread of thermal energy, as well as charring and sticking of instruments with eschar disruption针对开发新能源的主要领域之一是热能横向扩散，以及炭化和器械与焦痂中断的粘连Valleyl

13、ab The Ligasure System Valleylab The Ligasure 系统Combination of pressure and energy to create vessel fusion. 压力和能量的结合，产生血管的融合Melting the collagen and elastin in the vessel walls and reforming it into a permanent, plastic-like seal熔化血管壁的胶原蛋白和弹性蛋白，以及重整它转化为永久的、像塑料类闭合Also using the fundamental of BIPOLAR

14、 ENERGY 也是使用基本双极电流能量A feedback-controlled response system automatically discontinues energy delivery when the seal cycle is complete, eliminating guesswork and minimizing thermal spread to approximately 2 mm for most LigaSure instruments当闭合周期完成，反馈控制的响应系统自动中止能源的传递，为多数LigaSure结扎速器械消除猜测和降低热传导约2毫米。This

15、unique energy output results in virtually no sticking or charring, and the seals can withstand 3 times normal systolic blood pressure. 这独特的能量输出几乎没有导致粘连或炭化，以及密封可以承受的3倍正常血管收缩压。This system also requires a designated generator that works with several different instruments designed by the company.这个体系也要求

16、特定的发生器，与工厂指定的几种不同的器械一起工作。Valleylab The Ligasure SystemValleylab Ligasure体系优点:可闭合至7mm静脉血管强烈的爆发力359 旋转程式即时反应 技术强大的销售团队缺点:通常为双极切割电刀两部的价钱需要配套昂贵的LigaSure发生器机械刀（可能会变钝）切割刀在切割程序时没有视程净重 = 212g (外围缓冲器 99g)组织置在钳口可影响自动电凝功能没有弯型钳口Gyrus Medical PK Cutting Forceps佳乐 医疗器械PK 切割钳Unique technology called Vapor Pulse Co

17、agulation (VPC), which produces faster, more uniform results with pulsed energy instantly delivered in a controlled manner. 一种叫蒸气脉冲电凝(VPC)的特殊技术，其生产速度更快，更均匀的即时与控制的方式提供脉冲能量的结果。VPCs pulse-off periods allow tissue to cool and moisture to return to the targeted area, greatly reducing hot spots and coagul

18、um formation. VPC的脉冲时间使组织冷却和水分回到目标区域，大大减少热点和凝块的形成。This technology also results in evenly coagulated target tissue, minimal thermal spread, less sticking, and enhanced hemostasis.这种技术也导致均匀凝固靶组织，减少的热传导，少粘连，和增强止血能力。Specific generator required, which works in tandem with the Gyrus PK instruments.要求特殊的发生

19、器，与佳乐的PK电刀器械串联工作ACMI (Gyrus) Tripolar Ultra ForcepsACMI(佳乐)三极超钳SurgRx EnSeal Laparoscopic Vessel Fusion System SurgRx 安速刀腹腔镜血管融合系统Smart Electrode Technology. 巧妙的电极技术EnSeal adjust and dose energy simultaneously to various tissue types in a tissue bundle each with its own impedance characteristics. 调整

20、闭合电凝能量，同时对各种类型组织进行捆绑，每个组织有它的阻抗特性。 The electrode consists of millions of nanometer-sized conductive particles embedded in a temperature-sensitive material. 双极是由数以百万计的纳米大小的导电粒子嵌入一个对温度敏感的材料中。Each particle acts like a discrete thermostatic switch to regulate the amount of current that passes into the ti

21、ssue region with which it is in contact, thereby generating heat within it.每个粒子的行为像一个独立的恒温开关，调节控制电流传递到与它接触的区域组织中，从而产生热量。Advantages: 优点：Uniform sealing of complete tissue grip 统一完整密封的组织抓Auto-coagulation with less char 自动电凝少烧焦Vessel sealing up to 7mm 可闭合至7mm静脉血管Disadvantages: 缺点：Expensive typically do

22、uble price of PowerBlade 昂贵的一般为双极电凝钳Powerblade的两倍价钱RF controller unit necessary (investment) 必须有RF能量发生器（需投资）Mechanical cutting blade 机械切割刀片No curved jaws 没有弯型钳口设计Enseal + ERBE VIO安速刀 +爱尔博 VIO ERBE VIO + ERBE BICLAMPThe BiClamp is an instrument used for safe thermofusion of vessels and vascularized t

23、issue structures. In gynecology these properties are used to seal uterine tissue structures before separation and mobilization of the uterus during transvaginal hysterectomy. The cervix and parametrium are safely thermofused with the bipolar BiClamp procedure so that the surgeon does not need to use

24、 sutures or clips to treat the vesselsAesculap, Adtec Combi Multifunctional Instrument BipolarAdTec comBi - BIPOLAR MULTIFUNCTIONAL INSTRUMENTSALE ONLY IN: Germany, Italy, Switzerland, UK, GreeceCombination of bipolar forceps and mechanical scissorsGrasp, dissect, coagulate and cut with one instrume

25、ntFine instrument tips for precise preparation and coagulationNo current leakage thanks to bipolar technologyCompatible to all electrosurgical unitsAesculap, Adtec Combi Multifunctional Instrument BipolarAdTec comBi - BIPOLAR MULTIFUNCTIONAL INSTRUMENT4-in-1CoagulationDissectingGraspingCuttingBOWA N

26、ightKnife BOWA NightKnife FOR SURGERY, UROLOGY AND GYNAECOLOGYReusable, 20 times?5 seconds sealing on average and stops automatically when finished“The sealing process is having the correct effect when the translucent white coagulation zone can be seen, within which the tissue can then be safely cut

27、. In some individual cases it might be worthwhile creating two seals a short distance apart and making the incision between them.” possible to carry out bipolar sealing up to a vessel diameter of approximately 10 mmIt is endorsed for use up to 7 mmbursting pressure in more than 90% of cases was at m

28、ore than 400 mm Hg (up to 900 mm Hg) generally well above blood pressure values observed in clinical practice.Martin Marseal“MarSeal” the Reusable, Bipolar Sealing SystemDissect seal cut. This is exactly where the new, reusable marSeal sealing system from KLS Martin excels. Only available 10mmEthico

29、n Harmonic ScalpelEthicon (J&J) Harmonic Scalpel/ACE爱惜康（强生公司） -超声刀/酶抑制剂Ultrasonic energy is mechanical in nature and works at much lower temperatures. 超声波能量的机械性质，可在很低的温度下工作。 Electrosurgery and lasers coagulate by burning (obliterative coagulation) at higher temperatures (150 C to 400 C). 在较高温度下（150至

30、400）利用高频电凝燃烧（闭塞性凝血）。 Blood and tissue are desiccated and oxidized (charred), forming eschar that covers and seals the bleeding area. Rebleeding can occur when blades removed during electrosurgery stick to tissue and disrupt the eschar.血液和组织的干涸和氧化（烧焦），形成焦痂覆盖和百合出血面积。当刀片离开的过程中，电刀会粘着组织和中断焦痂，就会发生再次出血。The

31、 HARMONIC SCALPEL technology (Ethicon Endo-Surgery, Inc., Cincinnati, Ohio) controls bleeding by coaptive coagulation at low temperatures ranging from 50 C to 100 C. 超声刀技术（爱惜康内镜外科公司，辛辛那提市，俄亥俄州）控制出血是在50 C至100 C的低温范围内凝血。Ethicon (J&J) Harmonic Scalpel/ACE爱惜康（强生公司） -超声刀/酶抑制剂Vessels are coapted (tamponad

32、ed) and sealed by a protein coagulum. 血管的接合（压塞）和蛋白质凝固闭合。 Coagulation occurs by means of protein denaturation when the blade, vibrating at 55,500 Hz, couples with protein, denaturing it to form a coagulum that seals small coapted vessels. 凝血发生在蛋白质发生变性时，即当刀片在55,500赫兹振动，与蛋白质连接，使其变性，形成凝固闭合连接小血管。 When th

33、e effect is prolonged, secondary heat is produced that seals larger vessels. 当效果持续很久，二次加热可产生闭合较大的血管动脉。 One of the major downsides of this technology has been the inability to coapt larger vessels. 对这种技术的主要缺点之一是无法接合大的血管静脉。 Post-op Bleeding? 术后出血？Harmonic Scalpel VS Electrosurgery超声刀 VS 电刀超声刀电刀/激光手术蛋白

34、质破坏而形成凝固物水分气化，组织失水当组织燃烧产生焦痂Advantages: 优点：Coagulation at low temp, ranging from 50C to 100C 低温电凝，范围从50C至100CLess surgical smoke 少手术烟雾Disadvantages: 缺点：Aerosols spread (low, temp) gives higher risk of infectious spread 气溶胶传播（低温）以致高风险传染病的传播Vessel sealing only on up to 5mm只可闭合血管至5mmSlow coagulation 缓慢电

35、凝Expensive double price of PowerBlade昂贵两个双极电凝钳Powerblade的价钱Expensive ultrasound generator needed 需要昂贵的超声发生器Post-op bleeding? 术后出血？Ethicon (J&J) Harmonic Scalpel/ACEComparison Chart: PowerBalde, Ligasure, Harmonic Scalpel 比较图表：双极切割电刀，结扎速，超声刀44Area of ComparisonsLiNA PowerBladeLigasureHarmonic Scalpel

36、ManufacturerLiNA MedicalCovidien, VAlleylabJohnson & Johnson, EthiconFDA ApprovalYesYesYesSealing MethodBipolar coagulationVessel Sealing SystemUltrasonicIndicationGrasping, Dissecting,Coagulating and CuttingTissues Sealing and Cutting based on Macrobipolar/Bipolar/Pulse-SealingIndicated for use in

37、making soft tissue incisions, cutting and coagulation Unique FeatureBipolar Coagulation and Real Bipolar Cutting; all in one instrument, ideal for many complex and costly procedures.Low thermal spread, minimum sticking; Low temperature; Ultrasonic vibration ransmitted from the transducer to the atta

38、ched instrument for cutting and coagulation.GeneratorLiNA PowerBlade can be used together with all HF generators with bipolar output. LigaSure vessel sealing generator with Instant Response technologyEthicon Harmonic Scalpel GeneratorsComparison Chart: PowerBalde, Ligasure, Harmonic Scalpel比较图表：双极切割

39、电刀，结扎速，超声刀45比较范围LiNA 双极切割电刀Ligasure 结扎速Harmonic Scalpel 超声刀生产商LiNA 医疗设备Covidien, VAlleylab强生, 爱惜康FDA 认可有有有密封方法双极电凝血管密封系统超声波使用抓，分离，电凝，切割组织密封和切割基于双极宏/双极/脉冲密封在市场上使用在软组织切口,切割和电凝 独特的功能双极电凝和双极切割; 全在一个器械里体现, 是很多复杂和昂贵的程序的理想产品低热导性,最少的粘连; 低温;超声振动从传感器传播到附加器械进行切割和凝血。发生器LiNA 双极切割电刀可以 与所有的高频带双极输出的发生器连接LigaSure 血管

40、密封发生器采用Instant Response 技术爱惜康超声刀发生器Comparison Chart: PowerBalde, Ligasure, Harmonic Scalpel比较图表：双极切割电刀，结扎速，超声刀46Area of ComparisonsLiNA PowerBladeLigasureHarmonic ScalpelVessel SizeThe LiNA PowerBlade is intended for use on tissue, vessels and arteries. The recommended procedure for larger vessels/a

41、rteries is the 3-step-method: Coagulate one side of the vessel/artery Coagulate the other side of the vessel/artery Coagulate in the middle of the vessel/artery and then finally cut with the bipolar cutting electrode.The recommended maximum size of the vessels is up to 6-7mm and must be judged each

42、time by the surgeon.LigaSure V (seal & cut) 7mm without dissectionLigaSure Atlas Sealer/Divider 7mm without dissectionLigaSure Atlas Hand Switching Instruments (dissect, seal & cut) 7mmLigaSure Lap 7mmHarmonic Ace 5mmComparison Chart: PowerBalde, Ligasure, Harmonic Scalpel比较图表：双极切割电刀，结扎速，超声刀47比较范围Li

43、NA 双极切割电刀Ligasure 结扎速Harmonic Scalpel 超声刀血管大小LiNA 双极切割电刀是用于组织、血管和动脉。推荐使用程序为用于大的血管/动脉，分3个步骤:电凝血管/动脉的一边电凝血管/动脉的另一边电凝血管/动脉的中间部分，最后使用双极电流进行切割。 推荐的最大电凝血管大小达6-7mm，必须每次由外科医生作判断。LigaSure V (密封和切割) 7mm 没有分离LigaSure Atlas 密封/分离 7mm 无剥离LigaSure Atlas 手转器械 (分离,密封和切割) 7mmLigaSure Lap 7mm超声波 5mmComparison Chart:

44、PowerBalde, Ligasure, Harmonic Scalpel较图表：双极切割电刀，结扎速，超声刀48Area of ComparisonsLiNA PowerBladeLigasureHarmonic ScalpelJaw TypeStraight & Curve - 330mm, 420mm, 160mm length; 10mm, 5mmStraightLigaSure Lap Maryland Curve 15 - 320mm length only-Additional InvestmentNoneVessel Sealing System GeneratorHarmo

45、nic GeneratorSpecific Generator-dependantNoYesYesAuto-coagulationYes (possible when use with for some generator, eg. Erbe VIO)YesYesCoagulation EfficiencyFastFastSlowBipolar Coagulation with bipolar energyYes extra safetyNo NoSurgeon in control of coagulation YesUnlikely, generator-dependantUnlikely

46、, generator dependantCost of OperationLowHigh High Comparison Chart: PowerBalde, Ligasure, Harmonic Scalpel较图表：双极切割电刀，结扎速，超声刀49比较范围LiNA 双极切割电刀Ligasure 结扎速Harmonic Scalpel 超声刀钳口类型直线型和弯型 - 330mm, 420mm, 160mm 长; 10mm, 5mm直线型LigaSure Lap 马里兰弯钳 15 -只有320mm长-额外投资没有血管密封体系发生器超声波发生器连接特殊的发生器没有需要需要自动电凝是 (可能，当

47、使用一些发生器, 例如. 爱尔博 VIO)是是电凝效率快速快速缓慢双极电流能量电凝是非常安全没有没有外科医生可控制电凝是的不大可能，取决于发生器不大可能，取决于发生器操作成本低高高Comparison Chart: PowerBalde, Ligasure, Harmonic Scalpel较图表：双极切割电刀，结扎速，超声刀50Area of ComparisonsLiNA PowerBladeLigasureHarmonic ScalpelSummaryActive bipolar cut (LiNA International patent)Bipolar cutting with bi

48、polar energy no blunt bladeCutting electrode is visible during complete cut procedureOnly cut/coag forceps on market with curved jawsLight weight product - only 100 gramUsed with all bipolar generators (no investment)Vessels and arteries up to 7mm, with 3-steps-method Light weight ergonomic designVe

49、ssel sealing up to 7mmStrong burst strength359 rotation applicationAlmost double the price of PowerBladeSpecific Generator requiredTissue stick in jaws can affect auto-coagulation, functionHeavy 200gCoagulation at low temp, ranging from 50C to 100CLess surgical smoke Aerosols spread (low temp) assoc

50、iates with higher risk of infectious spreadVessel sealing only on up to 5mmDouble price of PowerBladeExpensive ultrasound generator neededComparison Chart: PowerBalde, Ligasure, Harmonic Scalpel比较图表：双极切割电刀，结扎速，超声刀51比较范围LiNA 双极切割电刀Ligasure 结扎速Harmonic Scalpel 超声刀摘要有用的双极切割 (LiNA 国际专利)双极电流能量进行切割不会使刀片变钝

51、切割电极是在整个切割程序中可见的只有切割/电凝钳在市场上有弯型钳口轻量级产品只有100g能和所以的双极发生器链接（不需要额外投资）血管和动脉能切割电凝到7mm，有3个步骤轻量级的人体工程学设计可闭合血管至7mm强烈的爆发力359 旋转程式几乎是双极切割电刀两倍的价钱要求特定的发生器组织粘连在钳口可影响自动电凝功能重量 200g低温电凝，范围从 50C 至 100C少产生手术烟雾 气溶胶传播 (低温) 传染病手术有高风险的传播血管密封只有5mm双极切割电刀两倍的价钱需要昂贵的超声波发生器52Generator Brand/ModelCompatibility with LiNA PowerBla

52、deBipolar Energy for CoagulationBipolar Energy for CuttingCoagulation Auto-Stop Possible?Aesculap GN640YESCOAG, 40 WattsCUT 1, 20 WattsYESBovie IDS300YESCOAG, 40 WattsCOAG 40 WattsNOBowa Arc350YESCOAG, 40 WattsCUT, 30 WattsNOConmed ExcaliburNON/AN/AN/AConmed System 2500YESCOAG, MACRO, 40 WattsCOAG,

53、MACRO, 40 WattsNOConmed System 5000YESCOAG, MACRO, 40 WattsCUT, 25 WattsNOEmed ES350YESCOAG, 40 WattsCOAG, 40 WattsNOERBE ICC300YESCOAG, 40 WattsCOAG, 40 WattsNOERBE ICC350YESCOAG, 40 WattsCUT, 30 WattsYESERBE VIO 300DYESCOAG, 60 Watts, Effect 3CUT 40 Watts, EFECT 4YESEschmann TD830YESCOAG, MACRO, 4

54、0 WattsCOAG, MACRO, 40 WattsNOEschmann TD850YESCOAG, MACRO, 40 WattsCOAG, MACRO, 40 WattsNOMartin ME MB2YESCOAG, MACRO, 60 WattsCOAG, MACRO, 60 WattsNOMartin MaxiumYESCOAG, 40 WattsCUT, 30 WattsYESUES40YESSOFT COAG 2, 40 WattsCUT, 30 WattsNOValleylab Force 2NON/AN/AN/AValleylab Force EZ-8CYESCOAG, 40 WattsCOAG, 40 WattsNOValleylab Force FxYESCOAG, MACRO, 40 WattsCOAG, MACRO, 40 WattsNOLiNA PowerBlade with Compatible ESU and Optimal Setting53发生器品牌/型号兼容 LiNA 双极切割电刀双极电流电凝双极电流切割电凝自动停止的可能？Aesculap GN640