scholarly journals A145 A SUBMUCOSAL FLUID CUSHION PREVENTS MUSCLE LAYER DAMAGE DURING ARGON PLASMA COAGULATION

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 8-9
Author(s):  
P J Belletrutti ◽  
R Maselli ◽  
T Stabler ◽  
M D Enderle ◽  
A Repici
Keyword(s):  
Normal Saline ◽  
Thermal Damage ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Muscle Layer ◽  
Tissue Temperature ◽  
Final Temperature ◽  
Injection Volume ◽  
Plasma Coagulation ◽  
Significant Difference

Abstract Background Thermal damage to the muscle layer of the gastrointestinal wall can occur during mucosal application of argon plasma coagulation (APC). This injury may be mitigated by creating a fluid cushion within the submucosal layer that physically separates the mucosa from the muscle layer and suppresses unwanted tissue temperature elevation. This in turn protects the muscle layer from thermal damage. The coagulative threshold of muscle proteins is known to be about 60°C, but there are no published systematic assessments of the minimum injection volume needed nor the ideal injectate to prevent thermal damage to the muscle layer during mucosal APC ablation. Aims Our aims were, firstly, to measure the final temperature inside the fluid cushion after mucosal ablation with APC and then to determine any differences in the final temperature between various injectable solutions. Secondly, we sought to determine the minimum volume of injectate required to protect the muscle layer from thermal damage. Methods All experiments were performed in an ex-vivo porcine gastrointestinal tract model. Five different fluids (normal saline, Glyceol, Gelafundin, Voluven and Eleview) of different volumes (range 0 - 5mL) were injected into the submucosa of the esophagus, stomach (fundus) and rectum to create a fluid cushion. APC was applied to the mucosa for a fixed duration (3s) at different power settings (ranging from 30 - 120W). Immediately after APC treatment, the final temperature was measured by placing a contact thermometer inside the fluid cushion, just on top of the muscle layer. Results There was no significant difference in the temperature measured at the surface of the muscle layer between elevation with normal saline, Glyceol, Gelafundin, Voluven and Eleview at all 3 tissue locations at equal injection volumes and power settings. The experiments showed that the temperature rose for each injectate with heightened power settings but also decreased with increasing volume of injected fluid. The minimum amount of fluid needed to protect the muscle layer from thermal damage was 2mL for the esophagus, stomach and rectum in the case of a power setting between 30 to 90W and 3mL in the case of 90 to 120W. Conclusions Normal saline and four commercially available submucosal injectates possess similar thermoregulatory effects as an insulator of the muscle layer during APC treatment. As opposed to the choice of injectate or anatomic location treated, the volume of fluid injected is the main determinant of the final temperature at the level of the muscularis propria. To reduce the likelihood of thermal damage to deeper layers of the GI tract when APC is applied, a minimum injection volume of 2mL is recommended if <90W of power is utilized. Funding Agencies None

scholarly journals A New Cold Plasma Jet: Performance Evaluation of Cold Plasma, Hybrid Plasma and Argon Plasma Coagulation

Plasma ◽  
2018 ◽  
Vol 1 (1) ◽  
pp. 189-200 ◽  
Author(s):  
Lawan Ly ◽  
Sterlyn Jones ◽  
Alexey Shashurin ◽  
Taisen Zhuang ◽  
Warren Rowe ◽  
...  
Keyword(s):  
Cold Plasma ◽  
Ex Vivo ◽  
Argon Plasma Coagulation ◽  
Tumor Resection ◽  
Argon Plasma ◽  
Plasma Jet ◽  
Atmospheric Plasma ◽  
Tissue Temperature ◽  
Plasma Coagulation ◽  
Plasma Energy

The use of plasma energy has expanded in surgery and medicine. Tumor resection in surgery and endoscopy has incorporated the use of a plasma scalpel or catheter for over four decades. A new plasma energy has expanded the tools in surgery: Cold Atmospheric Plasma (CAP). A cold plasma generator and handpiece are required to deliver the CAP energy. The authors evaluated a new Cold Plasma Jet System. The Cold Plasma Jet System consists of a USMI Cold Plasma Conversion Unit, Canady Helios Cold Plasma® Scalpel, and the Canady Plasma® Scalpel in Hybrid and Argon Plasma Coagulation (APC) modes. This plasma surgical system is designed to remove the target tumor with minimal blood loss and subsequently spray the local area with cold plasma. In this study, various operational parameters of the Canady Plasma® Scalpels were tested on ex vivo normal porcine liver tissue. These conditions included various gas flow rates (1.0, 3.0, 5.0 L/min), powers (20, 40, 60 P), and treatment durations (30, 60, 90, 120 s) with argon and helium gases. Plasma length, tissue temperature changes, and depth and eschar injury magnitude measurements resulting from treatment were taken into consideration in the comparison of the scalpels. The authors report that a new cold plasma jet technology does not produce any thermal damage to normal tissue.

scholarly journals Long exposure of argon plasma coagulation induces more thermal damage accompanied by a higher expression of NF-κB and caspase-3

2018 ◽  
Vol 3 (1) ◽  
pp. 5
Author(s):  
Rahmat Wariz ◽  
Keng-Liang Ou ◽  
Muhammad Ruslin ◽  
Bahruddin Thalib ◽  
Chung-Ming Liu ◽  
...  
Keyword(s):  
Normal Level ◽  
Caspase 3 ◽  
Thermal Damage ◽  
Morphological Changes ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Pulse Mode ◽  
Plasma Coagulation ◽  
Thermal Injuries ◽  
Liver Tissues

Objective: Long exposure of argon plasma coagulation (APC) causes thermal damage and apoptosis in tissues. However, whether the APC-induced thermal damage in tissues involves the expression of NF-κB and caspase-3 remains undetermined. In this study, we compared the effect of APC on liver damage at two different exposure time and tested the hypothesis that thermal injuries induced by APC are accompanied by induction of NF-κB and caspase-3 expression in rat liver.Material and Methods: Liver injuries were induced in rats by an APC device with pulse mode for 2 or 4 seconds under the same frequency of power (40W). The animals were sacrificed 0, 3, 7 and 21 days after injury and the liver tissues were harvested and used for western blotting, histological and immunohistochemical analyses.Results: Haematoxylin and eosin (H&E) stained sections of the liver tissues showed that two-second application of APC caused minimum thermal damage and apoptotic areas, less carbonization, and more fibrosis formation in liver than the four-second APC application at all time points examined. All of these APC-induced thermal effects and morphological changes in the two-second APC application group but not the four-second APC application group recovered 21 days after the treatment. Western blot results indicated that APC induced the expression of NF-κB on day 3, and peaked on days and 14. In the two-second APC application group, the expression of NF-κB returned to the normal level on day 28. However, the expression of NF-κB induced by 4 seconds of APC application remained high even 28 days after injury. The expression of caspase-3 induced by the 2 seconds or 4 seconds of APC application peaked at 7 or 14 days, respectively. Similarly, the APC-induce expression of caspase-3 returned to the normal level in the 2-second APC application group, but it still remained high in the 4-second APC application group even 28 days after injury. These results were further confirmed by The immunofluorescence data also indicated that APC exposure for 4 seconds induced a much higher expression of NF-κB than APC exposure for 2 seconds. The similar pattern was observed in the caspase-3 expression.Conclusions: Taken together, our results show that 2-second APC exposure causes minimum liver injury accompanied by the expressions of NF-κB and casapase-3 which return to the normal level 28 days after injury. These findings strongly suggest that the shortest pulse mode (2 seconds) application of APC is a safe, convenient, and effective approach for the treatment of particularly thermosensitive tissues.

scholarly journals Submucosal Injection of Normal Saline can Prevent Unexpected Deep Thermal Injury of Argon Plasma Coagulation in thein vivoPorcine Stomach

Gut and Liver ◽  
2008 ◽  
Vol 2 (2) ◽  
pp. 95-98 ◽  
Author(s):  
Mitsuhiro Fujishiro ◽  
Shinya Kodashima ◽  
Satoshi Ono ◽  
Osamu Goto ◽  
Nobutake Yamamichi ◽  
...  
Keyword(s):  
Normal Saline ◽  
Thermal Injury ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Submucosal Injection ◽  
Plasma Coagulation

scholarly journals Evaluation of the in vivo effect of argon plasma coagulation with prior submucosal injection (Hybrid APC) in the esophagus of pigs

2019 ◽  
Author(s):  
Satoshi Abiko ◽  
Yuichi Shimizu ◽  
Shunsuke Ohnishi ◽  
Marin Ishikawa ◽  
Kana Matsuda ◽  
...  
Keyword(s):  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Immunohistochemical Analysis ◽  
Type A ◽  
Muscle Layer ◽  
Type B ◽  
Submucosal Injection ◽  
Plasma Coagulation ◽  
Atrophic Muscle

Abstract Background Although argon-plasma coagulation (APC) is useful for treating early gastrointestinal cancer, safer ablation for oesophageal cancer is needed because the esophageal wall is very thin. The efficacy of APC with prior submucosal injection of saline (hybrid APC) by using a resected oesophagus of pig has been reported, but there has been no study in which the effects, biological reactions and delayed adverse effects of hybrid APC were evaluated. In this study, we evaluated the histological efficacy of APC with prior submucosal injection of saline (hybrid APC) by using an in vivo porcine model. Methods APC alone and hybrid APC were performed. Various settings of argon were used. The pigs were sacrificed after treatment (study 1) and 1 week after treatment (study 2). Histological evaluation of the deepest spot of coagulation from the basal layer (study 1) and non-atrophic muscle zone (study 2) in resected specimens was performed. Type A damage was defined as superficial tissue damage of the tunica mucosa, whereas type B damage was defined as an injury pattern limited to the tunica muscularis. The depths of type A and type B damage were measured in study 1. Immunohistochemical analysis was also performed in study 2. Results (study 1) Hybrid APC except for that at an excessive setting could prevent type B damage of the muscle layer. Standard APC at any setting could not prevent type B damage of the muscle layer. Results (study 2) The non-atrophic muscle zone was significantly larger in the hybrid APC group. Immunohistochemical analysis showed that the numbers of activated myofibroblasts and infiltrating neutrophils and macrophages were significantly smaller in the hybrid APC group than in the standard APC group. Conclusion APC following submucosal injection of saline contributes to sufficient and safe coagulation for oesophageal lesions.

scholarly journals PROSPECTIVE META-ANALYSIS OF RELEASED WEIGHT LOSS AND SUCCESS RATE OF ARGON PLASMA COAGULATION TO SUTURE AND SURGERY PROCEDURES POST-BARIATRIC SURGERY: STATUS OF THE ART OF ENDOSCOPIC TREATMENT

2021 ◽  
Author(s):  
Dr. Idiberto Jose Zotarelli Filho, MSc, Ph.D
Keyword(s):  
Weight Loss ◽  
Argon Plasma Coagulation ◽  
Meta Analysis ◽  
Argon Plasma ◽  
High Association ◽  
Plasma Coagulation ◽  
Vertical Gastrectomy ◽  
Significant Difference ◽  
Α Level ◽  
Post Bariatric Surgery

Introduction: Currently, 30% of the world’s population is overweight or obese. Roux-en-Y gastric bypass (BGYR) and vertical gastrectomy are the most commonly performed techniques in Brazil and worldwide. Objective: Conduct a meta-analysis of the results of using argon plasma coagulation (APC), suture (SUT), and surgery (SUR), to clarify the safety and efficacy of using argon plasma to other procedures. Methods: The quality of the evidence was classified as high, moderate, low, or very low, according to the risk of bias. The Variance (α2) and One-Way (ANOVA) test were applied, adopting the α level less than 0.05 with a statistically significant difference for the 95% CI. The value of R-sq (R2) was analyzed to discover the imprecision or heterogeneity of the analyzes. Results: A total of 34 studies were found, eight to APC, twenty to SUT, and six to SUR. For relapsed weight loss (RWL), the means for APC, SUT, and SUR were respectively 19.39 ± 10.94, 26.06 ± 16.71, and 17.05 ± 9.85, and for SR, the means were respectively 89.75 ± 16.75, 86.80 ± 11.44, and 76.00 ± 21.57. There was a small difference between the values of APC averages with SUT and SUR, both in relation to RWL and SR, with p>0.05, with a high association (R2 ≥ 50%). Conclusion: It was shown that the APC technique showed excellent results in terms of RWL and SR compared to the other techniques, with no statistically significant difference. Thus, the results of the APC strongly point to its potential use.

Argon plasma coagulation tonsillectomy versus coblation tonsillectomy: a comparison of efficacy and safety

2019 ◽  
Vol 133 (06) ◽  
pp. 520-525 ◽  
Author(s):  
R Loh ◽  
L Stepan ◽  
E Zhen ◽  
C-K L Shaw
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Standard Technique ◽  
Cost Effective ◽  
Operative Blood Loss ◽  
Plasma Coagulation ◽  
Post Operative Pain ◽  
Significant Difference

AbstractBackgroundTonsillectomy is one of the most common otolaryngological procedures. Nonetheless, there is still no universally approved ‘gold standard’ technique.ObjectiveTo compare the safety and efficacy of argon plasma coagulation and coblation techniques in tonsillectomy.MethodsA multi-institutional, retrospective cohort study was conducted, comprising 283 patients who underwent bilateral tonsillectomies performed by a single surgeon between 2014 and 2017. The outcome measures included: operative time, intra-operative blood loss, post-operative pain and post-operative haemorrhage.ResultsIn the argon plasma coagulation group, mean operative time and post-operative haemorrhage rate were significantly reduced, p = 0.0006 and p = 0.003 respectively. There was no statistically significant difference between the two groups in terms of post-operative pain and intra-operative blood loss.ConclusionThe argon plasma coagulation technique is easy, safe and efficacious. Argon plasma coagulation tonsillectomy seems cost-effective compared to coblation tonsillectomy: the single-use disposable electrode tip and wand used in this study cost AUD$76.50 and AUD$380 respectively. Argon plasma coagulation appears to be a favourable alternative to current modalities such as coblation.

scholarly journals Successful treatment of multiple angioectasia of the colon by argon plasma coagulation with normal saline injection (NS-APC)

2004 ◽  
Vol 64 (2) ◽  
pp. 104-105
Author(s):  
Atsushi Imagawa ◽  
Takuhei Hashimoto ◽  
Mitsuhiro Fujishiro ◽  
Naomi Kakushima ◽  
Katsuya Kobayashi ◽  
...  
Keyword(s):  
Successful Treatment ◽  
Normal Saline ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Saline Injection ◽  
Plasma Coagulation
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