Читать книгу Small Animal Laparoscopy and Thoracoscopy онлайн

218 страница из 232

Meticulous hemostasis, one of Halsted's seven principles, is important for any surgery, but particularly for minimally invasive procedures, in which a small amount of hemorrhage can compromise visualization. Numerous devices are available for hemostasis with laparoscopy and thoracoscopy, including hemostatic clips, endostapling equipment, and energy devices.

Energy has been used in surgery for thousands of years. The first form of energy used in surgery was thermal cautery, or the application of energy as heat to tissues. Although this was invaluable for controlling hemorrhage, lateral thermal damage to normal tissues was extensive. This technology evolved as William T. Bovie developed the first electrosurgical unit (ESU) that provided both cutting and coagulation settings. Rather than electrocautery, which relies on the transfer of heat directly to tissues, this new technology created an electrical current that was applied to the tissues and, in turn, created heat. Almost 100 years later, we are still using monopolar and bipolar electrosurgical devices similar to the “Bovie,” but advances in technology have created safer units with more consistent tissue effects. More recently, vessel sealant technology has gained popularity in minimally invasive procedures. These bipolar electrosurgical devices have been used in numerous types of minimally invasive procedures, including surgeries of the reproductive tract, splenectomies, adrenalectomies, nephrectomies, lung biopsies, and pericardial surgery.