Abstract
Background
Minimally invasive surgery is performed using an endoscope and other instruments including the electrosurgical units. However, concerns including surgical smoke, tissue sticking and thermal injury are remaining in electrosurgery.
Aims
Accordingly, a newly developed electrosurgical electrode coating with hydrogenated Cu-incorporated diamond-like carbon (DLC-Cu) film is purposed to improve the instrument performance.
Methods
The morphologies of DLC-Cu surfaces were characterized using transmission electron microscopy, scanning electron microscopy and atomic force microscopy. In this study, lesions were made on the liver lobes of adult rats, using a monopolar electrosurgical unit equipped with untreated stainless steel electrodes or treated-electrodes. Animals were killed for evaluations at 0, 3, 7 and 28 days postoperatively.
Results
Treated-electrodes generate less sticking tissues and adhesive blood cells. Thermography revealed that the surgical temperature in liver tissue from the treated-electrode was significantly lower than the untreated-electrode. Total injury area of livers treated with treated-electrodes was significantly smaller than the untreated-electrodes treatment. Moreover, treated-electrodes caused a relatively smaller area of lateral thermal injury, a smaller area of fibrotic tissue and a faster process of remodeling than the untreated-electrodes. Western blot analysis showed that rats treated with treated-electrode expressed lower levels of NF-κB, caspase-3 and MMP-9 than untreated-electrode. Immunofluorescence staining for caspase-3 revealed that the untreated-electrode caused more serious injury.
Conclusions
This study reveals that the plating of electrodes with hydrogenated Cu-incorporated diamond-like carbon film is an efficient method for improving the performance of electrosurgical units, and should benefit wound remodeling. However, more tests must be carried out to confirm these promising findings in human patients.
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Acknowledgments
The authors would like to thank the Ministry of Health and Welfare, Taiwan, for financially supporting this research under contract number MOST 103-3114-Y-043-012.
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Keng-Liang Ou, Chao-Chia Weng, Erwan Sugiatno, Muhammad Ruslin, Yun-Ho Lin and Han-Yi Cheng have no conflict of interests.
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Keng-Liang Ou and Chao-Chia Weng have contributed equally to this work.
All financially supporting have been listed in the Acknowledgment section in the manuscript.
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Ou, KL., Weng, CC., Sugiatno, E. et al. Effect of nanostructured thin film on minimally invasive surgery devices applications: characterization, cell cytotoxicity evaluation and an animal study in rat. Surg Endosc 30, 3035–3049 (2016). https://doi.org/10.1007/s00464-015-4596-9
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DOI: https://doi.org/10.1007/s00464-015-4596-9