Effective cooperation between medical specialists and engineers made it possible to introduce high-technology innovations into clinical praxis and improve efficacy of operations, make them less traumatic and reduce number of complications both during the procedure and postoperative period. The major problem with liver surgery is the production of adequate cholestasis and hemostatis. Today different apparatuses and instruments are available, as for instance cryoultrasonic, plasmic, and laser scalpels or electric coagulators that are of great help in surgical praxis. Some of them are advantageous in a particular field of surgery, others are universal and can be applied in various fields of surgery. A brilliant example of such universal device is the electrosurgical generator ELECTROPULSE S-350RF.

In our clinic of surgical diseases (under the faculty of pediatrics of the Siberian State University of Medicine) we have six-year hands-on experience in using this generator. As long as its performance reliability is guaranteed by a certificate of conformance and patents of Russian Federation, and a number of positive reports and letters of recommendation from the leading medical centers of Russia and CIS countries we use this generator for both general and pancreas and liver surgery of different sophistication. Microprocessor-based design of the generator enables automatic control of all output parameters providing the best efficacy with less injury when cutting tissues of various types and the best efficacy of parenchymatous and small blood vessel hemorrhage hemostasis.

To study the wound healing process after application of different electrocoagulators and an ordinary scalpel we have conducted an experimental investigation on 15 Wistar's rats. In our investigation we included "Force-300" (USA), "EHVCH" (Russia) and ELECTROPULSE generators.

During skin dissection with "Force-300" and "EHVCH" generators the depth of damage was 0,15-0,25 mm and up to 0,5 mm. With ELECTROPULSE generator it was 0,1 mm and not more than 1,15 mm. That is two times less. The necrotic zone when working on aponeurosis was 0,3-0,4 mm with "Force-300" and "EHVCH" generators and 0,2 mm with ELECTROPULSE. That is one and a half time less.

Advantages of ELECTROPULSE generator became truly obvious when dissecting liver tissues. The necrotic zone was 0,10-0,15 mm without damage of deeper layers. Liver cells (hepatocytes) destruction did not spread further the necrotic zone. Liver edge treated with ELECTROPULSE electrocoagulator had whitish color. Histologic study with van Gieson's stain and hematoxylin and eosin stain, Schick test and sudan showed that only superficial layers of hepatocytes were damaged. Glycogen amount was normal; there were no signs of fatty or albuminous degeneration. With "Force-300" and "EHVCH" generators in the same applications the necrotic zone was 0,2-0,4 mm deep. On deeper layers zones of damaged hepatocytes were observed.

ELECTROPULSE generator provides the same cutting speed as that of an ordinary scalpel. The instrument is quite elegant and mobile and very user-friendly. It allows for manipulations inside thoracic and abdominal cavities. The morphologist's report confirmed more sparing dissection of different tissue types produced by the generator. The hemorrhage during dissections was minimal.

When using noncontact monopolar coagulation of ELECTROPULSE generator the electrode has no contact with tissue. Energy is concentrated on the tip of the electrode and is distributed over the surface of the target tissue in the form of a beam. There is no contamination of the effective area of the electrode with remains of carbonization or cells disintegration. During application the electrode itself does not heat, but the energy concentrated in tissue provokes heating of cellular constructions that results in desiccation, protein denaturation and thrombus formation. When the electrode is brought to liver tissue at 2-5 mm electric discharge arises and radiofrequency current penetrates cells that causes coagulation of the group of cells located in the immediate zone of coagulation of 1-2 mm in diameter, deeper layers of skin remain undamaged, and sedimentation of coagulated particles on the effective area of the electrode is prevented. Manipulation is done on the entire wound surface with the operative angle within 45 degrees. For the purpose of cholestasis and hemostasis the electrode is passed over the wound without stoppage, energy is concentrated on its tip and spreads in the form of a beam.

During our investigation we operated 27 patients (pts) using ELECTROPULSE generator. They had following liver pathologies: cavernous hemangioma in 6 pts, alveococcosis in 1 pt, epatocellular carcinoma against cirrhosis background in 1 pt, hydatid disease of liver in 2 pts, in 13 pts cholecystectomy via the mini-approach was performed and in 4 pts laparoscopic cholecystectomy with noncontact coagulation for gallbladder bed processing. In 5 pts operations were performed against the opisthorchosis invasion background. In all cases during cholecystectomy there were no intraoperative complications. With noncontact coagulation mode we managed to achieve firm cholestasis and hemostasis of the gallbladder bed without charring of liver surface. Absence of tissue adhesion to the tip of the instrument allowed for significant increase of coagulation speed and made for minimal organ damage. All operations were completed with getting of a surgical drain to the gallbladder bed.

Postoperative period was without complications. There were no cases of bile flow through the drain. The drain was removed 2-5 days after an operation. Ultrasonic examination of the subhepatic space showed spare fluid only in one patient, hepatic parenchyma in all cases remained intact. Operative wounds healed by primary intention; sutures were removed after 6 days. All patients were discharged in satisfactory condition. Also the following operations were performed: lung resection in 2 pts, esophagoplasty in 2 pts, gastric resection in 23 pts, strumectomy in 5 pts, pancreas surgery in 10 pts. There were no complications after these operations.

On the basis of the conducted experiments and clinical studies we would like to mark the exceptional precision the electrosurgical generator ELECTROPULSE S-350RF enables for different kinds of operations on abdominal cavity organs. The generator provides associated hemostatic effect; no apparent inflammations in tissues. Automatic adjustment of generator output parameters facilitates the best cutting of various tissue types, hemostasia of parenchymatous and minor blood vessels hemorrhages and small injury.

The application of noncontact coagulation during laparoscopic operations is an effective method of treatment in patients with focal pathology of liver and gallbladder.

Prof. Boris I. Alperovich, MD
Head of the department of surgical diseases

Dr. Salo VN, Ph.D., assistant