title: Development of an articulating ultrasonically activated device for laparoscopic surgery.
abstract: BACKGROUND
  Ultrasonically activated devices (USADs) offer excellent coagulating dissection performance and are broadly used, particularly in endoscopic operations. Traditional USADs, however, have fixed linear shape and are thus limited in the directions from which organs can be approached. We have developed a small USAD transducer attached to the tip of an articulating device, offering a new kind of USAD in which the tip can bend as desired. We describe herein an evaluation of the coagulating dissection performance of this new articulating USAD and an in vivo confirmation of clinical usefulness.
  
  
  METHODS
  To evaluate coagulating dissection performance, we compared coagulating shearing on porcine splenic arteries between the articulating USAD and a Harmonic Scalpel II (HSII), representing a traditional USAD. Changing the amplitude of vibration between 60 microm and 80 microm and grip force among 1, 2, and 3 N, we measured the time required for division and bursting pressure of coagulating dissection. An in vivo experiment in a pig was also used to confirm the usefulness of the articulating USAD in laparoscopic operations.
  
  
  RESULTS
  Division time did not differ significantly between the articulating USAD and HSII with an 80-microm amplitude of vibration and a grip force of 2 or 3 N. Bursting pressure of blood vessels showed no significant difference between articulating USAD and HSII under all experimental conditions. In the in vivo experiment, the new bendable tip of the articulating USAD displayed coagulating dissection performance equivalent to that of the traditional USAD.
  
  
  CONCLUSIONS
  We have developed a new articulating USAD that can broaden the range of methods and approaches available for USADs and improve usefulness and safety.
authors.affiliation: Faculty of Advanced Techno-Surgery, Department of Advanced Biomedical Engineering and Science, Graduate School of Medical Science, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. ogur3307@am.aloka.co.jp
authors.forename: G
authors.initials: G
authors.lastname: Ogura
authors.forename: R
authors.initials: R
authors.lastname: Nakamura
authors.forename: Y
authors.initials: Y
authors.lastname: Muragaki
authors.forename: M
authors.initials: M
authors.lastname: Hashizume
authors.forename: H
authors.initials: H
authors.lastname: Iseki
mesh_terms: D000818:Animals; D004210:Dissection / Q000295:instrumentation*; D004867:Equipment Design; D016558:Hemostasis, Endoscopic / Q000295:instrumentation*; D057086:High-Intensity Focused Ultrasound Ablation / Q000295:instrumentation*; D010535:Laparoscopy / Q000379:methods*; D012371:Robotics / Q000295:instrumentation*; D013157:Splenic Artery / Q000601:surgery*; D034421:Sus scrofa; D014159:Transducers; D014656:Vascular Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D014732:Vibration