title: Efficacy of hemostasis for epidural venous plexus and safety for neural structure using soft coagulation system in spinal surgery: a laboratory investigation using a porcine model.
abstract: METHODS
  A laboratory investigation using porcine model.
  
  
  OBJECTIVE
  To clarify the effectiveness of the soft coagulation system for stopping bleeding from the epidural vein using different outputs and the safety in terms of tissue damage including spinal cord injury.
  
  
  BACKGROUND
  Problems associated with coagulation using an electrosurgical device, such as carbonization of tissue or adhesion to the electrode, have been highlighted. So called "soft coagulation" has been developed to solve these problems. Its' utility as well as the safety of the neural structure in spine surgery has never been reported.
  
  
  METHODS
  A total of 3 animals and 45 spinal segments were used. Total laminectomy was performed to expose the dural tube and epidural venous plexus. Stable bleeding was induced by a 22 G needle puncture. Soft coagulation monopolar output (SCM), soft coagulation bipolar output (SCB), and conventional bipolar output (CB) were used as the coagulators. Valid hemostasis was defined as macroscopically complete bleeding stoppage by coagulation within 3 minutes. The neurological assessment was evaluated by somatosensory evoked potential. Histologic analysis was performed to determine the area of thermal damage.
  
  
  RESULTS
  Valid hemostasis ratio was 75.0% of SCM group, 68.8% of SCB group, and 30.8% of CB group. Somatosensory evoked potential monitoring revealed that spinal cord injury was observed in 4 lesions (25%) of the SCM group. Neither bipolar groups (SCB and CB) showed any changes in waveform pattern. Histologic analysis revealed that severe thermal damages were observed in the epidural space of the SCM group.
  
  
  CONCLUSIONS
  The usefulness of soft coagulation is revealed in terms of bleeding stoppage from epidural vessels and reduced soft-tissue damage compared with the conventional electric device. However, assessing the potential risk of severe neural tissue damage including spinal cord injury, a bipolar soft coagulation is strongly recommended for use in spine surgery.
authors: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors: Kotaro
authors: K
authors: Nishida
authors: Kenichiro
authors: K
authors: Kakutani
authors: Koichiro
authors: K
authors: Maeno
authors: Toru
authors: T
authors: Takada
authors: Takashi
authors: T
authors: Yurube
authors: Ryosuke
authors: R
authors: Kuroda
authors: Masahiro
authors: M
authors: Kurosaka
mesh_terms: D000818:Animals; D004564:Electrocoagulation / Q000009:adverse effects*; D004824:Epidural Space / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery*; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006489:Hemostatic Techniques / Q000009:adverse effects*; D007796:Laminectomy; D023421:Models, Animal; D013119:Spinal Cord Injuries / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D034421:Sus scrofa / Q000601:surgery*; D016896:Treatment Outcome; D014680:Veins / Q000601:surgery*