title: Effect of nanostructured thin film on minimally invasive surgery devices applications: characterization, cell cytotoxicity evaluation and an animal study in rat.
abstract: 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.
  
  
  
  Accordingly, a newly developed electrosurgical electrode coating with hydrogenated Cu-incorporated diamond-like carbon (DLC-Cu) film is purposed to improve the instrument performance.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, 110, Taiwan.|Research Center for Biomedical Devices and Prototyping Production, Taipei Medical University, Taipei, 110, Taiwan.|Research Center for Biomedical Implants and Microsurgery Devices, Taipei Medical University, Taipei, 110, Taiwan.|Department of Dentistry, Taipei Medical University-Shuang Ho Hospital, New Taipei City, 235, Taiwan.
authors.forename: Keng-Liang
authors.initials: KL
authors.lastname: Ou
authors.affiliation: School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, 110, Taiwan.|Research Center for Biomedical Devices and Prototyping Production, Taipei Medical University, Taipei, 110, Taiwan.
authors.forename: Chao-Chia
authors.initials: CC
authors.lastname: Weng
authors.affiliation: Research Center for Biomedical Devices and Prototyping Production, Taipei Medical University, Taipei, 110, Taiwan.|Department of Prosthodontic, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia.
authors.forename: Erwan
authors.initials: E
authors.lastname: Sugiatno
authors.affiliation: Research Center for Biomedical Devices and Prototyping Production, Taipei Medical University, Taipei, 110, Taiwan.|Department of Oral and Maxillofacial Surgery, Facuty of Dentistry, University of Hasanuddin, Makassar, Indonesia.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ruslin
authors.affiliation: Department of Pathology, Taipei Medical University, Taipei, 110, Taiwan. kevinyhl@tmu.edu.tw.
authors.forename: Yun-Ho
authors.initials: YH
authors.lastname: Lin
authors.affiliation: Research Center for Biomedical Devices and Prototyping Production, Taipei Medical University, Taipei, 110, Taiwan. chytmu@gmail.com.|Research Center for Biomedical Implants and Microsurgery Devices, Taipei Medical University, Taipei, 110, Taiwan. chytmu@gmail.com.|Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei, 110, Taiwan. chytmu@gmail.com.
authors.forename: Han-Yi
authors.initials: HY
authors.lastname: Cheng
mesh_terms: D000818:Animals; D015153:Blotting, Western; D002056:Burns / Q000473:pathology / Q000517:prevention & control; D002244:Carbon / Q000737:chemistry; D053148:Caspase 3 / Q000378:metabolism; D020099:Coated Materials, Biocompatible / Q000737:chemistry*; D003300:Copper / Q000737:chemistry; D004195:Disease Models, Animal; D004566:Electrodes; D004598:Electrosurgery / Q000295:instrumentation*; D008099:Liver / Q000601:surgery; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism; D008855:Microscopy, Electron, Scanning; D046529:Microscopy, Electron, Transmission; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D016328:NF-kappa B / Q000378:metabolism; D049329:Nanostructures; D051381:Rats; D013193:Stainless Steel / Q000737:chemistry; D013696:Temperature; D013817:Thermography
chemical_list: D020099:Coated Materials, Biocompatible; D016328:NF-kappa B; D013193:Stainless Steel; D002244:Carbon; D003300:Copper; D053148:Caspase 3; D020780:Matrix Metalloproteinase 9; C572337:Mmp9 protein, rat
keywords: Biomedical coating; In vivo test; Minimally invasive surgery; Monopolar electrosurgery; Thermal injury; Tissue sticking