title: The Cavitron ultrasonic surgical aspirator with a low amplitude is a useful dissection device for surgical procedures: application to vascular detachment and lymph node dissection.
abstract: In surgical procedures, although resection and hemostasis maneuvers have become more efficient through the use of dedicated devices, no dedicated device for the dissecting (detaching) maneuver exists at present. The Cavitron ultrasonic surgical aspirator (CUSA: Integra lifesciences Corporation, NJ, USA) is a device originally used mainly for hepatic parenchyma resection in the gastrointestinal surgical field. Tissue is selectively fragmented by an ultrasonically vibrating chip at the tip of the device. Furthermore, physiologic saline is ejected from the tip and aspirated with the fragmented tissue by the device. By reducing the amplitude of the CUSA to 10-20 %, we have been using the device not only for hepatic parenchyma resection but also for dissection in gastrointestinal surgical procedures in general. Here, we explain the details of the techniques that we routinely use, such as dissection of vessels and lymph nodes in radical operations for gastrointestinal cancer. With the CUSA set at a greatly reduced amplitude, dissection can be performed in consideration of layers, surfaces, and membranes while tissue damage and bleeding are minimized. The device is useful for performing higher quality operations.
authors.affiliation: Department of Surgery, Otsu Municipal Hospital, 2-9-9 Motomiya, Otsu, 520-0804, Shiga, Japan. akiram7700@yahoo.co.jp.
authors.forename: Akira
authors.identifier: http://orcid.org/0000-0001-9402-4270
authors.initials: A
authors.lastname: Mitsuyoshi
authors.affiliation: Department of Surgery, Otsu Municipal Hospital, 2-9-9 Motomiya, Otsu, 520-0804, Shiga, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Inoguchi
authors.affiliation: Department of Surgery, Otsu Municipal Hospital, 2-9-9 Motomiya, Otsu, 520-0804, Shiga, Japan.
authors.forename: Daiju
authors.initials: D
authors.lastname: Yokoyama
mesh_terms: D004867:Equipment Design; D006498:Hepatectomy / Q000379:methods*; D006499:Hepatic Artery / Q000601:surgery*; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000601:surgery*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods*; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation*
keywords: Cavitron ultrasonic surgical aspirator (CUSA); Detachment; Dissection device; Lymph node dissection