The vessels separation by bipolar cautery: a new application in cerebral revascularization

Abstract

Objective To report the first application of bipolar coagulation in separating donor vessels of surgical revascularization and explore the differences with traditional separated techniques. Methods and Results Instruments included high⁃frequency electrosurgical electric knife with bipolar mode [electric coagulation energy 60-70 W (separation) or 4-8 W (hemostasis)], short bipolar forceps (body length was 12 cm and its tips was coated with strong anti⁃stick coating, of which diameter was＜0.50 mm) and a short microaspirator tip (its length was 15 cm with 0.50 mm diameter). Initially, the shape of superficial temporal artery (STA) was marked and an incision was made based on surgical types from damaging the root of STA. Following with the fixed flap, bipolar tweezers were employed to separate the artery with 70 W of electric energy. And in this procedure, the arterial pulse and walking was verified by fingers. Afterwards, the surgeon separated donor arteries from the deep connective tissue by short bipolar forceps with lifting vessels away from the flap on the other hand. Of notes, bipolar forceps should avoid direct contact with vessels and the maintain of moist arterial staus also requires in the whole process. In addition, cotton tablets which were soked with fasudil could wrap the donors for rapid angiectasis just in case of strong vasospasm. Conclusions The quality of donor vessels is a primary factor determining the success of cerebral revascularization. In contrast with the traditional separated techniques, short tweezers were applied in the separation of donor vessels with sharp tips, favorable safety, little damages, high power of electrocoagulation and efficiency. Besides, the length of arteries harvested by bipolar coagulation was longer than that by monopolar coagulation, so did with the vascular compliance. Precise coagulation should be applied at a certain distance from targeted blood vessels and a proper amount of soft tissues could be attached to vessels. Once donor arteries or these branches were bleeding, bipolar tips could be employed in the hemorrhagic sites with 6 W of the electric coagulation power softly. Meanwhile, the techniques in the separation of blood vessels by bipolar forceps required high surgical abilities which called for practices.

Keywords

• electrocoagulation
• cerebral revascularization
• temporal arteries