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 Lithotripsy
Machine |
| Harmonic
Scalpel |
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| Lithotripsy is a non-invasive
procedure which uses shock waves to pulverize urinary calculi (kidney stones).
This technique used to break up stones that form in the kidney, bladder, ureters,
or gallbladder. It is done by a machine called lithotriptor. Aastha has
obtained the first Lithotripsy machine in Mulund and surrounding suburbs used
for advanced laser treatment of stones. |
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| Lithotripsy
machine at Aastha |
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| What is lithotripsy? |
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 A
shock wave is characterized by a very rapid pressure increase in the transmission
medium and is quite different from Ultrasound. The shock waves are transmitted
through the patient's skin and pass harmlessly through the patient's soft tissue.
The shock wave passes through the kidney and strikes the stone. At the stone boundary,
energy is lost, and this causes small cracks to form on the edge of the stone.
The same effect occurs when the shock wave exits the stone. With successive shocks,
the cracks open up, and in turn, smaller cracks form within the large cracks.
Eventually, the stone is reduced to small particles, which are then flushed out
of the kidneys or ureter naturally during urination. |
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| There are several ways of doing this, although the
most common is extracorporeal (outside the body) shock wave lithotripsy. But there
are other ways also which are commonly being opted. Let us see all three techniques: |
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Extracorporeal shock wave lithotripsy (ESWL) uses highly focused impulses
projected from outside the body to pulverize kidney stones anywhere in the urinary
system. The stone usually is reduced to sand-like granules that can be passed
in the patient's urine. Large stones may require several ESWL treatments. ESWL
may be used on people with a kidney stone that is causing pain or blocking the
urine flow. Stones that are between 4 mm(0.16 in.) and 2 cm(0.79 in.) in diameter
are most likely to be treated with ESWL. It may work best for kidney stones in
the kidney, not in the ureter. It may be harder for ESWL to break up a stone that
has moved into the ureter, although this is still possible. Your surgeon may try
to push the stone back into the kidney with a small instrument (ureteroscope)
and then use ESWL.
- Ultrasonic lithotripsy uses high
frequency sound waves delivered through an electronic probe inserted into the
ureter to break up the kidney stone. The fragments are passed by the patient or
removed surgically.
- Electrohydraulic lithotripsy (EHL) uses
a flexible probe to break up small stones with shock waves generated by electricity.
The probe is positioned close to the stone through a flexible ureteroscope. Fragments
can be passed by the patient or extracted. EHL requires general anesthesia and
can be used to break stones anywhere in the urinary system.
- Lithotripsy
was developed in the early 1980s, and came into widespread use with the introduction
of the HM-3 lithotriptor in 1983. Within a few short years, ESWL revolutionized
treatment of Urinary calculus.
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| How
does it work? |
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| While
most kidney stones are treated with this type of lithotripsy, not all stones can
be treated this way. Sometimes a laser is used to pulverize the stone, but when
a laser is used, the doctor uses an endoscope, which is a tube introduced into
the body, via the urinary tract, to get close to the stone. |
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| The treatment usually starts at the equipment's lowest
power level, with a long gap between pulses, in order to accustom the patient
to the sensation. The frequency of pulses & power level will then be gradually
increased, in order to break up the stone more effectively. The final power level
will usually depend on the patient's pain threshold. If the stone is positioned
near a bone (usually a rib in the case of kidney stones), then this treatment
may be more uncomfortable as the shock waves can cause a mild resonance in the
bone which can be felt by the patient. Throughout the procedure, the doctor can
view what is happening to the stones through X-ray or ultrasound monitoring. |
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| The successive
shock wave pressure pulses result in direct shearing forces, as well as cavitation
bubbles surrounding the stone, which fragment the stones in smaller pieces, which
then can pass easily through the ureters or the cystic duct. The process takes
about an hour. A ureteral stent (a kind of expandable hollow tube) may be used
at the discretion of the urologist. The stent allows for easier passage of the
stone by relieving obstruction, and through passive dilatation of the ureter. |
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| What happens
during the procedure? |
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| The patient is asked not to drink or eat anything for 6
hours prior to the procedure. The procedure generally takes from 45 minutes to
1 hour. Typically, the patient receives anaesthesia. Since lithotripsy can cause
mild discomfort, a mild sedative or painkiller is given beforehand. |
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| In most cases,
the patient is asked to lie on a table on top of a soft cushion, through which
the shock waves are directed from the lithotripsy machine, called the lithotripter.
A shock wave is characterized by a very rapid pressure increase in the transmission
medium and is quite different from Ultrasound. The shock waves are transmitted
through the patient's skin and pass harmlessly through the patient's soft tissue.
The shock wave passes through the kidney and strikes the stone. Eventually, the
stone is reduced to small particles, which are then flushed out of the kidneys
or ureter naturally during urination. The process generally takes about 1 hour
during which up to 8,000 shocks are administered |
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| The doctor may also access the stone from the back
of the patient into the kidney, through a procedure called percutaneous lithotripsy.
Laser lithotripsy is usually used when the stone does not respond to extracorporeal
shock wave treatment or when it is in a place that is difficult to access. It
requires a hospital stay and carries a slightly greater risk of complications
than extracorporeal shock wave lithotripsy. |
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| What happens after the procedure? |
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| The patient is
monitored in a recovery room for few hours to recover from the anaesthetic effect
before going home. ESWL is usually an outpatient procedure. You go home after
the treatment and do not have to spend a night in the hospital. It may take a
few days or weeks for all the stone fragments to pass from your body. You may
have mild pain as the small fragments pass through the urinary tract. |
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| Slight Pain
might be felt as the pieces of stones will pass out of the ureter into the bladder.
The physician will advice to drink a lot of fluids to help keep stones from reforming
and to flush out the remaining pieces of stone. |
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| What are the benefits of this procedure? |
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| One can get rid
of the kidney stones and the problems without surgery. Today more and more physicians
prefer this non-invasive method. This procedure prevents one from having to undergo
surgery to have the stones removed, which reduces discomfort, complications, hospital
stay, cost, and recovery time. However ESWL usually is not used if one is: |
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- Pregnant,
because the sound waves and X-rays may be harmful to the foetus.
- Have
a bleeding disorder.
- Have a kidney infection, urinary tract infection,
or kidney cancer.
- Have kidneys with abnormal structure or function.
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| What are the risks associated with this procedure? |
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- There
is a very small risk of damage to the kidney or development of high blood pressure
when a stone in the kidney is treated. However, usually the risk of NOT treating
a stone is much greater than the risk of treatment itself.
- There
is a risk of infection or bleeding.
- Some of the broken kidney stones
could irritate the bladder or ureter or block the ureter itself.
- Pain
caused by the passage of stone fragments.
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| The Harmonic
Scalpel is the leading ultrasonic cutting and coagulation surgical device. It
came into use in 1993 and is now widely used for various surgeries. It is a comprehensive
system that has been used by thousands of surgeons worldwide in a broad range
of both endoscopic and open surgical procedures. This Ultrasonic instrument has
gained popularity in the operating room because of: the control given to the surgeon,
reduced tissue damage, decreased operating times and more rapid healing. Aastha
is proud to have installed the first Harmonic scalpel for advanced Laparoscopy
in Mulund and surrounding suburbs. |
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| How does it
work? |
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components of Harmonic Scalpel system consists of a generator, a hand piece with
a connecting cable, a blade system and a foot pedal. The generator is a microprocessor
controlled high frequency switching power supply that drives the acoustic system
in the hand piece. The Harmonic Scalpel has five power levels. The cutting speed
and coagulation are inversely related. |
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| The Harmonic Scalpel uses ultrasonic technology, the
unique energy form that allows both cutting and coagulation of haemorrhoidal tissue
at the precise point of application, resulting in minimal lateral thermal tissue
damage. It is a device which can cut and coagulate the vessels or tissues at low
temperature. It does not conduct electric current and has high ability of haemostasis.
The Harmonic Scalpel Technology controls bleeding by coaptive coagulation at low
temperature ranging from 50 to 100 degree Celsius. The vessels are tamponaded
and sealed by protein coagulum. Coagulation occurs by means of protein denaturing
when the blade vibrating at 55,500 Hz couples with protein, denaturing it to form
a coagulum that seals small coapted vessels. When the effect is prolonged, secondary
heat is produced that seals larger vessels. By contrast, electro surgery and lasers
coagulate by burning (obliterative coagulation) at higher temperatures (150 Degrees
C to 400 Degrees C). Blood and tissue are desiccated and oxidized (charred), forming
eschar that covers and seals the bleeding area. It causes less thermal damage,
with minimal smoke resulting in clear visual field. |
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 Surgeons
control the harmonic Scalpels coagulation rate and cutting speed by the time and
force applied to the tissue by the end effectors, and by the selected excursion
level of the end-effector. At the tip of the end-effector, energy is delivered
to tissue where it creates several effects within the tissue. Conversion of mechanical
energy to heat from friction at the blade tissue interface occurs along with bulk
heating due to tissue's viscoelastic nature. The Harmonic Scalpel uses ultrasonic
technology, and energy that allows both cutting and coagulation at the point of
impact. It is used for surgical procedures in which soft-tissue incisions will
be made and in which bleeding control and minimal lateral thermal damage to tissue
are desired. The instrument can be used as an adjunct to, or substitute for, electro
surgery lasers and steel scalpels. When compared with electro surgery, fewer instrument
exchanges are needed, less tissue charring and desiccation occur, and visibility
in the surgical field is improved. |
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| What are the Benefits? |
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| Since the harmonic scalpel uses ultrasound, there is
less smoke than is generated by both lasers and electrosurgical instruments. It
also cuts and coagulates by using lower temperatures than those used by electrosurgery
or lasers. The protein coagulum caused by the application of the harmonic scalpel
is superior at sealing off large bleeding vessels during surgery. This is the
reason why the Harmonic Scalpel is the leading ultrasonic cutting and coagulating
surgical device. Let us see again the benefits of harmonic scalpel to the surgeons:
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- Minimal lateral thermal tissue damage
- Minimal charring and desiccation
- It reduces the need for ligatures with simultaneous cutting and coagulation
- Fewer instrument exchanges simplify procedure steps
- No electricity
to or through the patient
- Greater precision near vital structures
- Minimal smoke for improved visibility in the surgical field
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| Harmonic
Scalpel: A cutting and coagulation surgical device |
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