Using TISSUE Select
4-12 CUSA Excel Ultrasonic Surgical Aspirator System User’s Guide
Using TISSUE Select
TISSUE Select is a feature that allows the surgeon to maintain a high
fragmentation rate while increasing selectivity and control at the surgical
site.
Fragmentation occurs when the vibrating tip interacts with tissue. As the
tip begins to move toward tissue, it accelerates, then impacts and
penetrates the tissue. The acceleration, impact, and penetration produce a
combination of direct mechanical forces and hydrodynamic pressures that
burst cells.
Several variables affect the fragmentation rate. Most are functions of the
CUSA EXcel system:
• Stroke (tip excursion—the total distance the tip travels) – greater
stroke results in greater fragmentation rate
•Suction
! Suction has two functions:
(1) It draws tissue toward the vibrating tip and creates a tip/tissue
coupling effect.
(2) It removes irrigation and fragmentation debris from the surgical
site.
! If there is no suction or low suction, coupling does not occur,
resulting in minimal tissue fragmentation and increased tissue
temperature.
• Tip acceleration – produces the peak forces and pressures that
fragment tissue.
• Tip cross-sectional area at the tip-tissue contact site.
These variables also affect tactile feedback—what the surgeon’s hand feels
when using the handpiece.
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