Using TISSUE Select
Using CUSA EXcel
Console Controls
CUSA Excel Ultrasonic Surgical Aspirator System User’s Guide 4-13
Inherent Tissue Selectivity
With all other variables remaining constant, the tip does not fragment all
tissue types equally effectively. Another variable – tissue strength – affects
fragmentation rate.
• “Low strength” (soft) tissues (easiest to fragment) include the brain
and most organs. Older, partially dried tissues are also easy to
fragment. “High strength” (strong) tissues (most difficult to fragment)
include vessel structures, tendons, ligaments, healthy skin, and organ
capsules.
• Strength increases and fragmentation rate decreases with tissue
containing greater collagen, elastin, or both (collagen type, quantity,
and organization affect cell structural quality).
Tissue strength also affects tactile feedback. The surgeon can feel a
difference between the tip contacting low strength tissue and the tip
contacting high strength tissue. As the tip works through low strength
tissue, the surgeon feels a smooth, rhythmic sensation from the handpiece.
When the tip contacts high strength tissue, it feels like it is “bouncing off”
the tissue. Also, the smooth, rhythmic sensation becomes rougher. To
avoid fragmenting high strength tissue, the surgeon must apply less
pressure to the tip or move the tip away from the tissue. To continue
fragmenting high strength tissue, the surgeon must manually apply more
pressure.
However, the surgeon may not always recognize the difference in tactile
feedback quickly enough, or react quickly enough, to avoid damaging
vital structures, particularly those with a tissue strength similar to the
tissue being fragmented. Fortunately, the CUSA EXcel system can help
the surgeon avoid these problems when dissecting near vital structures.
Increasing Tissue Selectivity
It is possible to increase the inherent selectivity resulting from variations
in tissue strength while maintaining stroke amplitude, tip acceleration,
and suction. This increase in selectivity results from reducing the reserve
power that drives the tip.
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