Enoc

ENOC – IRRIGATION/SUCTION SYSTEM

ENOC was created for the requirement to use washing liquids at room temperature up to 40 ° max and controlled outflow in laparoscopic surgery and laparotomy.

In particular, in General Surgery, Gynecology and Urology, operators need to use irrigation systems to remove any residuals of bleeding, blood clots or body fluids from operating field.

In most operating rooms, irrigation and suction system is simply composed of a saline bag connected to a pipe which conveys the washing solution to a cannula for gravity. The solution is used at ambient temperature (20° – 22°) or heated in microwave ovens and “bag warmer”, in both cases the temperature of the saline is not controlled but dangerously “boiling”.

In some cases, they use peristaltic pumps with limited adjustment and equipped with dedicated and expensive disposables.

As to suction, they normally use another circuit disposable connected to suction system present in the operating room.

These methods involve the continued presence of nursing staff who must provide assistance to the system functioning.

ENOC guarantees instead saline temperature and outflow adjustable from the display and verifiable at any time of the procedure. Once the system is activated, the nursing staff can devote to all the other tasks necessary for the proper maintenance of an operating room.

With ENOC, we have also concentrated three devices into a single one:

1. SALINE SOLUTION’S HEATING

2. IRRIGATION

3. SUCTION

1. SALINE SOLUTION’S HEATING USED NOW: Usually in operating rooms they use bags of saline solution at room temperature, in some cases they are warmed by microwave ovens or “bag warmer”. In both cases, the heating is achieved without any control of the temperature, often containers are taken to the operating room wrapped in cloth to prevent hands burnt.

a. RISKS: burn for the nursing staff and the patient’s internal organs;

b. CONTRAINDICATIONS: the operator is never aware of the saline solution’s temperature which is “hot” at the beginning of the procedure, but after a few minutes it is again at room temperature, the nursing staff must focus attention to the needs of washing of the operator;

CONCLUSION: It is a dangerous operation for the nursing staff and the patient, moreover the short duration of maintaining the temperature proves this “pre-heating method” as completely useless.

HEATING OF WASHING LIQUID WITH ENOC: bags of saline (1 x 5 liters, 2 liters or 3 x 3 x 2 liters) are immersed in the heating bath set from the display up to a maximum of 40 °. This temperature will be maintained and monitored through the display during the procedure. The nursing staff will only have to replace the bag when empty.

a. RISKS: none;

b. CONTRAINDICATIONS: none;

CONCLUSION: the operator knows that he can dispose of the hot solution at any time of the procedure. Once the system is started, the nursing staff can devote to other operating room activities

2. IRRIGATION: in most cases, irrigation is carried out for “gravity”, sometimes a peristaltic pump is used, often not easy to set, not immediate and not accurate.

a. RISKS: inability to wash quickly and effectively – in each case without a precise or totally absent outflow’s setting, in case of moderate bleeding the procedure must be converted by laparoscopy to laparotomy involving risks and damage to the patient and double expense of materials for a single procedure;

b. CONTRAINDICATIONS: washing for “gravity” does not allow the removal of clots from the operating field, to perform hydrodissection in adhesiolysis and then it is slow and ineffective; with a peristaltic pump nursing staff must focus their attention to the washing requirements of the operator;

CONCLUSION: The lack of precision and complexity of managing a peristaltic pump or irrigation for “gravity” do not provide regularity and stability to the phases of the procedure.

IRRIGATION WITH ENOC: next to the heater a peristaltic pump is installed. The flow setting is simple and quick via the display. Adjustable from a minimum of 200 ml/min – ideal for laparotomy to a maximum of 1950 ml/min – ideal for hydrodissection.

a. RISKS: none;

b. CONTRAINDICATIONS: none;

CONCLUSION: User-friendliness and rapidity of flow control setting gives the security to the operator of a system, which is quickly adaptable to every situation during the procedure.

3. SUCTION: in parallel with the disposable set for irrigation, a second one is connected to the central suction system of the operating room and so in continuous working. In some cases, “flute” cannulas are used with keys valves’ opening that allow the leakage of the saline solution .

a. RISKS : The suction flow is continuous and not controllable by the operator, if soft tissues are in proximity to the cannula, they get sucked into obstructing the cannula . The “flute” cannulas are often inhibited in their function due to blood clots around the valves that do not allow their opening/closing any more

b . CONTRAINDICATIONS : often the operator must pull out the suction cannula to restore the operation, in the case of occlusion by clot the disposable device must be replaced with another new device with undue additional costs ;

CONCLUSIONS : safety problems for the operator and low effectiveness in the suction’ control.

SUCTION WITH ENOC: the suction is regulated by a gate valve easily controlled by a special footswitch. The suction flow is not continuous and the operator can control the various phases according to the needs set out by the procedure. When the valve is closed, it creates a “depression” that amplifies the suction on the first press of the footswitch, allowing the aspiration even of large clots. The disposable set is only one for irrigation and suction, foot controls ensure non-occlusion of the cannula or the set.

a. RISKS: none;

b. CONTRAINDICATIONS: none;

CONCLUSIONS: total safety control for operator and highly effective suction; stainless steel cannula allows its use as a palpation’s tool.

Finally, we wish to highlight the seven major clinical aspects for which the hot water is appreciated by operators:

1. “COMPRESSED” water washes the surgical field quickly and dilutes the blood clots, allowing the suction system to remove even the biggest. It reduces peritoneal fluid concentration, dysplasias’ formation and protect peritoneum from scratches. Moreover hot compressed water helps to keep the laparoscope clean.

2. “THERMOHEMOSTASIS” The use of 40° hot water during all the procedure, avoid hypothermia risks and accelerates the biological hemostasis.

3. “HYDRODISSECTION” the water conditioned at a pressure between zero and 1.5 bar allows to separate the tissues in the adhesiolysis.

4. “HYDRO-PROTECTION” In destruction procedures of peritoneal disease, like laser, CO2 or bipolar electrocoagulation, the water can protect the underlying structures such as pelvic, ureter, bladder and rectum vessels.

5. “HYDRO-FLOATATION” particularly in Gynecology. For fertility problems in Douglas, sub-aquatic inspection is necessary, but in each kind of surgery, is really useful inspect the surgical field at the end of the procedure in sub-acquatic mode in order to highlighting bleeding.

6. “RESUSCITATION” in collaboration with anesthesiologists, from 100 to 300 cc. of saline left in the peritoneal cavity allows a faster peritoneal dialysis, replaces and complements the intra-venous perfusion.

7. “PAIN RELIEF”: the use of hot (40°) water during all the procedure and the filling of the abdominal cavity at the end of it, facilitates the escape of the last cc of CO2 and avoid almost totally the post-operative pain.

GENERAL CONCLUSIONS

• CLINICAL : The use of a washing system that allows the immediate setting via display of both temperature ( ambient to 40 ° C max ) and outflow allows operators to always have the opportunity to act properly at various stages of procedure without unnecessary and dangerous waiting. In the final stage, they can use all the saline solution required for sub-aquatic inspection without lowering the body temperature of the patient. The patient already subject to CO2 insufflation at a temperature much lower than the body temperature, does not risk hypothermia even during long procedures. Anesthesiologists are supported throughout the procedure, the patient will have a more gentle resuscitation and no post-operative pains.

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