Hemostasis in brain tumor surgery using the Aquamantys system

Adequate hemostasis in cranial and spinal tumor surgery is of paramount importance in neurosurgical practice. Generalized ooze bleeding from the surgical walls cavity, coming from neoplastic vessels or nervous tissue, may be problematic. Recent technical advances have dramatically reduced intraoperative complications related to blood loss. Several techniques are usually employed to control hemostasis in tumor surgery, including preoperative embolization, intraoperative hypotension, electrical coagulation, and local application of fibrin sealants or hemostatic matrix, which influence coagulation.

Our aim in this study was to evaluate the efficacy and the safety of the Aquamantys® system (Medtronic Advanced Energy, Portsmouth, NH, USA), a novel bipolar coagulation device that incorporates a new bipolar coagulation technique. This device has been used in 10 consecutive patients affected by cerebral tumor along with the standard microsurgical technique and well-known intraoperative tools. The technique is associated with simultaneous delivery of bipolar radio frequency energy and conductive fluid through its electrode tip. The volume of saline passing by the electrode tip prevents charring and maintains a clean tip. This cools the tissue as it raises the temperature sufficiently to shrink the collagen of veins and arteries.

Effective hemostasis was achieved in all the cases. No complications or unwanted reactions associated with the device have been observed.

Our findings suggest that the Aquamantys® system may be a highly effective adjuvant tool in minimizing blood loss in a patient with brain tumor, as well as reducing time of surgery.