Intra-operative acoustic hemostasis of liver: production of a homogenate for effective treatment.

Objective: We have shown that High-Intensity Focused Ultrasound (HIFU) can effectively control bleeding from injuries to solid organs such as liver, spleen, and lung. Achievement of hemostasis was augmented when a homogenate of tissue and blood was formed. The objective of this study was to investigate quantitatively the effect of homogenate production on HIFU application time for hemostasis. Possible mechanisms involved in homogenate production were also studied.

Methods: Ten anesthetized rabbits had laparotomy and liver exposure. Liver incisions, 15-25 mm long and 3-4 mm deep, were made followed immediately by HIFU application. Two electrical powers of 80 and 100 W corresponding to focal acoustic intensities of 2264 and 2829 W/cm(2), respectively were used. Tissue and homogenate temperatures were measured. Smear and histological tissue sample analysis using light microscopy were performed.

Results: In treatments with homogenate formation, hemostasis was achieved in 76+/-1.3 s (Mean+/-Standard Error Mean: SEM) at 80 W. In treatments without homogenate formation (at 80 W), hemostasis was achieved in 106+/-0.87 s. At 100 W, hemostasis was achieved in 46+/-0.3 s. The time required for homogenate formation, at 80 and 100 W were 60+/-2.5 and 23+/-0.3 s, respectively. The homogenate temperature was 83 degrees C (SEM 0.6 degrees C), and the non-homogenate tissue temperature at the treatment site was 60 degrees C (SEM 0.4 degrees C). The smear and histological analysis showed significant blood components and cellular debris in the homogenate, with some intact cells.

Conclusion: The HIFU-induced homogenate of blood and tissue resulted in a statistically significant shorter HIFU application time for hemostasis. The incisions with homogenate had higher temperatures as compared to incisions without homogenate. Further studies of the correlation between homogenate formation and temperature must be done, as well as studies on the long-term effects of homogenate in achieving hemostasis.