Vaporization

VAORIZATION (from Latin vapor-steam), atmousis, a surgical method proposed by V. Snegirev for stopping bleeding from tissues and organs, consisting in boiling their surface, which coagulates as if the entire organ had been immersed in boiling water. An burn is produced, protein substances coagulate, thrombi form in the gaping vessels, bleeding stops as after ligation of vessels, and the entire process is not accompanied by the introduction of infecting microbes. In operations on parenchymatous organs (liver, spleen, kidneys, etc.), V. offers great advantages, allowing one to manage without sutures. The eschar after cauterization in the abdominal cavity allows one to manage without any tamponation, everything is hermetically sutured without drainage. These basic advantages of the method were tested by Snegirev and his students (Blagovolin, Ivanov) in experiments on animals and in operations on humans. The method proved to be completely safe and practically quite suitable. The burn to tissues from the action of steam is very superficial (one or several mm), and the depth of the burn depends on the duration of boiling, measured in minutes and seconds. From the deeper damaging action of heat, the tissues are protected by the blood washing over them. Experiments on animals established that one can with V. amputate limbs without ligation even of large arteries. Thrombi in arteries hold very firmly and even more reliably than after cauterization with red-hot iron. V. of the mucous membrane of the uterus was also proposed by Snegirev. In terms of protection from infection, this method did not justify expectations, but for stopping climacteric and so-called essential bleeding it proved very suitable (as in many forms of chronic metritis). For complete boiling of the mucous membrane of the uterus, Snegirev established the time as two minutes (rarely more). It is necessary that during V. there be neither mucus nor blood in the uterine cavity, since much heat is spent on boiling them. To obtain a therapeutic effect, it is sufficient to carry out evaporation from half a minute to one minute. After such boiling, the mucous membrane usually soon regenerates. If it is boiled through its entire depth, then adhesions and obliteration of the cavity occur up to its complete disappearance (scar). The onset of changes associated with the climacteric can be accelerated by V. Practically, for this, a little more than 2 minutes is required. The temperature in the uterine cavity during evaporation should not rise above 100°; steam should come out completely freely to the outside, and its pressure in the uterus should not increase. In the vaporizer, from which steam is supplied, pressure is maintained from one to two atmospheres (i.e., the temperature in it can be 121-134°, in the uterus, where there should be no pressure, the temperature is 100° or a few degrees higher, if steam is not completely released from it). Under these conditions, there is no reason to fear damage caused by steam, and it usually does not occur. The passage of steam into the openings of the tubes, as in insufflation by the Rubin method, was not observed. Complications here are possible only with insufficient exit of steam through unsuitable instruments and from careless use of them. Perforations of the uterine wall have been described (Treub and others). In these cases, ruptures of the uterine wall depended on increased pressure in its cavity. For surgical boiling with steam, any vaporizer can be used, guided by a manometer and not raising the pressure above two atmospheres. In the apparatus of Pincus, the manometer is replaced by a thermometer, which is cheaper. In the apparatus of Razumov there is a manometer, and in his small vaporizer pressure and temperature are not measured at all, which does not compromise safety, since the exit of steam and the impossibility of increasing its pressure in the cavities into which it is conducted are excluded by the design of the instruments. For boiling the surface of organs (liver, spleen, etc.), the tip is a thin copper tube, the end of which during V. is held at a distance of 1/2 cm (see Figure 1). In addition, there is a small metal box into which the end of the tube is screwed, and the box is applied to the surface like a seal. Steam is supplied to the surface at 1 or 2 cm, and comes out through the openings provided for this purpose on the sides. Such a tip is moved as needed. For conducting steam into the uterine cavity, a lattice catheter is used, into which a thin steam-conducting tube is inserted, and steam freely comes out through the open end of the catheter, past the tube conducting it (see Figure 2). The mucous membrane of the cervical canal is protected from boiling by a piece of rubber drainage placed on the catheter, past which steam should not exit through the cervical canal. This eliminates the possibility of burning the vaginal vaults or external parts. Cauterization with steam is done without anesthesia. ** For the uterine cavity it is completely painless and gives no sensation. On external coverings and on limbs or on the walls of the abdomen, V. is a very painful procedure. The study of this method cannot be considered completed.