FMX Ferromagnetic Technology in Neurosurgery
Domain Surgical’s FMX Ferromagnetic Surgical System uses ferromagnetic technology to precisely cut, coagulate, and seal tissue; with a fraction of tissue injury compared to other surgical technologies, and without passing electrical current through the patient. Because no electrical current passes through the patient, FMX surgical instruments can be used safely near nerves, vessels, and other delicate tissue structures without interfering with intraoperative neuromonitoring, deep brain stimulators, cochlear implants, or other electrically-sensitive devices.
- Produces a precise, surface-only thermal effect with tactile control and minimal tissue drag
- Clean dissection results in superior visibility and clear margins for reliable pathology specimens
Minimized Thermal Injury
- As little as 1/10th the thermal injury compared to monopolar electrosurgery1,2
- As few as 80 microns (0.08 mm) of thermal spread in some tissue types1,2
- No electrical current passes through tissue – no grounding pad is used, and no spark, arcing, or stray current, no stimulation of muscles or nerves
- Surgeons using the FMwand report no interference with electrophysiological monitoring or cochlear implants1,3
Brain Corticotomy Study (Pig): First incision (1) was made by bipolar vascular sealing, followed by cold blade incision and suction dissection. Second incision (2) was made by FMwand at identical depth and in a single pass. MR imaging at 1.5 hours post procedure demonstrated FMwand incision resulted in less than 1/2 the edema depth.4
FMX Clinical Applications
- Cranial tumor resection*
- Spinal tumor resection*
- Chiari malformation*
- Tethered cord*
- Cortical resection*
* Based on surgeon experiences
FMX Papers & Publications
Peer-Reviewed Clinical Papers
- Comparison of ferromagnetic induction and bipolar electrosurgery and suction in corticotomies in pig cerebrum
Bowers, Christian A. et al. International Journal of Surgery , Volume 16 , 55 – 59 – The effects of newer energy-based surgical dissection and coagulation modalities on cerebral tissue have not been investigated. Several instruments have been developed to address the limitations of traditional electrosurgical instruments in the nervous system. We compared the effects of standard bipolar electrocautery and suction (BPS) with those of a new ferromagnetic induction (FMI) device in corticotomies of pig cerebral tissue as assessed by magnetic resonance imaging (MRI) and histological analysis.
- The application of ferromagnetic dissection in neurosurgery: A preliminary study. Aaron Mohanty MD; David Paul Paulson MD; Sohum K Desai MD; Achal Patel MD; Joel T. Patterson MD. Division of Neurosurgery. University of Texas Medical Branch at Galveston (UTMB), Galveston, Texas, USA. – We report our initial experience with the FM wand, a new tissue dissection technique using ferromagnetic energy. It differs from electrosurgery in that radio frequency (RF) current never passes into tissue
- Ferromagnetic Dissection in a Rat Glioma Model. Sina Tok, Marian C. Neidert, Momen Sharab, I-Mei Siu, Jeanine P. Reyes,
Vanessa Charubhumi, Robert T. Wicks, Charles Eberhart, George I. Jallo, Betty M. Tyler, Journal of Cancer Therapy, 2015, 6, 613-621 – The histologic and observational findings of this study suggest that FMwand is safe and effective for hemostatic soft-tissue cutting and coagulation. Further investigation including the evaluation of soft-tissue healing is mandatory to determine the long-term efficiency of the novel modality.
- Internal data on file
- Comparison of the effects of surgical dissection devices on the rabbit liver. MacDonald, J.D., Bowers, C.A., Chin, S.S. et al. Surg Today (2014) 44: 1116. doi:10.1007/s00595-013-0712-4
- Freedom from electromagnetic interference between cardiac implantable electronic devices and the FMwand ferromagnetic surgical system. Weiss, J. Peter Manwaring, Preston et al. Journal of Clinical Anesthesia , Volume 25 , Issue 8 , 681 – 684
- Comparison of ferromagnetic induction and bipolar electrosurgery and suction in corticotomies in pig cerebrum. Bowers, Christian A. et al. International Journal of Surgery , Volume 16 , 55 – 59
FMwand Hemostatic Dissector
FMwand hemostatic dissector is an intelligent thermal dissection device that precisely cuts and coagulates with a fraction of the tissue injury compared to monopolar electrosurgery, without passing any electrical current through the patient.
CO2 Laser in Neurosurgery
For over 30 years, the CO2 laser has been considered the gold standard for precise hemostatic tissue cutting, with a peer-reviewed publication base in the thousands. The CO2 laser has received such accolades due its superﬁcial and controlled interaction with tissue. OmniGuide Surgical is the ﬁrst to introduce a hand-held, ﬂexible CO2 laser, optimized for neurosurgery.
Tissue Interaction and Safety
Absorption in Water
- CO2 laser energy is highly absorbed in water and cuts tissue by vaporizing the water content of cells at the tissue surface.
- High absorption in water leads to a superﬁcial tissue interaction and sub-millimeter thermal effect on surrounding tissue.1
- During surgery, wet cottonoids can be used to shield delicate anatomy from the laser beam
- The hand-held CO2 laser produces a divergent beam, allowing control of resection depth by adjusting distance to tissue and power settings.
- When the CO2 laser cuts tissue, the surrounding thermally affected zone is approximately 150 microns.1
- In comparison, the thermal effect produced by bipolar electrocautery is approximately 1.5mm, a difference of 10x.1
CO2 Laser Clinical Applications
Skull Base: Meningioma & Acoustic Neuroma
- As a hemostatic cutting instrument, the laser enables a dry resection, improving visualization of the surgical ﬁeld. Dry piecemeal resection technique reduces instrument exchange, enhances surgical efﬁciency and may reduce operative time in both large and in ﬁbrous skull base tumor resections.
Recommended Technique: Piecemeal Resection
The laser is used in a cutting mode to resect large portions of tumor mass. Traction is used to achieve efficient hemostatic cutting. Illustrations by J. Pryll
Fig. 1: Cauterize feeding vessel.
Fig. 2: Wet cottonoid shields delicate anatomy. Counter traction used for efficient cutting.
Fig. 3: Suction repositioned to create local traction, enhancing cutting effect.
Fig. 4: Tumor section removed by piecemeal resection technique.
Fig. 5: Tumor debulked by repeating piecemeal resection technique.
Spine: Adherent tumors, Myelotomy, Detethering with Lipoma
- The laser is highly precise for delicate removal of adherent tumor tissue from healthy anatomy. The sub- millimeter thermal effect of the laser allows layer-by-layer removal of tumor tissue while sparing adjacent delicate anatomy.5 The non-electrical hemostatic effect of the laser enables dissection close to nerves without interfering with neuro-monitoring.2
Cerebrovascular: Cavernous Malformations
- The laser enables precise, no-touch dissection at the interface between diseased and healthy tissue. The low proﬁle of the instrument and its sub-millimeter thermal effect facilitate complex resections through deep approaches and within pristine anatomy (i.e., brainstem, thalamus).3
- Ryan RW, Wolf T, Spetzler RF, Coons SW, Fink Y, Preul MC. Application of a ﬂexible CO2 laser ﬁber for neurosurgery: laser-tissue interactions. J. Neurosurgery 2010; 112.2: 434-443
- Silverstein H, Norrel H, Hyman SM. Simultaneous use of CO2 laser with continuous monitoring of eighth cranial nerve action potential during acoustic neuroma surgery. Otolaryngology Head Neck Surg. 1984; 92.1
- Killroy, BD, Chang SW, Wait SD, Spetzler RF. Use of Flexible Hollow-Core CO2 Laser in Microsurgical Resection of CNS Lesions: Early Surgical Experience. Neurosurgery 2010; 66.6: 1187-1192
- Ryan RW, Spetzler RF, Preul MC. Aura of technology and the cutting edge: a history of lasers in neurosurgery. Neurosurgery Focus 2009; 27:E6
- Browd SR, Zauberman J, Karandikar M, Ojemann JG, Avellino AM, Ellenbogen RG. A new ﬁber-mediated carbon dioxide laser facilitates pediatric spinal cord detethering. Technical note. J Neurosurg Pediatr. 2009; 4:280-284.
BeamPath® NEURO Instrumentation
BeamPath NEURO instrumentation provides surgeons the visibility and access required to enable more complete disease removal in neurosurgical procedures. BeamPath NEURO handpieces are available in lengths ranging from 3.5cm to 10cm in both straight and bayonet configurations. (Not available for use in Europe)
Thulium Laser Technology in Neurosurgery
Neuro Tumor Resection
Endoscopic resection, vaporization and coagulation of tumors is carried out by means of the RevoLix jr. laser and the same ultra thin laser fiber through the working channel of the endoscope. Patient safety and procedural performance benefits form the universal use of the laser fiber and the avoidance of mechanical effect known from conventional instruments.
Open neurosurgical procedures like excision of brain tumours or lipoma resection (tethered cord syndrome) benefit from the precise laser effect of the RevoLix jr. laser for tissue resection, vaporization, coagulation and hemostasis.
Endoscopic ventriculocisternostomy, 3rd ventriculostomy and fenestration of cysts benefit from the precise vaporization, coagulation and hemostasis by the RevoLix jr. laser. The well defined optical penetration of the RevoLix jr. laser creates a self limited laser effect as well in tissue as in liquid for the fenestration of membranes and simultaneous protection of adjacent brain structure. Vascularized and avascular tissue is precisely vaporized by means of absorbed laser light. The surgical laser procedure eliminates any mechanical effect to the surrounding tissue.
* These products are not intended for use in clinical applications in neurosurgery in the USA.
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