Histological Analysis of the Damage Produced by a Novel Plasma Microscalpel (Airplasma)

Introduction: The technology known as Airplasma operates by converting air into plasma, creating an efficient energy carrier. The foundation of Airplasma hinges on nullifying the insulating properties of air, accomplished by subjecting it to a powerful oscillating electromagnetic field at high voltage. This process breaks dielectric bonds, effectively transforming air into a proficient conductor. The energy conveyed in the form of plasma becomes visually apparent through a luminous glow. The cutting action, conducted at an average dissipation temperature of 50°C, results in a clean, cool incision without the necessity to apply any mechanical force. More, it achieves absolute precision and gentle coagulation through protein denaturation of capillary vessels and trauma-free tissue cutting. This technology has already been used in several surgical scenarios (Dermatology, Plastic Surgery, Veterinary) but not yet in microneurosurgery.

Aims and Scopes: With the aim to understand the effect of this completely novel technology on neural tissues, we performed a prospective evaluation of histological damages created by Airplasma in comparison with those created by the most widely used bipolar forceps.

Methods: The study was approved by our local Ethical Committee (2022–3.11/653). The histopathological examination was conducted on a specimen of brain gliomas and intracranial meningiomas. Once the tumor is resected, two specimens (~1 × 1 cm) are created and then the surface of each is either cauterized or cut with a plasma tip. The pathologic evaluation of the specimens was performed using an in-house scale of tissue damages: (1) coagulative necrosis; (2) elongated nuclei; (3) homogeneous, eosinophilic aspect of the cytoplasm; (4) nucleus-cytoplasm shrinkage). These features were quantitively evaluated (the percentage of the analyzed section out of the total of examined sections). The neuropathologist was blind about the type of cut made on the specimen (cautery vs plasma).

Results: Forty specimens were analyzed (24 gliomas and 16 meningiomas). Histological observation demonstrates that the cellular damage was largely more evident in the specimens that were cauterized compared with those cut by plasma scalpel.

Conclusion: The Airplasma technology exhibited significantly reduced cellular harm in comparison to traditional electrocautery. Hence our results support a high level of safety in the use of this new technology since the lateral thermal injury is significantly reduced. This outcome is likely attributed not solely to its capacity for breaking and altering protein bonds, but also to the low operational temperatures (below 50°C). This study was not intended to present plasma technology as an alternative to bipolar cater, which is still of paramount utility in neurosurgery. Rather, this instrument appears suitable for microneurosurgery, where precise cutting, minimized temperature, very low lateral thermal injury, and the absence of mechanical forces are of paramount importance. Further studies are needed to confirm its utility in clinical practice.

Publication History

Article published online:
07 February 2025