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Yang Y, Peng Y, Chen K, Wei Y, Li B, Liu F. Laparoscopic liver resection with "ultrasonic scalpel mimic CUSA" technique. Surg Endosc 2022; 36:8927-8934. [PMID: 35672503 DOI: 10.1007/s00464-022-09341-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/13/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Liver parenchymal transection is the most critical step for laparoscopic liver resection (LLR). Ultrasonic scalpel (Harmonic) is a common used energy instrument in LLR; however, it is only recommended for superficial layer transection and the Cavitron Ultrasonic Surgical Aspirator (CUSA) is recommended for deep layer dissection. We herein introduce the "Harmonic mimic CUSA" technique for LLR. METHODS We retrospectively reviewed the medical records of the patients who underwent LLR using CUSA or the "Harmonic mimic CUSA" for parenchymal transection between July 2018 and October 2020 at West China Hospital of Sichuan University. Observation indicators included general demographic information, operative time, intraoperative blood loss, blood transfusion volume, complication rate, hospital stay, and the costs. Perioperative data was compared between the two groups by propensity score matching analysis (PSM). RESULTS A total of 298 patients, including 192 in Harmonic group and 106 in CUSA group, were enrolled in this study. After a 1:1 PSM, 99 patients using "Harmonic mimic CUSA" were matched with 99 patients via CUSA for parenchymal transection in LLRs. The Harmonic group had significantly less intraoperative blood loss (mean, 150 ml vs. 250 ml, P < 0.001), shorter operative time (mean 170 min vs. 250 min, P < 0.001) and less costs (mean 6723$ vs. 8307$, P < 0.001). The conversion to laparotomy, length of postoperative hospital stay, complications were comparable between the two groups. There perioperative mortality was nil. CONCLUSION The "Harmonic mimic CUSA" technique is safe, simple and feasible for LLR, which may be an alternative to CUSA for LLR.
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Affiliation(s)
- Yubo Yang
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu, 610041, Sichuan Province, China
| | - Yufu Peng
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu, 610041, Sichuan Province, China
| | - Kefei Chen
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu, 610041, Sichuan Province, China
| | - YongGang Wei
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu, 610041, Sichuan Province, China
| | - Bo Li
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu, 610041, Sichuan Province, China
| | - Fei Liu
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu, 610041, Sichuan Province, China.
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Manoli E, Mason S, Ford L, Adebesin A, Bodai Z, Darzi A, Kinross J, Takats Z. Validation of Ultrasonic Harmonic Scalpel for Real-Time Tissue Identification Using Rapid Evaporative Ionization Mass Spectrometry. Anal Chem 2021; 93:5906-5916. [PMID: 33787247 PMCID: PMC8153397 DOI: 10.1021/acs.analchem.1c00270] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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In this study, we integrate rapid
evaporative ionization mass spectrometry
(REIMS) with the Harmonic scalpel, an advanced laparoscopic surgical
instrument that utilizes ultrasound energy to dissect and coagulate
tissues. It provides unparalleled manipulation capability to surgeons
and has superseded traditional electrosurgical tools particularly
in abdominal surgery, but is yet to be validated with REIMS. The REIMS
platform coupled with the Harmonic device was shown to produce tissue-specific
lipid profiles through the analysis of porcine tissues in both negative
and positive ionization modes. Comparison with other methods of electrosurgical
dissection, such as monopolar electrosurgery and CO2 laser,
showed spectral differences in the profile dependent on the energy
device used. The Harmonic device demonstrated major spectral differences
in the phospholipid region of m/z 600–1000 compared with the monopolar electrosurgical and
CO2 laser-generated spectra. Within the Harmonic REIMS
spectra, high intensities of diglycerides and triglycerides were observed.
In contrast, monopolar electrosurgical and laser spectra demonstrated
high abundances of glycerophospholipids. The Harmonic scalpel was
able to differentiate between the liver, muscle, colon, and small
intestine, demonstrating 100% diagnostic accuracy. The validation
of the Harmonic device–mass spectrometry combination will allow
the platform to be used safely and robustly for real-time in vivo surgical tissue identification in a variety of clinical
applications.
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Affiliation(s)
- Eftychios Manoli
- Department of Surgery and Cancer, Imperial College London, St Marys Hospital, London W2 1NY, United Kingdom
| | - Sam Mason
- Department of Surgery and Cancer, Imperial College London, St Marys Hospital, London W2 1NY, United Kingdom
| | - Lauren Ford
- Department of Surgery and Cancer, Imperial College London, St Marys Hospital, London W2 1NY, United Kingdom
| | - Afeez Adebesin
- Department of Surgery and Cancer, Imperial College London, St Marys Hospital, London W2 1NY, United Kingdom
| | - Zsolt Bodai
- Department of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, St Marys Hospital, London W2 1NY, United Kingdom
| | - James Kinross
- Department of Surgery and Cancer, Imperial College London, St Marys Hospital, London W2 1NY, United Kingdom
| | - Zoltan Takats
- Department of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
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Arvind NK, Ali Q, Singh O, Gupta S, Sahay S. Contemporary use of ultrasonic versus standard electrosurgical dissection in laparoscopic nephrectomy: Safety, efficacy and cost. Arab J Urol 2018; 16:335-341. [PMID: 30147959 PMCID: PMC6105343 DOI: 10.1016/j.aju.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/02/2018] [Accepted: 05/15/2018] [Indexed: 12/04/2022] Open
Abstract
Objective To assess the safety, efficacy and cost-effectiveness of ultrasonic dissection (USD) compared with standard monopolar electrosurgery (ES) in laparoscopic nephrectomy (LN). Patients and methods Retrospective analysis of patients’ records who underwent elective LN was performed. Patients were divided in to two groups: USD and ES groups depending on the energy source used during LN. The preoperative (demographics, indication for surgery), intraoperative (conversion to open surgery, operative time, estimated blood loss [EBL], complications), and postoperative (morbidity/mortality, volume of drainage, hospital stay, cost) data were collected and analysed. Results Between February 2004 and February 2008, 136 patients were included. The indications for nephrectomy were: inflammatory (51 patients), non-inflammatory (64), and tumours (21). The two groups were similar for preoperative data. The conversion rate to open surgery (12.5%) and mean operative time did not differ significantly between the groups. However, intraoperative mean EBL was significantly less with USD, at 140.8 mL vs 182.6 mL for ES. There were no differences in postoperative parameters and morbidity. USD was significantly more expensive than ES (59 000 vs 26 000 Indian Rupees). Conclusions ES is a safe and feasible tool like USD in LN when used with caution. USD facilitates completion of difficult cases and reduces intraoperative blood loss. However, the majority of LNs can be completed safely with ES. ES is sturdy and cheap; therefore, selective use of USD appears to be the most cost-effective policy in the developing world.
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Affiliation(s)
- Nand Kishore Arvind
- Department of Urology, Bhopal Memorial Hospital and Research Centre, Bhopal, India
| | - Qutubuddin Ali
- Department of Urology, Bhopal Memorial Hospital and Research Centre, Bhopal, India
| | - Onkar Singh
- Department of Urology, Bhopal Memorial Hospital and Research Centre, Bhopal, India
| | - Shilpi Gupta
- Department of Urology, Bhopal Memorial Hospital and Research Centre, Bhopal, India
| | - Surbhi Sahay
- Department of Anaesthesiology, Bhopal Memorial Hospital and Research Centre, Bhopal, India
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Blankenship DR, Gourin CG, Porubsky EA, Porubsky ES, Klippert FN, Whitaker EG, Terris DJ. Harmonic Scalpel versus Cold Knife Dissection in Superficial Parotidectomy. Otolaryngol Head Neck Surg 2016; 131:397-400. [PMID: 15467607 DOI: 10.1016/j.otohns.2004.03.043] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES: Use of the Harmonic Scalpel has recently been described in thyroid surgery, in which it appears to result in decreased operative time and blood loss without increasing the incidence of nerve injury when compared to conventional techniques of vessel ligation and tissue division. We sought to determine whether the use of the Harmonic Scalpel in superficial parotidectomy was associated with a difference in operative time, blood loss, or facial nerve injury compared with conventional techniques. STUDY DESIGN AND SETTING: The medical records of all patients who underwent superficial parotidectomy for benign parotid pathology at the Medical College of Georgia and Veterans Affairs Hospital of Augusta, Georgia, from 1999 to 2002 were retrospectively reviewed. Patients were excluded if they had a history of a bleeding disorder, prior facial nerve weakness, prior parotid surgery, malignant pathology, or required total parotidectomy. RESULTS: Forty-two patients were eligible for inclusion. Nineteen patients underwent Harmonic Scalpel parotidectomy (HS) and 21 patients underwent conventional parotidectomy (control group). There were no significant differences between the 2 groups with respect to demographic data, pathology, or tumor size. Use of the Harmonic Scalpel was associated with a significant reduction in length of surgery (167.5 ± 42.6 min vs. 195.5 ± 37.4 min for controls, P = 0.03) and intraoperative blood loss (37.5 ± 25.8 mL vs. 60.0 ± 37.1 mL for controls, P = 0.03). There were no significant differences between the HS or control groups with respect to postoperative drain output (48.7 ± 33.8 mL vs. 48.0 ± 22.9 mL, respectively, P > 0.05) or facial nerve function. CONCLUSION: Use of the Harmonic Scalpel for superficial parotidectomy is safe and may result in reduced operative time and blood loss compared with conventional techniques. SIGNIFICANCE: A safe alternative to cold knife superficial parotidectomy is presented with the potential benefits of reduced operative time and blood loss demonstrated.
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Affiliation(s)
- D Russ Blankenship
- Department of Otolarygology-Head and Neck Surgery, Medical College of Georgia, Augusta 30912, USA
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White A, Kucukak S, Lee DN, Swanson SJ. Energy-Based Ligation of Pulmonary Vessels: A Six-Year Experience With Ultrasonic Shears in Video-Assisted Thoracoscopic Lobectomy and Segmentectomy. Ann Thorac Surg 2016; 101:1334-7. [PMID: 26794898 DOI: 10.1016/j.athoracsur.2015.10.070] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/05/2015] [Accepted: 10/26/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Mechanical staplers are widely employed in minimally invasive anatomic lung resections, but have limitations when managing smaller pulmonary arterial and venous branches. Published data is lacking regarding the safety and efficacy of pulmonary vessel ligation using ultrasonic shears. We describe a single-surgeon experience employing ultrasonic shears for the ligation of pulmonary vasculature during lobectomy and segmentectomy, primarily in the setting of video-assisted thoracic surgery (VATS) resection. METHODS A retrospective chart review was conducted for all patients, who underwent anatomic resection, between 2008 and 2014. Charts were divided into 2 groups based on method of ligation (energy based or conventional). Dictated operative reports were reviewed and patient demographics, tumor characteristics, and complications were recorded. RESULTS Ultrasonic shears were used for pulmonary vessel ligation (5 to 6 mm) in 82 of 283 anatomic resections. A total of 118 vessels were ligated with ultrasonic shears. The majority of patients (83%) in the energy-based ligation group underwent VATS resection. There were fewer complications in the energy-based ligation group (26% vs 38%; p = 0.05); however, rates of intraoperative transfusion, prolonged air leak, empyema, and return to the operating room were similar across the 2 groups, and no statistically significant difference was found. There were no postoperative complications directly attributable to ultrasonic vessel ligation. CONCLUSIONS Energy-based ligation of small-diameter pulmonary vessels is a safe and useful adjunct in anatomic VATS resection and a viable alternative to mechanical stapling. Its narrow profile and thin blades make it ideal for ligation of pulmonary vasculature, particularly where the size and necessary clearance of mechanical staplers prohibit safe dissection.
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Affiliation(s)
- Abby White
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Suden Kucukak
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel N Lee
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Scott J Swanson
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Sista F, Abruzzese V, Schietroma M, Cecilia EM, Mattei A, Amicucci G. New harmonic scalpel versus conventional hemostasis in right colon surgery: a prospective randomized controlled clinical trial. Dig Surg 2013; 30:355-61. [PMID: 24080607 DOI: 10.1159/000354864] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 08/02/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Harmonic Scalpel (HS) is a device that uses vibrations to coagulate and cut tissues simultaneously. Its advantages are represented by minimal lateral thermal tissue damage, less smoke formation, no neuromuscular stimulation and no transmission of electricity to the patient. METHODS A total of 211 consecutive patients (113 men, 98 women; mean age 64 years) undergoing hemicolectomy for cancer of the right colon were divided into two groups, namely those in whom the operation was performed using a new HS handpiece (NHS; 108 patients) and those assigned to conventional hemostasis (CH; 103 patients). The two surgical groups were compared regarding patients' age and sex, tumor size, location, histotype and local invasiveness assessed by American Joint Cancer Committee stage, operative time, fluid content in the suction balloon (drainage volume) during the first 1-3 days after surgery, hospital stay and complications. RESULTS Ultrasonic energy delivered through an HS has been shown to be safe and to produce minimal damage to the surrounding tissues because of its minimal heat production. Electrical devices allow hemostatic control in vessels up to 3 mm in diameter, while HS can coagulate vessels up to 5 mm in diameter; thus, HS allows not only better control of bleeding but also of lymphorrhea. In fact, the amount of fluid collected in the drainage was significantly lower in the NHS group compared to the CH group. Protein depletion influences the patient's regenerative capacity and thus also the occurrence of complications and recovery time. CONCLUSION NHS is a useful device in colon surgery; it facilitates surgical maneuvers and reduces operative times and blood and lymphatic losses, allowing satisfactory maintenance of protein storage. This results in a lower incidence of complications and faster recovery by patients.
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Affiliation(s)
- Federico Sista
- Dipartimento di Scienze Cliniche Applicate e Biotecnologie, University of L'Aquila, L'Aquila, Italy
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Common uses and cited complications of energy in surgery. Surg Endosc 2013; 27:3056-72. [PMID: 23609857 DOI: 10.1007/s00464-013-2823-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 11/05/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Instruments that apply energy to cut, coagulate, and dissect tissue with minimal bleeding facilitate surgery. The improper use of energy devices may increase patient morbidity and mortality. The current article reviews various energy sources in terms of their common uses and safe practices. METHODS For the purpose of this review, a general search was conducted through NCBI, SpringerLink, and Google. Articles describing laparoscopic or minimally invasive surgeries using single or multiple energy sources are considered, as are articles comparing various commercial energy devices in laboratory settings. Keywords, such as laparoscopy, energy, laser, electrosurgery, monopolar, bipolar, harmonic, ultrasonic, cryosurgery, argon beam, laser, complications, and death were used in the search. RESULTS A review of the literature shows that the performance of the energy devices depends upon the type of procedure. There is no consensus as to which device is optimal for a given procedure. The technical skill level of the surgeon and the knowledge about the devices are both important factors in deciding safe outcomes. CONCLUSIONS As new energy devices enter the market increases, surgeons should be aware of their indicated use in laparoscopic, endoscopic, and open surgery.
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Homayounfar K, Meis J, Jung K, Klosterhalfen B, Sprenger T, Conradi LC, Langer C, Becker H. Ultrasonic scalpel causes greater depth of soft tissue necrosis compared to monopolar electrocautery at standard power level settings in a pig model. BMC Surg 2012; 12:3. [PMID: 22361346 PMCID: PMC3305372 DOI: 10.1186/1471-2482-12-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 02/23/2012] [Indexed: 11/25/2022] Open
Abstract
Background Ultrasonic scalpel (UC) and monopolar electrocautery (ME) are common tools for soft tissue dissection. However, morphological data on the related tissue alteration are discordant. We developed an automatic device for standardized sample excision and compared quality and depth of morphological changes caused by UC and ME in a pig model. Methods 100 tissue samples (5 × 3 cm) of the abdominal wall were excised in 16 pigs. Excisions were randomly performed manually or by using the self-constructed automatic device at standard power levels (60 W cutting in ME, level 5 in UC) for abdominal surgery. Quality of tissue alteration and depth of coagulation necrosis were examined histopathologically. Device (UC vs. ME) and mode (manually vs. automatic) effects were studied by two-way analysis of variance at a significance level of 5%. Results At the investigated power level settings UC and ME induced qualitatively similar coagulation necroses. Mean depth of necrosis was 450.4 ± 457.8 μm for manual UC and 553.5 ± 326.9 μm for automatic UC versus 149.0 ± 74.3 μm for manual ME and 257.6 ± 119.4 μm for automatic ME. Coagulation necrosis was significantly deeper (p < 0.01) when UC was used compared to ME. The mode of excision (manual versus automatic) did not influence the depth of necrosis (p = 0.85). There was no significant interaction between dissection tool and mode of excision (p = 0.93). Conclusions Thermal injury caused by UC and ME results in qualitatively similar coagulation necrosis. The depth of necrosis is significantly greater in UC compared to ME at investigated standard power levels.
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Affiliation(s)
- Kia Homayounfar
- Department of General and Visceral Surgery, University Medical Center Goettingen, Georg-August-University, Germany.
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Kowalski LP, Sanabria A, Vartanian JG, Lima RA, Toscano de Mendonca UB, Roberto dos Santos C, Boldrini Júnior D, Barbalho de Mello LE, Pinto FP, Lehn CN, Correa LAC, Dedivitis RA, Guimarães AV, Pedruzzi PAG, Ramos GHA, Gonçalves AJ, Suehara AB, Kanda JL, de Castro Capuzzo R, Carlos de Oliveira J, Curado MP, Francisco de Góis Filho J, Fukuyama E, Beserra Júnior IM, Bentes de Carvalho Neto P, Carvalho AL. Total thyroidectomy with ultrasonic scalpel: A multicenter, randomized controlled trial. Head Neck 2012; 34:805-12. [DOI: 10.1002/hed.21815] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2011] [Indexed: 11/10/2022] Open
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Burton JN, El-Deiry MW. Use of ultrasonic shears in the harvest of the free osteocutaneous fibula flap. Ann Otol Rhinol Laryngol 2011; 120:563-8. [PMID: 22032068 DOI: 10.1177/000348941112000902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Traditionally, the fibula free flap has been raised by electrocautery and sharp dissection with clipping and tying of vessels. Use of the ultrasonic scalpel has been proposed to be a faster, more hemostatic, and less traumatic method of harvest. METHODS We performed a retrospective chart review of 58 patients who underwent fibula free flap reconstruction between 2007 and 2010. The main outcome measures were blood loss, operative time, and flap harvest time. RESULTS Use of the ultrasonic shears was not associated with a statistically significant reduction in intraoperative blood loss, operative time, or flap harvest time. However, the flap harvest time did trend toward statistical significance (p = 0.073). Use of distribution-based effect sizes demonstrated a moderate clinically important difference in favor of the ultrasonic shears for both operative time and flap harvest time. CONCLUSIONS The use of ultrasonic shears is comparable to traditional methods of fibula free flap harvest and can be considered an alternative method of harvest.
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Affiliation(s)
- Jon N Burton
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida College of Medicine, USA
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Mantke R, Halangk W, Habermann A, Peters B, Konrad S, Guenther M, Lippert H. Efficacy and safety of 5-mm-diameter bipolar and ultrasonic shears for cutting carotid arteries of the hybrid pig. Surg Endosc 2010; 25:577-85. [PMID: 20614136 DOI: 10.1007/s00464-010-1224-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 01/07/2010] [Indexed: 01/11/2023]
Abstract
BACKGROUND Experimental data about the efficacy and safety of sealing devices are rare. Therefore, this study investigated these parameters for three commercially available energy-based vascular sealing and cutting systems. METHODS In male hybrid pigs, 487 carotid artery segments were sealed and cut using the harmonic scalpel or several bipolar sealing devices. The sealing failure rate, burst pressure, process time, and extent of lateral thermal damage were analyzed. RESULTS A regular sealing and cutting process in more than 90% of the carotid arteries was found using the following instruments: LS1520, ACE (level 1), ACE (level 3), CS14C (level 1), WAVE (level 1), and WAVE (level 5). The largest failure rate was found for the CS14C device (level 5: initial sealing failure, 21.5%). The maximal mean burst pressure (1727±453 mmHg) was reached using the ACE device (level 1). Significant differences were found in the size of the lateral thermal damage, which a ranged from 2.5 mm (LS1520) to 1.51 mm (CS14C, level 1). The process time ranged widely from 6.8 s (ACE, level 5) to 31.83 s (WAVE, level 1). CONCLUSION The current study demonstrated that all the tested devices are efficacious and safe in sealing and cutting arteries up to 5 mm in diameter. All the devices showed supraphysiologic mean burst pressures. Differences in failure rate, thermal damage, and process time lead to an advised application of the different systems.
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Affiliation(s)
- René Mantke
- Department of Surgery, Otto-von-Guericke-University of Magdeburg, Magdeburg, Germany.
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Comparison of Ligasure Vessel Sealing System, Harmonic Scalpel, and Conventional Hemostasis in Total Thyroidectomy. Otolaryngol Head Neck Surg 2009; 141:496-501. [DOI: 10.1016/j.otohns.2009.06.745] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 05/14/2009] [Accepted: 06/29/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE: The aim of the study was to compare the efficiency, safety, and cost of the different methods of hemostasis (conventional hemostasis versus LigaSure vessel sealing system [LVSS] versus harmonic scalpel) currently available for thyroid surgery. STUDY DESIGN: Randomized, controlled trial. SETTING: The study was conducted from September 2007 to December 2008 in a university hospital. PATIENTS AND METHODS: Sixty patients (48 females and 12 males) underwent a total thyroidectomy for multinodular goiter. They were randomly assigned into three groups: group one (n = 20), conventional hemostasis; group two (n = 20), LigaSure; and group three (n = 20), harmonic scalpel. RESULTS: For group three, the mean operative time was 37 minutes shorter than group one ( P < 0.001) and eight minutes shorter than group two ( P = 0.04). The complications rate was similar among the three groups. The mean postoperative paracetamol consummation in group one was 1.4 g greater than in group two ( P = 0.016) and 1.3 g greater than in group three ( P = 0.02). The overall average operative cost was 11 and 85 dollars cheaper for groups two and three than for group one, respectively ( P < 0.001). CONCLUSION: Total thyroidectomy using the harmonic scalpel was the fastest procedure because it was bloodless, and hemostasis and sectioning were controlled with a single instrument; it was, therefore, the most inexpensive procedure because of the reduction of operative time and staff cost. The operative safety was similar for all three procedures. In our series, the harmonic scalpel and the LVSS caused less pain than the conventional hemostasis.
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Pons Y, Gauthier J, Clément P, Conessa C. Ultrasonic partial glossectomy. HEAD & NECK ONCOLOGY 2009; 1:21. [PMID: 19552821 PMCID: PMC2710330 DOI: 10.1186/1758-3284-1-21] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Accepted: 06/24/2009] [Indexed: 11/18/2022]
Abstract
Introduction Partial glossectomy is the main treatment for tongue carcinoma. The resection of the tongue, which is a very vascularised tissue, requires a good hemostasis. The advantage of the harmonic scalpel is in combining sectioning and hemostasis in one single instrument, allowing a bloodless dissection of soft tissue. The aim of this prospective study was to evaluate the benefits and risks when using a harmonic scalpel in partial glossectomy. Subjects and Methods In this prospective study conducted in a university hospital from march 2004 to Decemeber 2008, eighteen consecutive patients underwent a partial glossectomy with the use of harmonic scalpel. Results were compared with previous surgical procedures performed between September 2000 and February 2004 by monopolar hemostasis by our team (n = 12) when the harmonic scalpel was not available. Results All 18 patients underwent partial glossectomy with the harmonic scalpel as the only instrument of section and hemostasis. The median blood loss was of 0 mL. The median operative time was 29 minutes (16 minutes less than partial glossectomies performed with conventional hemostasis. P < .001). No operative complications occurred. Two post-operative bleedings (5 days and 7 days after the glossectomy) occurred necessitating a new surgery to ligate the lingual artery. The margins of the resection were acceptable and no recurrence appeared. Conclusion The harmonic scalpel makes it fast and easy to perform a partial glossectomy with no bleeding. Ligation of the lingual artery (when it is visualized during the dissection) should be performed because of the frequency (more than 10% in our series) and because of the potential gravity of a lingual post-operative bleeding.
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Affiliation(s)
- Yoann Pons
- Head and Neck Surgery Department, Val of Grace's Academic Military Hospital, Paris, France.
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Rimonda R, Arezzo A, Garrone C, Allaix ME, Giraudo G, Morino M. Electrothermal bipolar vessel sealing system vs. harmonic scalpel in colorectal laparoscopic surgery: a prospective, randomized study. Dis Colon Rectum 2009; 52:657-61. [PMID: 19404071 DOI: 10.1007/dcr.0b013e3181a0a70a] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to compare the efficacy and safety of laparoscopic colorectal surgery performed with the aid of LigaSure vessel-sealing system or Ultracision. METHODS Patients eligible for elective laparoscopic right or left hemicolectomy or anterior resection of rectum were randomly assigned to either the use of Ligasure or Ultracision. The primary end point was intraoperative reduction of blood loss. Secondary end points were intraoperative and postoperative morbidity and operative time. RESULTS Between April 2005 and December 2006, 140 consecutive patients were included in the study (70 Ligasure and 70 Ultracision. We performed 31 right hemicolectomies, 69 left hemicolectomies, and 40 anterior resections of rectum. Blood loss was 109.6 ml (Ultracision 107.9 ml vs. Ligasure 111.2 ml, P value = 0.72). Intraoperative complication rate was 2.8 percent (Ultracision 1.4 percent vs. Ligasure 4.2 percent, P value < 0.01). Postoperative mortality was 0.7 percent. The overall conversion rate was 7.8 percent, 6 in the Ligasure group and 5 in the Ultracision group (P value = 0.09). Operative time, considered from pneumoperitoneum to minilaparotomy, was 115.7 minutes (Ultracision 114.8 minutes vs. Ligasure 116.3 minutes, P value = 0.89). CONCLUSIONS Results showed that Ligasure and Ultracision are both useful instruments for laparoscopic colorectal surgery with no significant difference in terms of intraoperative/postoperative morbidity and operative time. Choice of which technique to perform should be according to the surgeon's preference.
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Ogura G, Nakamura R, Muragaki Y, Hashizume M, Iseki H. Development of an articulating ultrasonically activated device for laparoscopic surgery. Surg Endosc 2008; 23:2138-42. [PMID: 19116745 DOI: 10.1007/s00464-008-0248-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 10/17/2008] [Indexed: 12/16/2022]
Abstract
BACKGROUND Ultrasonically activated devices (USADs) offer excellent coagulating dissection performance and are broadly used, particularly in endoscopic operations. Traditional USADs, however, have fixed linear shape and are thus limited in the directions from which organs can be approached. We have developed a small USAD transducer attached to the tip of an articulating device, offering a new kind of USAD in which the tip can bend as desired. We describe herein an evaluation of the coagulating dissection performance of this new articulating USAD and an in vivo confirmation of clinical usefulness. METHODS To evaluate coagulating dissection performance, we compared coagulating shearing on porcine splenic arteries between the articulating USAD and a Harmonic Scalpel II (HSII), representing a traditional USAD. Changing the amplitude of vibration between 60 microm and 80 microm and grip force among 1, 2, and 3 N, we measured the time required for division and bursting pressure of coagulating dissection. An in vivo experiment in a pig was also used to confirm the usefulness of the articulating USAD in laparoscopic operations. RESULTS Division time did not differ significantly between the articulating USAD and HSII with an 80-microm amplitude of vibration and a grip force of 2 or 3 N. Bursting pressure of blood vessels showed no significant difference between articulating USAD and HSII under all experimental conditions. In the in vivo experiment, the new bendable tip of the articulating USAD displayed coagulating dissection performance equivalent to that of the traditional USAD. CONCLUSIONS We have developed a new articulating USAD that can broaden the range of methods and approaches available for USADs and improve usefulness and safety.
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Affiliation(s)
- G Ogura
- Faculty of Advanced Techno-Surgery, Department of Advanced Biomedical Engineering and Science, Graduate School of Medical Science, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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Roth JA, Pincock T, Sacks R, Forer M, Boustred N, Johnston W, Bailey M. Harmonic Scalpel Tonsillectomy versus Monopolar Diathermy Tonsillectomy: A Prospective Study. EAR, NOSE & THROAT JOURNAL 2008. [DOI: 10.1177/014556130808700613] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
For tonsillectomy, the ultrasonic harmonic scalpel has been purported to cause less tissue injury and postoperative morbidity while providing adequate levels of hemostasis. We undertook a prospective study to compare outcomes in 162 patients who had undergone harmonic scalpel tonsillectomy and 40 patients who had undergone monopolar diathermy tonsillectomy over a 33-month period. We found that patients in the harmonic scalpel group experienced significantly less intraoperative bleeding (5.0 vs. 16.5 ml; p < 0.0001). There was no clinically significant difference between the groups with respect to (1) the amount of operating time, (2) the incidence of postoperative nausea and vomiting, dysphonia, and primary or secondary bleeding, and (3) the amount of time patients needed to resume normal diet and activities.
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Affiliation(s)
- Jason A. Roth
- From the Department of Otorhinolaryngology, Royal Prince Alfred Hospital, New South Wales (NSW), Australia
| | - Tobias Pincock
- From the Department of Otorhinolaryngology, Royal Prince Alfred Hospital, New South Wales (NSW), Australia
| | - Raymond Sacks
- Department of Otorhinolaryngology, Concord Repatriation General Hospital, NSW
| | - Martin Forer
- Department of Otorhinolaryngology, Royal North Shore Hospital, NSW
| | - Neil Boustred
- Department of Otorhinolaryngology, Concord Repatriation General Hospital, NSW
| | - William Johnston
- Department of Otorhinolaryngology, Concord Repatriation General Hospital, NSW
| | - Michael Bailey
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University/The Alfred Hospital, Melbourne, Victoria, Australia
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Gilbey P, Gadban H, Letichevsky V, Talmon Y. Harmonic Scalpel Tonsillectomy Using the Curved Shears Instrument versus Cold Dissection Tonsillectomy: A Retrospective Study. Ann Otol Rhinol Laryngol 2008; 117:46-50. [DOI: 10.1177/000348940811700110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: We compared operating time, intraoperative blood loss, and rate of postoperative bleeding in harmonic scalpel (HS) tonsillectomy using the curved shears instrument to those in cold dissection (CD) tonsillectomy. Methods: The charts of 560 patients who underwent tonsillectomy were retrospectively reviewed. Three hundred nineteen patients underwent CD tonsillectomy between the years 1998 and 1999, and 241 patients underwent HS tonsillectomy using the curved shears instrument between the years 2001 and 2005. For the purpose of evaluation of postoperative bleeding rates, the groups were further stratified by age (11 years of age or less versus 12 years of age or more). Results: For the HS group, the mean operating time was shorter (7 minutes versus 17.57 minutes) and the intraoperative blood loss was lower (0 mL versus 42.12 mL). These differences were statistically significant (p < .05). There was no significant difference in the overall postoperative bleeding rates between the two groups. The postoperative bleeding rate in the HS patients 11 years of age or younger was lower than that in the equivalent age group in the CD group (0.56% versus 2%, respectively), although this difference did not reach statistical significance. The postoperative bleeding rate in the HS patients 12 years of age or older was significantly higher than that in the equivalent age group in the CD group (7.93% versus 1%, respectively; p < .05). Conclusions: Harmonic scalpel tonsillectomy using the curved shears instrument offers advantages over CD tonsillectomy regarding operating time and intraoperative blood loss. In our patients more than 12 years of age, HS tonsillectomy using the curved shears instrument was associated with an increased postoperative bleeding rate compared to CD tonsillectomy.
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Abstract
Since the surgical treatment of hemorrhoidal disease has been characterized by intense postoperative pain, recent studies have tried to modify the standard Milligan-Morgans technique. The up-to-date literature, in the experience of authors, has confirmed that the new method of Harmonic Scalpel? hemorrhoidectomy reduces postoperative pain. The aim of our study was to statistically evaluate, based on our experience, the efficacy of this surgical approach in terms of reducing postoperative pain and establishing a stable hemostasis. Seventy-seven (77) patients suffering from hemorrhoid disease, stage III and IV, underwent surgery in our clinic during the last five years. The postoperative pain was determined using the visual analog scale on the 1st, 2nd and 7th postoperative days. Patients were divided into two groups in regard to the surgical procedure applied. The data were statistically processed using the Statistica 7.0 software. We concluded that Harmonic Scalpel? hemorrhoidectomy, due to less thermal damage, statistically significantly reduced postoperative pain with better hemostasis, compared with Milligan-Morgan's method of treating hemorrhoidal disease. .
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Abstract
Since its first described case in 1991, laparoscopic colon surgery has lagged behind minimally invasive surgical methods for solid intra-abdominal organs in terms of acceptability, dissemination, and ease of learning. In colon cancer, initial concerns over port site metastases and adequacy of oncologic resection have considerably dampened early enthusiasm for this procedure. Only recently, with the publication of several large, randomized controlled trials, has the incidence of port site metastases been shown to be equivalent to that of open resection. Laparoscopic surgery for colon cancer has also been demonstrated to be at least equivalent to traditional laparotomy in terms of adequacy of oncologic resection, disease recurrence, and long-term survival. In addition, numerous reports have validated short-term benefits following laparoscopic resection for cancer, including shorter hospital stay, shorter time to recovery of bowel function, and decreased analgesic requirements, as well as other postoperative variables. In benign colonic disease, much less high-quality literature exists supporting the use of laparoscopic methods. Two recent randomized controlled trials have demonstrated some short-term benefits to laparoscopic ileocolic resection for CD, in addition to evident cosmetic advantages. On the other hand, the current evidence on laparoscopic surgery for UC does not support its routine use among nonexpert surgeons outside of specialized centers. Laparoscopic colonic resection for diverticular disease appears to provide several short-term benefits, although these advantages may not translate to cases of complicated diverticulitis. Despite the increasing acceptability of minimally invasive methods for the management of benign and malignant colonic pathologies, laparoscopic colon resection remains a prohibitively difficult technique to master. Numerous technological innovations have been introduced onto the market in an effort to decrease the steep learning curve associated with laparoscopic colon surgery. Good evidence exists supporting the use of second-generation, sleeveless, hand-assist devices in this context. Similarly, new hemostatic devices such as the ultrasonic scalpel and the electrothermal bipolar vessel sealer may be particularly helpful for extensive colonic mobilizations, in which several vascular pedicles must be taken. The precise role of these hemostatic technologies has yet to be established, particularly in comparison with stapling devices and significantly cheaper laparoscopic clips. Finally, recent advances in camera systems are promising to improve the ease with which difficult colonic dissections can be performed.
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Affiliation(s)
- Guillaume Martel
- Division of General Surgery, Minimally Invasive Surgery Research Group, University of Ottawa, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
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Abstract
AIM: To design a hand-assisted laparoscopic approach in an attempt to provide an option for laparoscopic resection of abdominal large viscera.
METHODS: A 5-6 cm incision (for HandPort) and 2 trocars were employed. The main vessel of the target organ was taken as a “core”, and all tissues around the core were taken as peripheral structures. The peripheral structures were dissected first, and the core vessels were treated last. Twenty-six patients underwent laparoscopic deroofing of the hepatic huge cysts, resection of the segments lying at the outer edge of the liver (segments 2 to 6), splenectomy, hemicolectomy, ileocecectomy and subtotal gastrectomy with HandPort device, harmonic scalpel, or Ligasure.
RESULTS: The duration of the procedure was within 2 hours. Blood loss amounted to 8-120 mL. The conversion rate was 3.8% (1/26). All patients had uneventful postoperative courses with less pain, earlier oral intake, and faster recovery, compared with conventional surgery.
CONCLUSION: This method combines the advantages of both open and laparoscopic techniques, achieving better hemostasis effect, shortening the operative time, and is beneficial to the patients.
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Affiliation(s)
- Li-Hua Dai
- Department of Surgery, The First Hospital of Guangzhou,1 Panfu Road, Guangzhou 510180, Guangdong Province, China.
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Morino M, Rimonda R, Allaix ME, Giraudo G, Garrone C. Ultrasonic versus standard electric dissection in laparoscopic colorectal surgery: a prospective randomized clinical trial. Ann Surg 2006; 242:897-901, discussion 901. [PMID: 16327500 PMCID: PMC1409879 DOI: 10.1097/01.sla.0000189607.38763.c5] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the safety and efficacy of the ultrasonic dissection (UC) compared with standard electrosurgery (ES) in laparoscopic colorectal surgery. BACKGROUND DATA High-frequency ultrasound energy was introduced in laparoscopic surgery to improve dissection and coagulation. Very limited data have been published on its use in laparoscopic colorectal surgery. METHODS Patients eligible for elective laparoscopic right or left hemicolectomy (RH and LH), sigmoidectomy (SG), or low anterior resection (LAR) were randomized to either UC or ES. The following data were collected and analyzed: preoperative data (individual patient data, indication for surgery), intraoperative data (conversion to open surgery, conversion ES to UC, operative time, blood loss, complication rate), and postoperative data (morbidity and mortality, volume of drainage, hospital stay). RESULTS Between January 2002 and December 2003, 171 patients underwent elective laparoscopic colorectal resection. Twenty-5 patients did not satisfy the inclusion criteria and were excluded. The diagnosis of the remaining 146 patients was diverticulitis (44), colonic adenoma (31), adenocarcinoma (70), or epidermoid carcinoma (1). These patients underwent laparoscopic RH (28), LH (31), SG (47), or LAR (40). There were no differences in preoperative data. The overall conversion rate to open surgery was 11.6%, with no differences between the two groups; 20.8% undergoing ES were converted to UC, more frequently during right hemicolectomy or low anterior resection. Operative time, the primary endpoint of this study, did not differ between the two groups: UC 93 minutes versus ES 102.6 minutes (P = 0.46). Intraoperative blood loss was significantly less in UC 140.8 mL versus ES 182.6 mL (P = 0.032). No differences were observed in postoperative morbidity or other preoperative or postoperative parameters. CONCLUSIONS UC is a useful device in laparoscopic colorectal surgery that facilitates completion of difficult cases and reduces intraoperative blood loss. Nevertheless, the majority of laparoscopic procedures can be completed with ES. Therefore, selective use of UC appears to be the most cost-effective policy.
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Affiliation(s)
- Mario Morino
- Department of Surgery, Minimally Invasive Surgery Center, University of Turin, Corso A.M. Dogliotti 14, 10126 Turin, Italy.
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Deo S, Hazarika S, Shukla NK, Kar M, Samaiya A. A prospective randomized trial comparing harmonic scalpel versus electrocautery for pectoralis major myocutaneous flap dissection. Plast Reconstr Surg 2005; 115:1006-9. [PMID: 15793437 DOI: 10.1097/01.prs.0000154209.21728.51] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Conventionally, the pectoralis major myocutaneous flap is raised using electrocautery and/or other sharp instruments. The reported morbidity rate using conventional techniques of flap dissection varies from 16 to 63 percent. The purpose of this study was to consider the feasibility of myocutaneous flap dissection using the harmonic scalpel and to compare operative time, blood loss, drainage volume, and morbidity between patients undergoing flap dissection with the harmonic scalpel and those being treated with electrocautery. METHODS Thirty patients with oral cancer, for whom resection and reconstruction using a pectoralis major myocutaneous flap was planned, were recruited in a prospective, randomized two-arm trial. Patients in arm I (n = 15) had flap dissection using electrocautery and patients in arm II (n = 15) had flap dissection using the harmonic scalpel. RESULTS The mean operative duration for flap dissection (84 versus 47 minutes), blood loss (129 versus 36 ml), and total drainage volume (551 versus 302 ml) were found to be significantly less in the harmonic scalpel group. CONCLUSION The results of the study indicate that it is feasible to dissect pectoralis major myocutaneous flaps using the harmonic scalpel with less operative time, blood loss, drainage volume, and morbidity in comparison with electrocautery.
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Affiliation(s)
- Suryanarayana Deo
- Department of Surgical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
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Abstract
Hemostasis and coagulation are vital during thyroidectomy. The gland is highly vascularised and any lack in the control of thyroid vessels has immediate consequence in terms of morbidity. General principles of coagulation are reminded and the use of ultrasonic dissector is presented as an attractive alternative. A comparative study performed in 2000 and more recent data confirm the advantage of the new device in terms of operative time saving.
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Affiliation(s)
- T Defechereux
- Département de Chirurgie Endocrine et Transplantation, CHU de Sart-Tilman, B35, 4000 Liège, Belgique.
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Jackson LL, Gourin CG, Thomas DS, Porubsky ES, Klippert FN, Terris DJ. Use of the Harmonic Scalpel in Superficial and Total Parotidectomy for Benign and Malignant Disease. Laryngoscope 2005; 115:1070-3. [PMID: 15933523 DOI: 10.1097/01.mlg.0000163336.37077.8f] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Use of the harmonic scalpel in superficial parotidectomy for benign parotid disease has been shown to reduce surgical time as well as intraoperative blood loss. We sought to determine whether similar results could be achieved with the expanded use of the harmonic scalpel in parotidectomy for both benign and malignant disease. STUDY DESIGN Retrospective review. METHODS The medical records of all patients undergoing superficial or total parotidectomy from 1999 to 2004 were reviewed. Patients were excluded for a history of bleeding disorder, prior facial nerve weakness, or concurrent neck dissection at the time of parotidectomy. RESULTS Forty-four patients underwent harmonic scalpel parotidectomy and 41 patients underwent conventional cold knife parotidectomy (control group). Use of the harmonic scalpel was associated with a significant reduction in intraoperative blood loss (38.0 +/- 3.6 mL vs. 66.0 +/- 10.8 mL for controls, P < 0.05) and duration of drainage (31.80 +/- 2.4 h vs. 39.29 +/- 2.21 h for controls, P < 0.05). Use of the harmonic scalpel in superficial parotidectomy (n = 35) compared to controls (n = 37) was associated with a significant reduction in intraoperative blood loss (38.0 +/- 4.23 mL vs. 68.0 +/- 12.0 mL, P < 0.05) and reduced incidence of facial nerve injury (P < 0.05). In patients undergoing total parotidectomy, no significant differences were observed between the harmonic scalpel (n = 9) and control groups (n = 4) in length of surgery, intraoperative blood loss, postoperative drainage, duration of drainage, and facial nerve injury. CONCLUSIONS Use of the harmonic scalpel in the surgical treatment of parotid disease is safe and confers some advantages over conventional methods of parotid dissection.
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Affiliation(s)
- Lana L Jackson
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, Georgia 30912, USA
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Pietrow PK, Weizer AZ, L'Esperance JO, Auge BK, Silverstein A, Cummings T, Preminger GM, Albala DM. PlasmaKinetic Bipolar Vessel Sealing: Burst Pressures and Thermal Spread in an Animal Model. J Endourol 2005; 19:107-10. [PMID: 15735394 DOI: 10.1089/end.2005.19.107] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Laparoscopic bipolar instruments are commonly employed to cauterize and divide tissue. A next-generation bipolar device has been developed that employs vapor pulse coagulation energy. We assessed the vessel-sealing capability of this device and quantified thermal spread during application. MATERIALS AND METHODS Bilateral laparoscopic nephrectomy was performed on six common swine >25 kg. Five-millimeter clips and surgical staplers (US Surgical, Norwalk, CT) were utilized to perform nephrectomy on one side, while the Gyrus PlasmaKinetic bipolar device (Minneapolis, MN) was employed for the contralateral nephrectomy. Vessel-sealing capabilities were assessed via burst-pressure studies. The extent of thermal spread was measured after tissue fixation and hematoxylin and eosin staining. RESULTS Surgical clips/vascular staplers adequately controlled/sealed renal hilar vessels with burst pressures nearing 300 mm Hg. The Gyrus bipolar device reliably sealed and divided renal arteries <or=5 mm with burst pressures averaging 291 mm Hg. Renal arteries above this size were not consistently sealed, but, with the exception of one technical error, renal veins of all sizes (3-12 mm) were reliably controlled (average burst pressure 288 mm Hg). Histologic evidence of thermal spread extended an average of 3.6 mm from the cut edges of arteries and 3.4 mm from the edges of veins. CONCLUSIONS The Gyrus PlasmaKinetic bipolar device is capable of reliably sealing/ dividing arteries as large as 6 mm, although we recommend restricting its use to vessels no larger than 5 mm in diameter to allow a safety margin. In addition, porcine renal veins of all sizes are adequately controlled. These sealed vessels are able to withstand pressures approaching 300 mm Hg. Thermal spread affects only the area surrounding the divided vessel. Further clinical studies are warranted.
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Affiliation(s)
- Paul K Pietrow
- Department of Urology, Duke University Medical Center, Durham, North Carolina 27710, USA
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Kim J, Ahmad SA, Lowy AM, Buell JF, Pennington LJ, Soldano DA, James LE, Matthews JB, Hanto DW. Increased Biliary Fistulas after Liver Resection with the Harmonic Scalpel. Am Surg 2003. [DOI: 10.1177/000313480306900918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Harmonic Scalpel (HS) is frequently used for hepatic resection. Yet, no current study addresses its utility compared to conventional methods. We reviewed our experience with this device to determine if it decreased perioperative complications when compared to the traditional clamp crushing technique. One hundred forty-nine anatomic hepatic resections were performed at our institution from September 1992 to February 2002. Patients were divided into two groups based on the technique of resection: HS [53% (n = 79)] versus clamp crushing [47% (n = 70)]. Use of the HS was associated with a shorter mean operative time (357 ± 15.0 vs. 404 ± 19.1 min; p = 0.05) and a trend toward decreased blood loss (1211 ± 125.5 vs. 1411 ± 180.7 mL; P = NS) and transfusion requirements (2.6 ± 0.5 vs. 1.7 ± 0.3 units; P = 0.10). However, use of the HS was associated with a significant increase in biliary fistulas [24% (n = 19) vs. 7% (n = 5); P = 0.01]. Use of the Harmonic Scalpel was associated with decreased operative time and a trend toward decreased blood loss and transfusion requirements. Its use was also associated with a significant increase in the incidence of postoperative bile leaks, and, therefore, surgeons must be vigilant during liver parenchymal transection when using this device.
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Affiliation(s)
- Joseph Kim
- From the Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Syed A. Ahmad
- From the Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew M. Lowy
- From the Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Joseph F. Buell
- From the Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Linda J. Pennington
- From the Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Debbie A. Soldano
- From the Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Laura E. James
- From the Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jeffrey B. Matthews
- From the Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Douglas W. Hanto
- Department of Surgery, Division of Transplantation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Düsterdieck KF, Pleasant RS, Lanz OI, Saunders G, Howard RD. Evaluation of the harmonic scalpel for laparoscopic bilateral ovariectomy in standing horses. Vet Surg 2003; 32:242-50. [PMID: 12784201 DOI: 10.1053/jvet.2003.50022] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate use of the Harmonic Scalpel (Ethicon Endo-Surgery Inc., Cincinnati, OH) for performing laparoscopic bilateral ovariectomy in standing horses. STUDY DESIGN Experimental study. ANIMALS Eight mares aged 2-20 years and weighing 410-540 kg. METHODS Standing laparoscopic bilateral ovariectomy was performed in 8 mares with normal reproductive tract anatomy. The Harmonic Scalpel (an ultrasonically activated instrument) was used to simultaneously transect and obtain hemostasis of the ovarian pedicle. Necropsy was performed on 4 mares 3 days after surgery and 4 mares 30 days after surgery. Gross and histopathologic evaluation of the ovarian pedicles was performed to characterize tissue reaction. RESULTS Complete hemostasis of the ovarian pedicles was obtained in all mares. Median transection time for the ovarian pedicle was 28 minutes. Postoperative complications included transient fever, moderate subcutaneous emphysema, and incisional seroma formation. On necropsy examination, there were no signs of generalized peritonitis, postoperative hemorrhage, or adhesion formation. Mild to moderate acute inflammation and scar formation with moderate chronic inflammation at the ovarian pedicle was found at 3 and 30 days. Median depth of coagulation necrosis at 3 days was 2.87 mm. CONCLUSIONS The Harmonic Scalpel appears to provide reliable hemostasis of the ovarian pedicle during elective laparoscopic ovariectomy in horses. Clinical Relevance-The Harmonic Scalpel represents a safe alternative to other methods of hemostasis during elective laparoscopic ovariectomy in horses.
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Affiliation(s)
- Katja F Düsterdieck
- Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24061, USA
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Abstract
OBJECTIVE To describe the Harmonic scalpel and review recent studies comparing its use in tonsillectomy with standard dissection and electrocautery. STUDY DESIGN Review. METHODS The Harmonic scalpel uses ultrasonic technology to cut and coagulate tissues at lower temperatures than those associated with electrocautery and lasers. Studies of the use of this device have assessed its performance with respect to intraoperative blood loss, postoperative hemorrhage, and postoperative pain. RESULTS Intraoperative blood loss and episodes of postoperative hemorrhages have been found to be minimal in patients in whom the Harmonic scalpel was used for tonsillectomy. The device also appears to be associated with a reduction in postoperative pain. CONCLUSION Use of the Harmonic scalpel for tonsillectomy may have several advantages over standard methods.
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Affiliation(s)
- Brian J Wiatrak
- Children's Hospital of Alabama, Birmingham, Alabama 35233, USA.
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Miccoli P, Berti P, Raffaelli M, Materazzi G, Conte M, Galleri D. Impact of harmonic scalpel on operative time during video-assisted thyroidectomy. Surg Endosc 2002; 16:663-6. [PMID: 11972210 DOI: 10.1007/s00464-001-9117-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2001] [Accepted: 09/06/2001] [Indexed: 10/28/2022]
Abstract
BACKGROUND Minimally invasive video-assisted thyroidectomy (MIVAT) has been practiced in our department since 1998. It has some advantages over conventional surgery in terms of postoperative pain and cosmetic result. The aim of this study was to evaluate the use of the Harmonic scalpel (HS) on the performance of this procedure. METHODS Between October 1998 and January 2001, 116 patients underwent MIVAT. The HS was used for the last 26 operations. We compared this group of patients (HS-G) with a control group (C-G) of 26 patients who had undergone MIVAT before the introduction of the HS. The following parameters were considered: age, gender, preoperative diagnosis, size of the lesion, type of operation (lobectomy or total thyroidectomy), operative time, complication rate, and postoperative hospital stay. RESULTS The two groups were well matched for age, gender, preoperative diagnosis, lesion size, and type of operation. The mean operative time was significantly reduced in the HS-G for both lobectomy (37.3 +/- 8.4 vs 49.4 +/- 18.0 min) and total thyroidectomy (53.8 +/- 16.3 vs 90.6 +/- 22.1 min). No differences were found for postoperative stay. One patient in the C-G experienced a transient recurrent nerve palsy. There were no other complications. CONCLUSIONS This study showed that the utilization of the HS for MIVAT is safe and associated with a shorter operative time. A reduction of the rates for such complications such as hypoparathyroidism and recurrent nerve injuries was not possible to demonstrate in the present study. Much larger series are needed for further evaluation of this instrument.
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Affiliation(s)
- P Miccoli
- Department of Surgery, University of Pisa, Via Roma 67, 56100, Pisa, Italy.
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Msika S, Iannelli A, Deroide G, Jouët P, Soulé JC, Kianmanesh R, Perez N, Flamant Y, Fingerhut A, Hay JM. Can laparoscopy reduce hospital stay in the treatment of Crohn's disease? Dis Colon Rectum 2001; 44:1661-6. [PMID: 11711739 DOI: 10.1007/bf02234387] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this article was to investigate the safety, outcome, length of stay, and cost of hospital admission in patients with Crohn's disease who underwent laparoscopy compared with open surgery. METHODS Among 51 consecutive patients with inflammatory bowel disease (1996-2000), 46 with Crohn's disease were included in this nonrandomized prospective study. Of these, 20 patients underwent laparoscopic surgery and 26 underwent open surgery. Data collected included the following information: age, gender, body mass index, diagnosis, duration of disease, preoperative medical treatment, previous abdominal surgery, present indication for surgery, and procedure performed (comparability measures), as well as conversion to open surgery, operating time, time to resolution of ileus, morbidity, duration of hospital stay, and cost of hospital admission (outcome measures). RESULTS There was no significant difference with respect to comparability measures between the laparoscopic and the open-surgery groups. There was no mortality. There was no intraoperative complication in either group and no conversion in the laparoscopic group. Operating time was significantly longer in the laparoscopic group (302 minutes) vs. the open group (244.7 minutes) (P < 0.05), but this difference disappeared when data were adjusted for the extra time required to perform the laparoscopic hand-sewn anastomoses (288.2 minutes vs. 244.7 minutes). Bowel function returned more quickly in the laparoscopic group vs. the open group in terms of passage of flatus (3.7 vs. 4.7 days) (P < 0.05) and resumption of oral intake (4.2 vs. 6.3 day) (P < 0.01). There were significantly fewer postoperative complications in the laparoscopic group (9.5 percent) vs. the open group (18.5 percent) (P < 0.05); the length of stay was significantly shorter in the laparoscopic group (8.3 days) vs. the open group (13.2 days) (P < 0.01); and the cost of hospital admission was significantly lower in the laparoscopic group ($6106, United States dollars) vs. the open group ($9829, United States dollars) (P < 0.05). CONCLUSION There is a reduction in the postoperative ileus, length of stay, cost of hospital admission, and postoperative complication rate in the laparoscopic group. Laparoscopic surgery for Crohn's disease is safe, and it is potentially more cost-effective than traditional open surgery.
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Affiliation(s)
- S Msika
- Gastrointestinal Surgical Unit, University Hospital Louis Mourier, Colombes, France
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