Basic Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 27, 2022; 14(7): 1357-1364
Published online Jul 27, 2022. doi: 10.4254/wjh.v14.i7.1357
Tissue pad degradation of ultrasonic device may enhance thermal injury and impair its sealing performance in liver surgery
Masatoshi Kajiwara, Takahisa Fujikawa, Suguru Hasegawa
Masatoshi Kajiwara, Suguru Hasegawa, Department of Gastroenterological Surgery, Fukuoka University, Fukuoka 814-0180, Fukuoka, Japan
Takahisa Fujikawa, Department of Surgery, Kokura Memorial Hospital, Kitakyushu 802-8555, Fukuoka, Japan
Author contributions: Kajiwara M, Fujikawa T, and Hasegawa S designed and coordinated the study; Kajiwara M, and Fujikawa T performed the experiments, acquired and analyzed data; Kajiwara M, Fujikawa T, and Hasegawa S interpreted the data; Kajiwara M, and Fujikawa T wrote the manuscript; all authors approved the final version of the article.
Institutional review board statement: All procedures performed in this study were in strict accordance with international guidelines for animal welfare. IRB number were not obtained, as it was an ex vivo animal study.
Institutional animal care and use committee statement: All procedures performed in this study were in strict accordance with international guidelines for animal welfare. IRB number were not obtained, as it was an ex vivo animal study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest.
Data sharing statement: No additional data are available.
ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Takahisa Fujikawa, FACS, MD, PhD, Chief Doctor, Department of Surgery, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu 802-8555, Fukuoka, Japan. fujikawa-t@kokurakinen.or.jp
Received: March 11, 2022
Peer-review started: March 11, 2022
First decision: April 8, 2022
Revised: April 12, 2022
Accepted: July 6, 2022
Article in press: July 6, 2022
Published online: July 27, 2022
ARTICLE HIGHLIGHTS
Research background

Ultrasonic devices are widely used in many surgical fields including hepatectomy in the modern era, while the negative effects of tissue pad degradation of ultrasonic devices in liver surgery still remain unknown.

Research motivation

As the liver is a solid organ, liver parenchymal dissection may burden ultrasonic devices with more mechanical stresses compared to the digestive tract surgery (in which, membrane and fat are the main dissection targets) and demand the enhanced tissue pad life. Therefore, we chose liver surgery for evaluating the effect of the tissue pad degradation.

Research objectives

To elucidate ultrasonic device tissue pad degradation effects on instrument temperature and sealing performance using ex vivo porcine liver/vessel models.

Research methods

Two different harmonic scalpels were used and compared: Harmonic® 1100 (a new model; H-1100) and Harmonic® HD1000i (a previous model; H-HD1000i). The device temperature (passive jaw temperature), tissue pad degradation after 300 repeated activations, vessel sealing speed and burst pressure were measured.

Research results

H-1100 scalpel consistently maintained a lower passive jaw temperature and sustained its superior sealing performance by avoiding tissue pad degradation compared to that with the H-HD1000i scalpel.

Research conclusions

In an ex vivo porcine hepatectomy model, the cutting-edge H-1100 scalpel maintains excellent performance throughout the procedure with the enhanced tissue pad life.

Research perspectives

This study provides a new insight into understanding the negative influence of tissue pad degradation of ultrasonic devices on device temperature and sealing performance. H-1100 scalpel solves issues related to tissue pad degradation. Furthermore, use of the H-1100 scalpel may eventually reduce hospital costs.