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Thiel C, Frericks LT, Schenk M, Königsrainer A, Brucker SY, Kraemer B, Steger V, Biber U, Linzenbold W, Enderle MD, Thiel K. A new bipolar device for sealing and cutting: ex and in vivo studies for performance evaluation. MINIM INVASIV THER 2022; 31:1131-1139. [PMID: 36260701 DOI: 10.1080/13645706.2022.2124523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION A novel multipurpose bipolar radiofrequency instrument, the Erbe Dissector (EDS), which simultaneously seals and cuts tissue, was developed. Ex vivo sealing rate and time, burst pressure, jaw temperature and thermal spread were studied in porcine renal arteries. MATERIAL AND METHODS In vivo, 13 surgical tasks were performed in two pigs: beside sealing rate and time, overall performance in sharp and blunt dissection, tissue sticking, hemostasis, precision, etc., were evaluated by four surgeons compared with ENSEAL G2 (EG2) using surveys on a Likert scale (1 = very poor; 5 = very good). RESULTS Ex vivo, the EDS sealing rate was 91.7% (33/36 arteries) at an average sealing time of 2.1 s (range 1.7-2.8) and a burst pressure of 1040 ± 350 mmHg. The maximum jaw temperature was 87 ± 4 °C and the mean lateral thermal spread was 0.8 ± 0.2 mm. In vivo, the sealing rate for arteries and veins was 92.6% (50/54) and the median seal and cut time was 1.6 s (range: 1.3-2.9). The average EDS performance score across all tasks was 4.4 ± 0.6 Likert points. For five shared tasks, EDS was better than EG2 (4.4 ± 0.5 versus 3.4 ± 0.6 Likert points; p = 0.016). CONCLUSIONS EDS seals and cuts arteries and veins rapidly with good safety and user-friendliness.
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Affiliation(s)
- Christian Thiel
- Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Luca T Frericks
- Department of Research and Basic Technologies, Erbe Elektromedizin GmbH, Tuebingen, Germany
| | - Martin Schenk
- Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Sara Y Brucker
- Department of Gynaecology and Obstetrics, Tuebingen University Hospital, Tuebingen, Germany
| | - Bernhard Kraemer
- Department of Gynaecology and Obstetrics, Tuebingen University Hospital, Tuebingen, Germany
| | - Volker Steger
- Department of Thoracic, Cardiac and Vascular Surgery, Tuebingen University Hospital, Tuebingen,Germany
| | - Ulrich Biber
- Department of Research and Basic Technologies, Erbe Elektromedizin GmbH, Tuebingen, Germany
| | - Walter Linzenbold
- Department of Research and Basic Technologies, Erbe Elektromedizin GmbH, Tuebingen, Germany
| | - Markus D Enderle
- Department of Research and Basic Technologies, Erbe Elektromedizin GmbH, Tuebingen, Germany
| | - Karolin Thiel
- Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Tuebingen, Germany
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Kim J, Shin Y, Jeong W. Harmonic scalpels compared with electrocautery in reconstructive flap harvesting: A meta-analysis. Microsurgery 2021; 42:89-96. [PMID: 34652038 DOI: 10.1002/micr.30831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/01/2021] [Accepted: 09/28/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Numerous studies have compared electrical devices used for flap surgery, but the results are inconsistent. This research was performed to evaluate the efficacy of two different types of electric devices: electrocautery and ultrasonic shears. METHODS The PubMed, Embase, and Scopus databases were searched systematically. A total of 505 cases were included in this study, including 209 electrocautery and 296 harmonic scalpel cases. The following information was retrieved from the included studies: the first author of the article, publication year, flap type, flap harvest time, drain volume, bleeding volume and postoperative complications. Hematoma, infection, flap necrosis and wound dehiscence were considered postoperative complications. The Q statistic for heterogeneity and the I2 index were calculated. If I2 < 50%, we used a fixed-effects model; if I2 > 50%, we employed a random-effects model in our meta-analysis. RESULTS A total of eight studies which met the inclusion criteria were included and reviewed systematically for a meta-analysis. The harmonic scalpel yielded a statistically significantly more favorable flap harvest time and drain volume than did electrocautery. The Harmonic scalpel led to a shorter flap harvest time by 26.29 min (95% CI = -39.38 to -13.2; p < .00001) and smaller drain volume by 58.76 ml (95% CI = -105.27 to -12.25; p = .01) on average. However, there were no significant differences in the bleeding volume or incidence rates of infection, flap necrosis and wound dehiscence. CONCLUSION The Harmonic scalpel method yields better outcomes in terms of the flap harvest time and drain volume than does the conventional electrocautery method. Therefore, the Harmonic scalpel is a better option for cauterization and dissection in flap surgery.
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Affiliation(s)
- Jaehoon Kim
- Department of Plastic and Reconstructive Surgery, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
| | - Youngmin Shin
- Department of Oromaxillofacial Surgery, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
| | - Woonhyeok Jeong
- Department of Plastic and Reconstructive Surgery, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
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Taki Y, Watanabe M, Sato S, Higashizono K, Nagai E, Nishida M, Oba N. Duplicate left gastric artery identified during laparoscopic distal gastrectomy. Asian J Endosc Surg 2021; 14:290-292. [PMID: 32875746 DOI: 10.1111/ases.12854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/30/2020] [Accepted: 08/02/2020] [Indexed: 11/29/2022]
Abstract
The reported incidence of duplicate left gastric artery is not very low, with a rate of 0.4%. However, there have been no reports of the surgical management of patients with a duplicate left gastric artery. Here, we report a 60-year-old Japanese man diagnosed with clinical T1bN0M0 stage IA gastric cancer. Preoperative 5-mm slice CT showed no anatomical abnormality, and the patient underwent laparoscopic distal gastrectomy. When we dissected the nerve plexus around the left gastric artery with an ultrasonic vessel-sealing device, pulsating bleeding was observed from a small vessel in the nerve plexus. The bleeding was stopped by suture and clipping. A 1.2-mm vessel was identified on 1-mm slice preoperative CT and postoperative CT angiography. The patient was discharged without any complications. To the best of our knowledge, this is the first report of a patient undergoing surgery for a duplicate left gastric artery.
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Affiliation(s)
- Yusuke Taki
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Masaya Watanabe
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Shinsuke Sato
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Kazuya Higashizono
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Erina Nagai
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Masato Nishida
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Noriyuki Oba
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
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Quitzan JG, Singh A, Beaufrere H, Valverde A, Lillie B, Salahshoor M, Bardelcik A, Saleh TM. Evaluation of the performance of an endoscopic 3-mm electrothermal bipolar vessel sealing device intended for single use after multiple use-and-resterilization cycles. Vet Surg 2020; 49 Suppl 1:O120-O130. [PMID: 32053219 DOI: 10.1111/vsu.13396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/22/2019] [Accepted: 01/18/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the performance of an endoscopic 3-mm electrothermal bipolar vessel sealing device (EBVS) intended for single use after multiple use-and-resterilization cycles. STUDY DESIGN Ex vivo study. SAMPLE POPULATION Eight 3-mm EBVS handpieces. METHODS Handpieces were subjected to a maximum of 15 cycles of testing, including simulated surgery, sealing and burst pressure testing of porcine carotid arteries, reprocessing, and hydrogen peroxide plasma resterilization. Failure was defined as two sequential vascular seal leakage events occurring at <250 mm Hg. Histological evaluation, maximum external temperature of the jaws, sealing time, tissue adherence, jaw surface characterization, and mechanical deterioration were studied. Failure rate was analyzed by using a Kaplan-Meier curve. Linear and ordinal logistic mixed models were used to analyze sealing time, handpiece jaw temperature, and adherence score. RESULTS Mean ± SD diameter of arteries was 3.22 ± 0.35 mm. Failure was observed starting at cycle 10 and going up to cycle 13 in 37.5% (3/8) of the handpieces. Tissue adherence increased after each cycle (P < .001). Maximum external temperature (79.8°C ± 13.9°C) and sealing time (1.8 ± 0.5 seconds) were not significantly different throughout cycles up to failure. A flatter surface and large scratches were observed microscopically throughout the jaw surface after repeated use and resterilization. CONCLUSION The 3-mm EBVS handpiece evaluated in this study can be considered safe to use for up to nine reuse-and-resterilization cycles. CLINICAL SIGNIFICANCE These data provide the basis for establishing preliminary guidelines for the reuse and hydrogen peroxide plasma resterilization of an endoscopic 3-mm EBVS handpiece.
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Affiliation(s)
- Juliany Gomes Quitzan
- School of Veterinary Medicine and Animal Science, Sao Paulo State University, Botucatu, Sao Paulo, Brazil.,Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Ontario, Canada
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Ontario, Canada
| | - Hugues Beaufrere
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Ontario, Canada
| | - Alexander Valverde
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Ontario, Canada
| | - Brandon Lillie
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Ontario, Canada
| | - Masoomeh Salahshoor
- School of Engineering, College of Engineering and Physical Sciences, University of Guelph, Ontario, Canada
| | - Alexander Bardelcik
- School of Engineering, College of Engineering and Physical Sciences, University of Guelph, Ontario, Canada
| | - Tarek M Saleh
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Ontario, Canada
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Kraemer B, Tsaousidis C, Kruck S, Schenk M, Scharpf M, Kommoss S, Brucker S, Nuessle D, Enderle MD, Biber U. Safety and effectiveness of a novel generator algorithm for bipolar vessel sealing: a randomised controlled chronic animal study. BMC Surg 2019; 19:160. [PMID: 31690302 PMCID: PMC6833204 DOI: 10.1186/s12893-019-0625-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electrosurgical vessel sealers are gradually replacing conventional techniques such as ligation and clipping. Algorithms that control electrosurgical units (ESU), known as modes, are important for applications in different surgical disciplines. This chronic porcine animal study aimed to evaluate the safety and effectiveness of the novel thermoSEAL electrosurgical vessel sealing mode (TSM). The BiClamp® mode (BCM) of the renowned VIO® 300 D ESU served as control. BCM has been widely available since 2002 and has since been successfully used in many surgical disciplines. The TSM, for the novel VIO® 3 ESU, was developed to reduce sealing time and/or thermal lateral spread adjacent to the seal while maintaining clinical success rates. The primary aim of this study was to investigate the long-term and intraoperative seal quality of TSM. METHODS The BiCision® device was used for vessel sealing with TSM and BCM in ten German Landrace pigs which underwent splenectomy and unilateral nephrectomy during the first intervention of the study. The seals were cut with the BiCision® knife. Ninety-nine arteries, veins and vascular bundles were chronically sealed for 5 or 21 days. Thereafter, during the second and terminal intervention of the study, 97 additional arteries and veins were sealed. The carotid arteries were used for histological evaluation of thermal spread. RESULTS After each survival period, no long-term complications occurred with either mode. The intraoperative seal failure rates, i.e. vessel leaking or residual blood flow after the first sealing activation, were 2% with TSM versus 6% with BCM (p = 0.28). The sealing time was significantly shorter with TSM (3.5 ± 0.69 s vs. 7.3 ± 1.3 s, p < 0.0001). The thermal spread and burst pressure of arteries sealed with both modes were similar (p = 0.18 and p = 0.61) and corresponded to the histological evaluation. The measured tissue sticking parameter was rare with both modes (p = 0.33). Tissue charring did not occur. Regarding the cut quality, 97% of the seals were severed in the first and 3% in the second attempt (both with TSM and BCM). CONCLUSIONS The novel TSM seals blood vessels twice as fast as the BCM while maintaining excellent tissue effect and clinical success rates. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
| | | | | | | | | | | | - Sara Brucker
- University Hospital Tuebingen, Tuebingen, Germany
| | - Daniela Nuessle
- Erbe Elektromedizin GmbH, Waldhoernlestrasse 17, 72072 Tuebingen, Germany
| | - Markus D. Enderle
- Erbe Elektromedizin GmbH, Waldhoernlestrasse 17, 72072 Tuebingen, Germany
| | - Ulrich Biber
- Erbe Elektromedizin GmbH, Waldhoernlestrasse 17, 72072 Tuebingen, Germany
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Thiel K, Linzenbold W, Enderle MD, Nold B, Königsrainer A, Schenk M, Thiel C. Evaluation of a novel electrosurgical sealing mode in an ex vivo and in vivo porcine model. Surg Endosc 2017; 32:1456-1463. [DOI: 10.1007/s00464-017-5832-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/20/2017] [Indexed: 01/16/2023]
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Kirschbaum A, Rüdell F, Pehl A, Bartsch DK. More compression improves sealing effect on larger pulmonary arteries. J Surg Res 2016; 201:202-7. [PMID: 26850203 DOI: 10.1016/j.jss.2015.09.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/12/2015] [Accepted: 09/24/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Small arteries and veins up to 7 mm can be sealed safe and divided with a bipolar sealing instrument. The results for the safe sealing of larger vessels were unsatisfactory in the past. Using an ex vivo pulmonary artery model, we aimed to investigate, if a higher compression force and duration will improve the bursting pressures in case of vessels >7 mm. MATERIAL AND METHODS Heart-lung preparations (from 90 kg pigs) were removed en bloc at a slaughterhouse. The whole pulmonary artery was exposed from the pulmonary valve up to the periphery of the left lung. In the laboratory, a digital pressure sensor was implanted in the central end of the blood vessel to measure the bursting pressure (in mbar). The vessels examined were divided into three groups by diameter: 1-6 mm, 7-12 mm and >12 mm. After bipolar sealing, bursting pressures were determined by pneumatic testing. Seals were made using three equal MARSEAL instruments (Gebrüder Martin GmbH & CoKG, Tuttlingen, Germany) with a SealSafe G3 electric current and different jaw compression forces of each 35 N, 45 N, and 55 N. Bursting pressures were also measured for different compression durations (0 s, 5 s, 10 s, and 20 s) with 35 N compression. Mean bursting pressures were calculated for each group (n = 15). Groups were compared using a nonparametric test (Mann-Whitney U test). The significance level was P < 0.05. RESULTS Mean bursting pressures in the 1-6 mm blood vessels were 290.5 ± 77.1 mbar (35 N), 323.0 ± 76.0 mbar (45 N) and 301.6 ± 69.9 mbar (55 N). The groups did not differ significantly. Mean bursting pressures in the 7-12 mm vessels were 108.1 ± 19.1 mbar (35 N), 154.3 ± 28.5 mbar (45 N), and 212.4 ± 45.3 mbar (55 N). In blood vessels >12 mm in diameter, we found mean bursting pressures of 77.7 ± 11.7 mbar (35 N), 117.6 ± 27.1 mbar (45 N), and 166.3 ± 56.6 mbar (55 N). The results for the groups with 55 N compression were significantly higher than for the other groups. A compression duration of 5 s led to significantly higher mean bursting pressures than a duration of 0 s but a duration of >5 s did not bring a further significant increase in mean bursting pressure. Histologic staining of the seal zone and microscopic examination did not reveal any differences relating to compression force. CONCLUSIONS With a higher compression force, we reached satisfactory bursting pressures in case of pulmonary arteries >7 mm. An additional 5 s of compression before starting coagulation brings a further significant increase in bursting pressure. However, there is no advantage in a longer compression.
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Affiliation(s)
- Andreas Kirschbaum
- Department of Visceral, Thoracic and Vascular Surgery, Giessen and Marburg University Hospital (UKGM), Marburg, Germany.
| | - Franziska Rüdell
- Department of Visceral, Thoracic and Vascular Surgery, Giessen and Marburg University Hospital (UKGM), Marburg, Germany
| | - Anika Pehl
- Institute of Pathology, Giessen and Marburg University Hospital (UKGM), Marburg, Germany
| | - Detlef K Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Giessen and Marburg University Hospital (UKGM), Marburg, Germany
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Timm RW, Asher RM, Tellio KR, Welling AL, Clymer JW, Amaral JF. Sealing vessels up to 7 mm in diameter solely with ultrasonic technology. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:263-71. [PMID: 25114600 PMCID: PMC4124047 DOI: 10.2147/mder.s66848] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction Ultrasonic energy is a mainstay in the armamentarium of surgeons, providing multifunctionality, precision, and control when dissecting and sealing vessels up to 5 mm in diameter. Historically, the inability to seal vessels in the 5–7 mm range has been perceived as an inherent limitation of ultrasonic technology. The purpose of this study was to evaluate sealing of vessels up to 7 mm in diameter with an ultrasonic device that modulates energy delivery during the sealing period. Methods In ex vivo benchtop and in vivo acute and survival preclinical models, a new ultrasonic device, Harmonic ACE®+7 Shears (Harmonic 7), was compared with advanced bipolar devices in sealing vessels 1–7 mm in diameter with respect of burst pressure, seal reliability, and seal durability. Lateral thermal damage and transection time were also evaluated. Results Ex vivo tests of Harmonic 7 demonstrated significantly greater median burst pressures than an advanced bipolar device both for vessels <5 mm in diameter (1,078 mmHg and 836 mmHg, respectively, P=0.046) and for those in the range of 5–7 mm (1,419 mmHg and 591 mmHg, P<0.001). In vivo tests in porcine and caprine models demonstrated similar rates of hemostasis between Harmonic 7 and advanced bipolar devices, with high success rates at initial transection and seal durability of 100% after a 30-day survival period. Conclusion Sealing 5–7 mm vessels is not a limitation of the type of energy used but of how energy is delivered to tissue. These studies document the ability of ultrasonic energy alone to reliably seal large vessels 5–7 mm in diameter, with significantly greater burst pressure observed in in vitro studies than those observed with an advanced bipolar technology when energy delivery is modulated during the sealing cycle. Furthermore, the seals created in 5–7 mm vessels are shown to be reliable and durable in in vivo preclinical studies.
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Ferri E, Armato E, Spinato G, Lunghi M, Tirelli G, Spinato R. Harmonic scalpel versus conventional haemostasis in neck dissection: a prospective randomized study. Int J Surg Oncol 2013; 2013:369345. [PMID: 24490063 PMCID: PMC3881528 DOI: 10.1155/2013/369345] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 12/01/2013] [Accepted: 12/01/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The aim of this prospective randomized trial was to compare operative factors, postoperative outcomes, and surgical complications of neck dissection (ND) when using the harmonic scalpel (HS) versus conventional haemostasis (CH) (classic technique of tying and knots, resorbable ligature, and bipolar diathermy). MATERIALS AND METHODS Sixty-one patients who underwent ND with primary head and neck cancer (HNSCC) resection were enrolled in this study and were randomized into two homogeneous groups: CH (conventional haemostasis with classic technique of tying and knots, resorbable ligature, and bipolar diathermy) and HS (haemostasis with harmonic scalpel). Outcomes of the study included operative time, intraoperative blood loss, drainage volume, postoperative pain, hospital stay, and incidence of intraoperative and postoperative complications. RESULTS The use of the HS reduced significantly the operating time, the intraoperative blood loss, the postoperative pain, and the volume of drainage. No significant difference was observed in mean hospital stay and perioperative, and postoperative complications. CONCLUSION The HS is a reliable and safe tool for reducing intraoperative blood loss, operative time, volume of drainage and postoperative pain in patients undergoing ND for HNSCC. Multicenter randomized studies need to be done to confirm the advantages of this technique and to evaluate the cost-benefit ratio.
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Affiliation(s)
- Emanuele Ferri
- Otorhinolaryngology Department ULSS 17, General Hospital of Monselice, Via G. Marconi 19, Monselice, 35043 Padua, Italy
| | - Enrico Armato
- Otorhinolaryngology Department ULSS 13, General Hospitals of Dolo and Mirano, Via Mariutto 76, Mirano, 30035 Venice, Italy
| | - Giacomo Spinato
- Head and Neck Department, ENT Clinic, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Marcello Lunghi
- Otorhinolaryngology Department ULSS 17, General Hospital of Monselice, Via G. Marconi 19, Monselice, 35043 Padua, Italy
| | - Giancarlo Tirelli
- Head and Neck Department, ENT Clinic, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Roberto Spinato
- Otorhinolaryngology Department ULSS 13, General Hospitals of Dolo and Mirano, Via Mariutto 76, Mirano, 30035 Venice, Italy
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Rothmund R, Kraemer B, Brucker S, Taran FA, Wallwiener M, Zubke A, Wallwiener D, Zubke W. Laparoscopic Supracervical Hysterectomy Using EnSeal vs Standard Bipolar Coagulation Technique: Randomized Controlled Trial. J Minim Invasive Gynecol 2013; 20:661-6. [DOI: 10.1016/j.jmig.2013.04.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/23/2013] [Accepted: 04/24/2013] [Indexed: 12/11/2022]
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A prospective, randomized clinical comparison between UltraCision and the novel sealing and cutting device BiCision in patients with laparoscopic supracervical hysterectomy. Surg Endosc 2013; 27:3852-9. [DOI: 10.1007/s00464-013-2994-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 04/23/2013] [Indexed: 12/31/2022]
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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: 85] [Impact Index Per Article: 7.7] [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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van de Berg NJ, van den Dobbelsteen JJ, Jansen FW, Grimbergen CA, Dankelman J. Energetic soft-tissue treatment technologies: an overview of procedural fundamentals and safety factors. Surg Endosc 2013; 27:3085-99. [PMID: 23572215 DOI: 10.1007/s00464-013-2923-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 02/25/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Energy administered during soft-tissue treatments may cauterize, coagulate, seal, or otherwise affect underlying structures. A general overview of the functionality, procedural outcomes, and associated risks of these treatments, however, is not yet generally available. In addition, literature is sometimes inconsistent with regards to terminology. Along with the rapid expansion of available energetic instruments, particularly in the field of endoscopic surgery, these factors may complicate the ability to step back, review available treatment options, and identify critical parameters for appropriate use. METHODS Online databases of PubMed, Web of Science, and Google Scholar were used to collect literature on popular energetic treatments, such as electrosurgery, plasma surgery, ultrasonic surgery, and laser surgery. The main results include review and comparison studies on the working mechanisms, pathological outcomes, and procedural hazards. RESULTS The tissue response to energetic treatments can be largely explained by known mechanical and thermal interactions. Application parameters, such as the interaction time and power density, were found to be of major influence. By breaking down treatments to this interaction level, it is possible to differentiate the available options and reveal their strengths and weaknesses. Exact measures of damage and alike quantifications of interaction are, although valuable to the surgeon, often either simply unknown due to the high impact of tissue and application-dependent parameters or badly documented in previous studies. In addition, inconsistencies in literature regarding the terminology of used techniques were observed and discussed. They may complicate the formulation of cause and effect relations and lead to misconceptions regarding the treatment performance. CONCLUSIONS Some basic knowledge on used energetic treatments and settings and a proper use of terminology may enhance the practitioner's insight in allowable actions to take, improve the interpretation and diagnosis of histological and mechanical tissue changes, and decrease the probability of iatrogenic mishaps.
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Affiliation(s)
- N J van de Berg
- Department of Biomechanical Engineering, Delft University of Technology, 3mE, Mekelweg 2, 2628 CD Delft, The Netherlands.
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Shin YS, Koh YW, Kim SH, Choi EC. The efficacy of the harmonic scalpel in neck dissection: a prospective randomized study. Laryngoscope 2012. [PMID: 23208767 DOI: 10.1002/lary.23704] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Recently, the Harmonic scalpel (HS) has been used in head and neck surgery as an alternative to conventional hand-tied ligation for hemostasis. Limited data have been published on the evidence of its safety in neck dissection (ND), especially in radical ND. We intended to investigate the safety and efficacy of the HS in ND, while using conventional hand-tied ligation to a minimum. METHOD Fifty-nine patients who underwent ND with primary head and neck cancer resection were enrolled in this study. The group using HS consisted of 29 patients, and the conventional hand-tied ligation technique (CT) group comprised of 30 patients. The following variables were examined: operating time, intraoperative bleeding, incidence of perioperative complications, the number of lymph nodes, total amount of drainage, duration of drain placement, and days of hospital stay. RESULT The use of the HS reduced the operating time of comprehensive ND by an average of 46.5 minutes (P < 0.001), and blood loss was significantly decreased in the HS group than the CT group (163.8 ± 33.8 cc vs. 203.8 ± 36.5 cc, P = 0.002). The number of lymph nodes was not significantly different between the two groups. No significant difference was observed in the total amount of drainage, duration of drain placement, days of hospital stay, and perioperative complications. CONCLUSIONS The HS is a relatively safe and effective alternative method for hand-tie ligation in ND. Moreover, the HS significantly reduced the operating time and amount of blood loss.
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Affiliation(s)
- Yoo Seob Shin
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
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Rothmund R, Kraemer B, Neis F, Brucker S, Wallwiener M, Reda A, Hausch A, Scharpf M, Szyrach MN. Efficacy and safety of the novel electrosurgical vessel sealing and cutting instrument BiCision®. Surg Endosc 2012; 26:3334-43. [DOI: 10.1007/s00464-012-2337-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 04/16/2012] [Indexed: 12/31/2022]
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Safety and efficacy of new integrated bipolar and ultrasonic scissors compared to conventional laparoscopic 5-mm sealing and cutting instruments. Surg Endosc 2012; 26:2541-9. [PMID: 22447285 PMCID: PMC3427482 DOI: 10.1007/s00464-012-2229-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 02/20/2012] [Indexed: 12/12/2022]
Abstract
Background Hemostasis is a central issue in laparoscopic surgery. Ultrasonic scissors and bipolar clamps are commonly used, with known advantages with each technique. Methods The prototype of new surgical scissors, delivering ultrasonically generated frictional heat energy and bipolar heat energy simultaneously (THUNDERBEAT® [TB]), was compared to ultrasonic scissors (Harmonic ACE® [HA]) and an advanced bipolar device (LigaSure® [LS]) using a pig model. As safety parameters, temperature profiles after single activation and after a defined cut were determined. As efficacy parameters, seal failures and the maximum burst pressure (BP) were measured after in vivo sealing of vessels of various types and diameters (categories 2–4 and 5–7 mm). Moreover, the vertical width of the tissue seal was measured on serial histological slices of selected arteries. The cutting speed was measured during division of isolated arteries and during dissection of a defined length of compound tissue (10 cm of mesentery). Burst-pressure measurement and histological analysis were performed by investigators blinded to the used sealing device. Results Using the TB, the burst pressure in larger arteries was significantly higher (734 ± 64 mmHg) than that of the HA (453 ± 50 mmHg). No differences in the rate of seal failures were observed. The cutting speed of the TB was significantly higher than that of all other devices. Safety evaluation revealed temperatures below 100 °C in the bipolar device. The maximum temperature of the HA and the TB was significantly higher. No relevant differences were observed between the HA and the TB. Conclusions The ultrasonic and bipolar technique of the TB has the potential to surpass the dissection speed of ultrasonic devices with the sealing efficacy of bipolar clamps. However, heat production that is comparable to conventional ultrasonic scissors should be minded for clinical use.
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Postoperative efficacy and safety of vessel sealing: an experimental study on carotid arteries of the pig. Surg Endosc 2012; 26:2388-93. [DOI: 10.1007/s00464-012-2177-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 01/13/2012] [Indexed: 12/18/2022]
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