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Kang B, Keum H, Park HY, Jung JH, Kim WW, Lee J. Usefulness of cordless ultrasonic cutting energy devices in endoscopic nipple-sparing mastectomy: a retrospective study. Ann Surg Treat Res 2024; 106:147-154. [PMID: 38435493 PMCID: PMC10902625 DOI: 10.4174/astr.2024.106.3.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/15/2023] [Accepted: 12/02/2023] [Indexed: 03/05/2024] Open
Abstract
Purpose Endoscopic nipple-sparing mastectomy (E-NSM) is a minimally invasive surgical technique that shows good results in patients with breast cancer. The authors compared 3 different types of commercial energy devices to examine their efficacy and safety in E-NSM performed with breast reconstruction. Methods A total of 36 cases of E-NSM were conducted with either Sonicision (S group, n = 11), Harmonic (H group, n = 6), or Thunderbeat (T group, n = 19). The clinicopathologic factors and postoperative complications, including nipple or skin necrosis and surgical site seroma volume, were evaluated for 3 months after surgery. Results The surgical duration of E-NSM was significantly shorter in the S group than in the H group (P = 0.043) and T group (P = 0.037). However, the total surgical duration including E-NSM and breast reconstruction, and the total and daily drainage volume of postoperative seroma did not differ significantly among the 3 groups. Even when the energy devices were compared according to their working principle, i.e., ultrasonic (S and H) vs. hybrid (T), the total breast surgery duration and total and daily drainage volume of seroma showed no difference between the 2 groups. Although surgeon satisfaction did not significantly differ when using 3 devices for E-NSM (P = 0.428), surgeon's fatigue was found to be lowest in the S group, though it was not significant (P = 0.064). Conclusion Any energy device can be safely used for E-NSM with breast reconstruction without causing any major complications. However, cordless ultrasonic energy devices allow greater mobility for the surgeon and, therefore, may shorten surgical time in breast surgery.
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Affiliation(s)
- Byeongju Kang
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Heejung Keum
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Ho Yong Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Jin Hyang Jung
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Wan Wook Kim
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Jeeyeon Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
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Accardo C, Gruttadauria S, Decarlis L, Agnes S, Schmeding M, Avolio AW, Buscemi V, Ardito F, Kienlein S, Mbuvi PM, Giuliante F. The CUSA Clarity Soft Tissue Removal Study: Clinical Performance Investigation of the CUSA Clarity Ultrasonic Surgical Aspirator System for Soft Tissue Removal During Liver Surgery. J Laparoendosc Adv Surg Tech A 2024; 34:99-105. [PMID: 38294895 DOI: 10.1089/lap.2023.0467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Background: Intraoperative blood loss has an unfavorable impact on the outcome of patients undergoing liver surgery. Today, the use of devices capable of minimizing this risk with high technical performance becomes mandatory. Into this scenario fits the CUSA® Clarity Ultrasonic Surgical Aspirator System. This prospective survey involving five liver surgery centers had the objective of investigating whether this innovative ultrasonic surgical aspirator is safe and effective in the transection of the liver parenchyma. Materials and Methods: This clinical study was a prospective, multicenter, single-arm Post-Market Clinical Follow-up study investigating 100 subjects who underwent liver surgery using the CUSA Clarity Ultrasonic Surgical Aspirator System at five centers during a period of 1 year and 8 months. After collecting all the patient's clinical information and instrument usage details, surgeons completed a brief survey giving their opinions on the performance of CUSA. Therefore, safety and efficacy outcomes were evaluated. Results: Surgeons had a 95% success rate in complete removal of the mass with an average overall operative time of 4 hours and 34 minutes. Overall, there were no complications or device deficiencies. Conclusion: The CUSA Clarity Ultrasonic Surgical Aspirator System performs well during liver surgery with a low complication rate. ClinicalTrials.gov Identifier: NCT04298268.
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Affiliation(s)
- Caterina Accardo
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC), Palermo, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC), Palermo, Italy
- Department of Surgery and Medical and Surgical Specialties, University of Catania, Catania, Italy
| | - Luciano Decarlis
- Department of General Surgery and Abdominal Transplantation, Niguarda-Cà Granda Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Salvatore Agnes
- Department of General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Alfonso W Avolio
- Department of General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo Buscemi
- Department of General Surgery and Abdominal Transplantation, Niguarda-Cà Granda Hospital, Milan, Italy
| | - Francesco Ardito
- Department of Hepatobiliary Surgery, Foundation "Policlinico Universitario A. Gemelli", IRCCS, Catholic University, Rome, Italy
| | - Stefan Kienlein
- Department of Surgery, Clinic Dortmund gGmbH, Dortmund, Germany
| | - Phoebe M Mbuvi
- Global Medical Affairs at Integra LifeSciences, Baltimora, Maryland, USA
| | - Felice Giuliante
- Department of Hepatobiliary Surgery, Foundation "Policlinico Universitario A. Gemelli", IRCCS, Catholic University, Rome, Italy
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Lee M, Bang H, Lee E, Park S, Yoo H, Oh WY, Lee S. Imaging peritoneal blood vessels through optical coherence tomography angiography for laparoscopic surgery. JOURNAL OF BIOPHOTONICS 2024; 17:e202300221. [PMID: 37675626 DOI: 10.1002/jbio.202300221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/20/2023] [Accepted: 09/05/2023] [Indexed: 09/08/2023]
Abstract
Laparoscopic surgery presents challenges in identifying blood vessels due to lack of tactile feedback. The image-guided laparoscopic surgical tool (IGLaST) integrated with optical coherence tomography (OCT) has potential for in vivo blood vessel imaging; however, distinguishing vessels from surrounding tissue remains a challenge. In this study, we propose utilizing an inter-A-line intensity differentiation-based OCT angiography (OCTA) to improve visualization of blood vessels. By evaluating a tissue phantom with varying flow speeds, we optimized the system's blood flow imaging capabilities in terms of minimum detectable flow and contrast-to-noise ratio. In vivo experiments on rat and porcine models, successfully visualized previously unidentified blood vessels and concealed blood flows beneath the 1 mm depth peritoneum. Qualitative comparison of various OCTA algorithms indicated that the intensity differentiation-based algorithm performed best for our application. We believe that implementing IGLaST with OCTA can enhance surgical outcomes and reduce procedure time in laparoscopic surgeries.
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Affiliation(s)
- Minsuk Lee
- Medical Device Development Center, Osong Medical Innovation Foundation, Cheongju, Chungbuk, Korea
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Hyeonjin Bang
- Medical Device Development Center, Osong Medical Innovation Foundation, Cheongju, Chungbuk, Korea
| | - Eungjang Lee
- Medical Device Development Center, Osong Medical Innovation Foundation, Cheongju, Chungbuk, Korea
| | - Sungsoo Park
- Division of Foregut Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Korea
- Department of Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hongki Yoo
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Wang-Yuhl Oh
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Seungrag Lee
- Medical Device Development Center, Osong Medical Innovation Foundation, Cheongju, Chungbuk, Korea
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Narita M, Suzuki K, Ogimoto K, Ichida K, Aratake J, Nakazawa H, Shibutani T, Kitai M, Shiozaki T, Wakahashi S, Yamaguchi S. A case series title: femoral nerve injury with an episode of motor neuropathy caused by gynecological surgery: a case series. Int Cancer Conf J 2023; 12:294-298. [PMID: 37577344 PMCID: PMC10421834 DOI: 10.1007/s13691-023-00612-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/24/2023] [Indexed: 08/15/2023] Open
Abstract
Background Although iatrogenic nerve injury is sometimes diagnosed after gynecological surgery, its incidence is underestimated because most cases are self-limiting and underreported. Herein, we report on six cases of femoral nerve injury after gynecological surgery with both sensory and motor neuropathy. Methods We retrospectively analyzed 785 patients with gynecological cancer requiring surgery, including lymph node dissection, between 2012 and 2016 at our center. The functional damage due to femoral nerve injury was postoperatively assessed and classified according to the Medical Research Council (MRC) scale by an orthopedist and a physiatrist. The eligibility criteria were grade 3 or less hip joint bending and muscular weakness due to nerve injury. Patients were excluded if they had been diagnosed with an isolated sensory disorder. Results We found six cases (0.76%) of femoral motor neuropathy resulting from gynecological surgery. All six patients underwent laparotomy using energy devices under general anesthesia with epidural anesthesia in the lithotomy position. Four of them recovered fully within 8 months from surgery with either physical therapy or no treatment, while the other two died within a year post-treatment; thus, recovery evaluation could not be accurately performed. Conclusion Postoperative femoral nerve injury can be diagnosed based on gait disturbances and difficulties climbing stairs. It is difficult to identify risk factors for femoral nerve injury as they may involve a combination of features, such as intraoperative compression with self-retaining retractors, the lithotomy position, and the use of energy devices. The surgeon should be familiar with the nature of energy devices, make every effort to understand the necessary anatomy, and make every effort to avoid femoral nerve injury. Iatrogenic femoral nerve injury caused by gynecological surgery should be further investigated regarding the patients' quality of life postoperatively.
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Affiliation(s)
- Moyu Narita
- Department of Gynecologic Oncology, Hyogo Cancer Center, 13-70 Kita-Oji-cho, Akashi, Hyogo 673-0021 Japan
| | - Kazuhiro Suzuki
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550 Japan
| | - Keisuke Ogimoto
- Department of Gynecologic Oncology, Hyogo Cancer Center, 13-70 Kita-Oji-cho, Akashi, Hyogo 673-0021 Japan
| | - Keisuke Ichida
- Department of Gynecologic Oncology, Hyogo Cancer Center, 13-70 Kita-Oji-cho, Akashi, Hyogo 673-0021 Japan
| | - Junichi Aratake
- Department of Gynecologic Oncology, Hyogo Cancer Center, 13-70 Kita-Oji-cho, Akashi, Hyogo 673-0021 Japan
| | - Hiroshi Nakazawa
- Department of Gynecologic Oncology, Hyogo Cancer Center, 13-70 Kita-Oji-cho, Akashi, Hyogo 673-0021 Japan
| | - Takashi Shibutani
- Department of Gynecologic Oncology, Hyogo Cancer Center, 13-70 Kita-Oji-cho, Akashi, Hyogo 673-0021 Japan
| | - Miho Kitai
- Department of Gynecologic Oncology, Hyogo Cancer Center, 13-70 Kita-Oji-cho, Akashi, Hyogo 673-0021 Japan
| | - Takaya Shiozaki
- Department of Gynecologic Oncology, Hyogo Cancer Center, 13-70 Kita-Oji-cho, Akashi, Hyogo 673-0021 Japan
| | - Senn Wakahashi
- Department of Gynecologic Oncology, Hyogo Cancer Center, 13-70 Kita-Oji-cho, Akashi, Hyogo 673-0021 Japan
| | - Satoshi Yamaguchi
- Department of Gynecologic Oncology, Hyogo Cancer Center, 13-70 Kita-Oji-cho, Akashi, Hyogo 673-0021 Japan
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Pontes-García A, Martínez-López A, Rodríguez-Ortiz L, Valenzuela-Molina F, Rufián-Andújar B, Sánchez-Hidalgo JM, Casado-Adam A, Gordon-Suarez A, Rufián-Peña S, Vázquez-Borrego MC, Romero-Ruiz A, Arjona-Sánchez A. Establishment of a desirable dose using neutral argon plasma to eradicate miliary peritoneal implants: A phase I/II controlled trial. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106978. [PMID: 37460370 DOI: 10.1016/j.ejso.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/02/2023] [Accepted: 07/03/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Neutral argon plasma (NAP) system could meet the requirements to achieve oncological cytoreduction of peritoneal carcinomatosis with miliary lesions, minimizing the associated morbidity. This phase I/II trial aims to establish the desirable dose that is safe and effective in eliminating tumor cells with lower penetration. METHODS Patients diagnosed with different origins for peritoneal carcinomatosis and miliary implants were selected for the study. The safe and potentially effective dose (desirability) of NAP was evaluated according to three factors: distance (mm), application time (s) and power (%), to evaluate the response variables such as the presence of tumor cells (Y/N) and the depth of penetration. RESULTS Ten patients and 120 samples were evaluated and treated with NAP. There was no vascular or organ injury intraoperative using a pre-established dose of 100% (coagulation mode) at a distance of 2-3 cm. The distance was found to be correlated with the presence of the tumor cells in ex-vivo analysis, with an OR of 15.4 (4.0-111.4). The time and energy used were protective factors to eliminate tumor cells with an OR of 0.4 (0.1-0.9) and 0.8 (0.8-0.9), respectively. The safest and most effective desirability results were as follows i) energy 80% during 2-4 s with a distance of 2 cm (0.89), and ii) energy 100% during 2-4 s with a distance of 3 cm (0.90). CONCLUSIONS The use of NAP during a CRS and HIPEC is safe and effective for eradicating tumor cells on the peritoneal surface at suggested doses of energy, distance and duration. TRIAL IDENTIFICATION ClinicalTrials.gov Identifier: NCT04904042.
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Affiliation(s)
- A Pontes-García
- Unit of Surgical Oncology, Reina Sofía University Hospital, Córdoba, Spain
| | - A Martínez-López
- GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Department of Biochemistry and Molecular Biology, University of Cordoba, Córdoba, Spain; Unit of Pathology, Reina Sofia University Hospital, Córdoba, Spain
| | - L Rodríguez-Ortiz
- Unit of Surgical Oncology, Reina Sofía University Hospital, Córdoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Department of Biochemistry and Molecular Biology, University of Cordoba, Córdoba, Spain
| | - F Valenzuela-Molina
- Unit of Surgical Oncology, Reina Sofía University Hospital, Córdoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Department of Biochemistry and Molecular Biology, University of Cordoba, Córdoba, Spain
| | - B Rufián-Andújar
- Unit of Surgical Oncology, Reina Sofía University Hospital, Córdoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Department of Biochemistry and Molecular Biology, University of Cordoba, Córdoba, Spain
| | - J M Sánchez-Hidalgo
- Unit of Surgical Oncology, Reina Sofía University Hospital, Córdoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Department of Biochemistry and Molecular Biology, University of Cordoba, Córdoba, Spain
| | - A Casado-Adam
- Unit of Surgical Oncology, Reina Sofía University Hospital, Córdoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Department of Biochemistry and Molecular Biology, University of Cordoba, Córdoba, Spain
| | - A Gordon-Suarez
- Unit of Surgical Oncology, Reina Sofía University Hospital, Córdoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Department of Biochemistry and Molecular Biology, University of Cordoba, Córdoba, Spain
| | - S Rufián-Peña
- Unit of Surgical Oncology, Reina Sofía University Hospital, Córdoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Department of Biochemistry and Molecular Biology, University of Cordoba, Córdoba, Spain
| | - M C Vázquez-Borrego
- GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Department of Biochemistry and Molecular Biology, University of Cordoba, Córdoba, Spain
| | - A Romero-Ruiz
- GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Department of Biochemistry and Molecular Biology, University of Cordoba, Córdoba, Spain
| | - A Arjona-Sánchez
- Unit of Surgical Oncology, Reina Sofía University Hospital, Córdoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Department of Biochemistry and Molecular Biology, University of Cordoba, Córdoba, Spain.
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Casey VJ, McNamara LM. Instrumental in Surgery: A Narrative Review on Energy-based Surgical Cutting Devices and Surgical Smoke. Ann Surg 2023; 278:e457-e465. [PMID: 36762559 PMCID: PMC10414159 DOI: 10.1097/sla.0000000000005816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To provide an informed understanding of existing energy-based surgical cutting technologies and aerosol-generating surgical procedures. We provide a perspective on the future innovation and research potential in this space for the benefit of surgeons, physicians, engineers, and researchers alike. BACKGROUND Surgery is a treatment for many medical conditions, the success of which depends on surgical cutting instruments that enable surgeons to conduct surgical procedures for tissue cutting and manipulation. Energy-based surgical cutting tools improve accuracy and limit unnecessary destruction of healthy tissues and cells, but can generate surgical smoke and aerosols, which can be handled using surgical smoke evacuation technology. METHODS A narrative review was conducted to explore existing literature describing the history and development of energy-based surgical instruments, their mechanisms of action, aerosol-generating medical procedures, surgical smoke and aerosols from aerosol-generating medical procedures, and the recommended mitigation strategies, as well as research on rapid biological tissue analyzing devices to date. CONCLUSIONS Smoke evacuation technology may provide diagnostic information regarding tissue pathology, which could eliminate health concerns and revolutionize surgical accuracy. However, further research into surgical smoke is required to quantify the measurable risk to health it poses, the cutting conditions, under which it is generated and to develop advanced diagnostic approaches using this information.
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Affiliation(s)
- Vincent J. Casey
- Mechanobiology and Medical Devices Research Group (MMDRG), Biomedical Engineering, University of Galway, Ireland
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
| | - Laoise M. McNamara
- Mechanobiology and Medical Devices Research Group (MMDRG), Biomedical Engineering, University of Galway, Ireland
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
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Xia W, Lai G, Li Y, Zeng C, Sun C, Zhang P, Zhu G, Li L, Wu L. Photo-crosslinked adhesive hydrogel loaded with extracellular vesicles promoting hemostasis and liver regeneration. Front Bioeng Biotechnol 2023; 11:1170212. [PMID: 37234477 PMCID: PMC10208220 DOI: 10.3389/fbioe.2023.1170212] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023] Open
Abstract
Hepatectomy is an effective surgical method for the treatment of liver diseases, but intraoperative bleeding and postoperative liver function recovery are still key issues. This study aims to develop a composite hydrogel dressing with excellent hemostatic properties, biocompatibility, and ability to promote liver cell regeneration. The modified gelatin matrix (GelMA, 10%) was mixed with equal volumes of sodium alginate-dopamine (Alg-DA) at concentrations of 0.5%, 1%, and 2%. Then a cross-linking agent (0.1%) was added to prepare different composite hydrogels under UV light, named GelMA/Alg-DA-0.5, GelMA/Alg-DA-1 and GelMA/Alg-DA-2, respectively. All the prepared hydrogel has a porous structure with a porosity greater than 65%, and could be stabilized in a gel state after being cross-linked by ultraviolet light. Physicochemical characterization showed that the elastic modulus, water absorption, adhesion, and compressibility of the composite hydrogels were improved with increasing Alg-DA content. Furthermore, the prepared hydrogel exhibits in vitro degradability, excellent biocompatibility, and good hemostatic function. Among all tested groups, the group of GelMA/Alg-DA-1 hydrogel performed the best. To further enhance its application potential in the field of liver regeneration, adipose-derived mesenchymal stem cell exosomes (AD-MSC-Exo) were loaded into GelMA/Alg-DA-1 hydrogel. Under the same conditions, GelMA/Alg-DA-1/Exo promoted cell proliferation and migration more effectively than hydrogels without extracellular vesicles. In conclusion, the prepared GelMA/Alg-DA-1 composite hydrogel loaded with AD-MSC-Exo has great application potential in liver wound hemostasis and liver regeneration.
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Affiliation(s)
- Wuzheng Xia
- Department of Organ Transplantation, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Guanzhi Lai
- Department of Organ Transplantation, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Yichuan Li
- Department of Hepatobiliary and Pancreatic Surgery, People’s Hospital of Guang’an City, West China-Guang’an Hospital, Sichuan University, Guang’an, China
| | - Cong Zeng
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of General Practice, Hospital of South China Normal University, Guangzhou, China
| | - Chengjun Sun
- Department of Organ Transplantation, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Pinzhe Zhang
- Department of Organ Transplantation, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Guanghao Zhu
- Department of Organ Transplantation, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Leping Li
- Department of Organ Transplantation, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Linwei Wu
- Department of Organ Transplantation, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Shantou University Medical College, Shantou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Vyacheslavovich NT, Mikhailovich LK, Romanovich CE, Evgenievich TA, Vyacheslavovich SA. Surgeons know that they don't know about the safe use of surgical energy: an international study reveals that the knowledge gap persists. Surg Endosc 2023:10.1007/s00464-023-09936-5. [PMID: 36879166 DOI: 10.1007/s00464-023-09936-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/05/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION The rate of electrosurgery complications is 0.1-2.1%. More than 10 years ago, SAGES pioneered a well-structured educational program (FUSE) aimed to teach about the safe use of electrosurgery. This inspired the development of similar training programs around the globe. Still, the knowledge gap persists among surgeons, possibly due to the lack of judgment. AIM To investigate factors affecting the level of expertise in electrosurgical safety and their correlation with self-assessment scores among surgeons and surgical residents. MATERIALS AND METHODS We conducted an online survey consisting of 15 questions that could be thematically broken down into 5 blocks. We analyzed how the objective scores were correlated with the self-assessment scores, professional experience, past participation in training programs, and work at a teaching hospital. RESULTS A total of 145 specialists took part in the survey, including 111 general surgeons and 34 s-year surgical residents from Russia, Belarus, Ukraine, and Kirgizia. Only 9 (8.1%) surgeons scored "excellent," 32 (28.8%) scored "good," and 56 (50.4%) scored "fair." Of all surgical residents participating in the study, only 1 (2.9%) scored "excellent," 9 (26.5%) scored "good," and 11 (32.4%) scored "fair." The test was failed by 14 surgeons (12.6%) and 13 (38.2%) residents. The difference between the trainees and the surgeons was statistically significant. Our multivariate logistic model identified 3 significant factors predisposing to successful performance on the test: past training in the safe use of electrosurgery, professional experience, and work at a teaching hospital. Of all study participants, those with no past training in the safe use of electrosurgery, and non-teaching surgeons were the most realistic about their competencies. CONCLUSION We have identified alarming gaps in the knowledge of electrosurgical safety among surgeons. Faculty staff and experienced surgeons scored higher, but past training was the most influential factor in improving knowledge of electrosurgical safety.
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Stefanovic S, Sütterlin M, Gaiser T, Scharff C, Neumann M, Berger L, Froemmel N, Tuschy B, Berlit S. Microscopic, Macroscopic and Thermal Impact of Argon Plasma, Diode Laser, and Electrocoagulation on Ovarian Tissue. In Vivo 2023; 37:531-538. [PMID: 36881055 PMCID: PMC10026650 DOI: 10.21873/invivo.13111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/24/2022] [Accepted: 01/09/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM To compare the microscopic, macroscopic and thermal damage inflicted to ovarian tissue by conventional monopolar and bipolar energy, argon plasma coagulation (APC) and diode laser. MATERIALS AND METHODS Bovine ovaries were used as a substitute for human tissue and subjected to the four aforementioned techniques and the inflicted damage was measured. Sixty fresh and morphologically similar cadaveric bovine ovaries were divided into five equal groups, each group was subjected to one of the following energy applications for both 1 and 5 s: Monopolar, bipolar electrocoagulation, diode laser, preciseAPC® and forcedAPC® Ovarian temperatures were measured at 4 and 8 s after treatment. Formalin-fixed ovarian specimens were examined by pathologists regarding macroscopic, microscopic and thermal tissue damage. RESULTS None of the ovaries reached the temperature producing severe damage (40°C) after 1 s of energy transfer. Heating of adjacent ovarian tissue was least pronounced when preciseAPC® and monopolar electrocoagulation were applied (27.2±3.3°C and 28.2±2.9°C after 5 s of application, respectively). Conversely, 41.7% of the ovaries subjected to bipolar electrocoagulation for 5 s overheated. ForcedAPC® resulted in the most pronounced lateral tissue defects (2.8±0.3 mm after 1 s and 4.7±0.6 mm after 5 s). When the modalities were applied for 5 s, the electrosurgical instruments (mono- and bipolar) and preciseAPC® induced similar lateral tissue damage (1.3±0.6 mm, 1.1±1.6 mm and 1.2±1.3 mm, respectively). preciseAPC® created the shallowest defect of all the techniques (0.05±0.1 mm after 5 s of application). CONCLUSION Our study hints at superior safety profiles of preciseAPC® and monopolar electrocoagulation compared to bipolar electrocoagulation, diode laser and forcedAPC® for ovarian laparoscopic surgery.
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Affiliation(s)
- Stefan Stefanovic
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany;
| | - Marc Sütterlin
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Timo Gaiser
- Institute of Pathology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Scharff
- Institute of Pathology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Marcel Neumann
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Laura Berger
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Benjamin Tuschy
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Sebastian Berlit
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
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Spaich S, Berlit S, Berger L, Weiss C, Tuschy B, Sütterlin M, Stefanovic S. First experiences with a diode laser in major gynecological laparoscopic procedures show lack of benefit and impaired feasibility. Lasers Med Sci 2023; 38:34. [PMID: 36600026 DOI: 10.1007/s10103-022-03696-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE The aim of this study is to evaluate feasibility and potential benefit of a diode laser in major laparoscopic procedures in gynecology. METHODS Between 2018 and 2020, a total of 42 cases were enrolled in this study comparing standard electrosurgery with diode laser-supported therapy in laparoscopic supracervical hysterectomy (LASH), total laparoscopic hysterectomy (TLH), or laparoscopic myoma enucleation (LME). Dual wavelength 45 W diode laser light was used to cut and coagulate during laparoscopy in the prospective interventional arm consisting of 11 cases, while 31 matching patients who received conventional treatment with monopolar/bipolar current for the same interventions were retrospectively identified in our laparoscopy database. Recruitment in the prospective interventional laser diode arm was terminated after only 11 patients (instead of planned 50) due to intense hemorrhage and massive smoke development. RESULTS A total of 42 cases were analyzed (11 LME, 19 LASH, and 12 TLH). Strong smoke development was evident in all 11 cases in the diode laser arm. It was necessary to convert to bipolar or monopolar current in all hysterectomies (n = 9) with initial diode laser implementation due to increased bleeding and smoke development. Conventional current sources had to be used in LMEs (n = 2) due to excessive bleeding and poor visibility during enucleation of the fibroid. A significant difference (p < 0.0001) was observed regarding smoke development when comparing the laser arm with the control arm. CONCLUSION We found a 45-W diode laser to be inferior to electrosurgical techniques for major laparoscopic gynecologic surgeries regarding bleeding control and smoke development.
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Affiliation(s)
- Saskia Spaich
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.
| | - Sebastian Berlit
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Laura Berger
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan Stefanovic
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
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Wikiel KJ, Powlan FJ, Jones TS, Robinson TN, Jones EL. Robotic stray energy with constant-voltage versus constant-power regulating electrosurgical generators. Surg Endosc 2023; 37:580-586. [PMID: 35612638 DOI: 10.1007/s00464-022-09316-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 04/27/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Stray energy from surgical energy instruments can cause unintended thermal injuries. There are no published data regarding electrosurgical generators and their influence on stray energy transfer during robotic surgery. There are two approved generators for the DaVinci Xi robotic platform: a constant-voltage regulating generator (cVRG) and a constant-power regulating generator (cPRG). The purpose of this study was to quantify and compare stray energy transfer in the robotic Xi platform using a cVRG versus a cPRG. METHODS An ex vivo bovine model was used to simulate a standard multiport robotic surgery. The DaVinci Xi (Intuitive Surgical, Sunnyvale, CA) robotic platform was attached to a trainer box using robotic ports. A 5 s, open-air activation of the monopolar scissors was done with commonly used electrosurgical settings using a cPRG (ForceTriad, Covidien-Medtronic, Boulder, CO) or cVRG (ERBE VIO 300 dV 2.0, ERBE USA, Marietta, GA). Stray energy transfer was quantified as the change in tissue temperature (°C) nearest the tip of the assistance grasper (which was not in direct contact with the active monopolar scissors). RESULTS Stray energy transfer occurred with both generators. Utilizing common, comparable settings for standard coagulation, significantly less stray energy was transferred with the cVRG versus cPRG (4.4 ± 1.6 °C vs. 41.1 ± 13.0 °C, p < 0.001). Similarly, less stray energy was transferred using cut modes with the cVRG compared to the cPRG (5.61 ± 1.79 °C vs. 33.9 ± 18.4 °C, p < 0.001). CONCLUSION Stray energy transfer increases tissue temperatures more than 45C in the DaVinci Xi robotic platform. Low voltage modalities, such as cut or blend; as well as a cVRG generator, significantly reduces stray energy. Robotic surgeons can minimize the risk of stray energy injuries by using these low risk modes and/or generator.
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Affiliation(s)
- Krzysztof J Wikiel
- Department of Surgery, The University of Colorado School of Medicine, Aurora, CO, USA. .,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA.
| | - Franklin J Powlan
- Department of Surgery, The University of Colorado School of Medicine, Aurora, CO, USA
| | - Teresa S Jones
- Department of Surgery, The University of Colorado School of Medicine, Aurora, CO, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Thomas N Robinson
- Department of Surgery, The University of Colorado School of Medicine, Aurora, CO, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Edward L Jones
- Department of Surgery, The University of Colorado School of Medicine, Aurora, CO, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
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Understanding the safe application of electrosurgery: A cross sectional study of surgeons in KSA. J Taibah Univ Med Sci 2022; 18:595-599. [PMID: 36818175 PMCID: PMC9906003 DOI: 10.1016/j.jtumed.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/29/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives To determine whether surgeons at different levels and in different specialties are aware of the safe and acceptable use of electrosurgery. In addition, we aimed to provide a fundamental understanding of electrosurgery and surgical diathermy. Materials and Methods A total of 83 doctors from different specialties were randomly selected from several hospitals across KSA. The participants answered a questionnaire featuring 16 questions that addressed 10 domain questions regarding the safe use of electrosurgery. Results Analysis revealed that the respondents either lacked knowledge or were unfamiliar with the use and safety of monopolar and bipolar electrosurgery in terms of application. Some respondents were unable to distinguish between the two protocols; this may have resulted in injuries being incurred by patients under their supervision. Conclusions Electrosurgery should be formally included in specialty surgical Saudi hospital training programs to increase electrosurgery expertise and surgeons should be re-tested periodically. Our findings may be used to drive future learning. Surgeons may improve their electrosurgery skills by progressing along their learning curve to reach their peak. In addition, surgeons can use virtual reality surgical simulators to practice fundamental and sophisticated electrosurgery skills.
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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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Kajiwara M, Fujikawa T, Hasegawa S. Tissue pad degradation of ultrasonic device may enhance thermal injury and impair its sealing performance in liver surgery. World J Hepatol 2022; 14:1357-1364. [PMID: 36158911 PMCID: PMC9376783 DOI: 10.4254/wjh.v14.i7.1357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/12/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ultrasonic devices are widely used in many surgical fields, including hepatectomy; however, the negative effects of tissue pad degradation of ultrasonic devices, including those in liver surgery, remain unknown. The Harmonic® 1100 (H-1100) scalpel has advanced heat control technology than previous models, such as the Harmonic® HD1000i (H-HD1000i). We hypothesized that, because of its advanced temperature-control technology, the H-1100 scalpel would show less tissue pad degradation, resulting in superior sealing performance, compared to that with the H-HD1000i scalpel.
AIM To elucidate ultrasonic device tissue pad degradation effects on instrument temperature and sealing performance using ex vivo porcine liver/vessel models.
METHODS Two different harmonic scalpels were used and compared: A newer model, the H-1100 scalpel, and an older model, the H-HD1000i scalpel. Using ex vivo porcine livers, each instrument was activated until the liver parenchyma was dissected. The device temperature (passive jaw temperature) was measured after every 10 consecutive activations, until 300 transections of the porcine liver were performed. Tissue pad degradation was evaluated after 300 activations. Sealing performance was evaluated using excised porcine carotid vessels; vessel sealing speed and frequency of vessel burst pressure below 700 mmHg were determined after 300 transections of porcine liver parenchyma.
RESULTS The temperature of the H-HD1000i scalpel was approximately 10°C higher than that of the H-1100 scalpel, and gradually increased as the number of activations increased. The median passive jaw temperature of the H-HD1000i scalpel was significantly higher than that of the H-1100 scalpel (73.4°C vs 65.1°C; P < 0.001). After 300 transections of porcine liver parenchyma, less tissue pad degradation was observed with the H-1100 scalpel than with the H-HD1000i scalpel (0.08 mm vs 0.51 mm). The H-1100 scalpel demonstrated faster vessel-sealing speed (4.9 sec. vs 5.1 sec.) and less frequent vessel burst pressure < 700 mmHg (0% vs 40%) after 300 activations than the H-HD1000i scalpel; however, the difference did not reach statistical significance (P = 0.21 and P = 0.09, respectively).
CONCLUSION In an ex vivo porcine hepatectomy model, the H-1100 scalpel shows lower passive jaw temperature and maintains its sealing performance by avoiding tissue pad degradation compared to that with the H-HD1000i.
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Affiliation(s)
- Masatoshi Kajiwara
- Department of Gastroenterological Surgery, Fukuoka University, Fukuoka 814-0180, Fukuoka, Japan
| | - Takahisa Fujikawa
- Department of Surgery, Kokura Memorial Hospital, Kitakyushu 802-8555, Fukuoka, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Fukuoka University, Fukuoka 814-0180, Fukuoka, Japan
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Shiver AL, Webber C, Sliker T, Rushford P, Shaw A. Bigger Is Not Always Better: Effects of Electrocautery Setting on Tissue Injury in a Porcine Model. Cureus 2022; 14:e26841. [PMID: 35974853 PMCID: PMC9375435 DOI: 10.7759/cureus.26841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Electrosurgery for dissection and hemostasis remains one of the foundational tools for the field of surgery as a whole. Monopolar cautery remains the most utilized modality for achieving the aforementioned goals. Given the prolonged history and pre-modern development of "Bovie" cautery, there remains a paucity of data regarding appropriate settings and intensity for various tissue types, procedures, or locales. As a result, utilized settings depend on precedent and personal preference. We aimed to determine the amount of secondary soft tissue injury by volume and depth beyond the electrocautery pen tip in the skin and subcutaneous tissue as well as skeletal muscle. Methods Porcine samples were used for experimental testing using two testing types: 1) skin and subcutaneous tissue and 2) Skeletal muscle. Sample sizes were standardized at 1 cm3 cubes. For skin samples, tissue injury was created with either a scalpel or electrocautery pen on cut setting, and tested at intensities from 10 to 150 in increments of 10. Skeletal muscle samples were similarly tested using the electrocautery pen only in either a cut or coagulation setting. Samples were tested at incremental intensities from 10 to 120 for both settings. Electrocautery was tested for a period of five seconds with a continuous current. All samples were placed in formalin and underwent histologic staining with hematoxylin and eosin staining to be assessed for the extent of tissue injury in terms of depth, radius, and volume. The measurements were recorded in millimeters. Results For skin incision, there was a positive and significant correlation with respect to the radius (R=.73, p=0.006). When considering intensity with an interval of 10-70 there was a positive and significant correlation with respect to the radius, depth, and volume. The cold knife incision had no notable soft tissue injury beyond the depth of the incision. Regarding skeletal muscle, again, a significant and positive correlation between increasing monopolar settings was noted for both the coagulation and cut functions (R=.84, p=.0005; R=0.84, p=0.0006). A positive correlation was found between increasing cut intensity and volume of soft tissue injury (R=0.73, p=.008); this was not reflected in the coagulation setting. When limited to an intensity range of 10-60, a significant relationship was noted for depth, radius and volume (R=.95, p= <0.001; R=0.98, p= <.001; R=.92, p=.001). Conclusion In all samples, apart from the cold knife skin incision, additional soft tissue injury beyond the tip of the electrocautery pen was noted. Given our findings, recommendations include using the lowest setting required for the purposes of the given surgical case as well as minimizing electrocautery use for skin incisions given its association with a larger volume of tissue injury in comparison with a scalpel. Additionally, electrocautery should be used with care in, and around neurovascular structures as soft tissue injury did occur several millimeters beyond the tip of the electrocautery pen. Further study is needed to see if these patterns are similar in living animals as well as human tissue and whether they bear any clinical impact on surgical wound healing or other surgical complications.
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Olasehinde O, Owojuyigbe A, Adeyemo A, Mosanya A, Aaron O, Wuraola F, Owoniya T, Owojuyigbe T, Alatise O, Adisa A. Use of energy device in general surgical operations: impact on peri-operative outcomes. BMC Surg 2022; 22:90. [PMID: 35264141 PMCID: PMC8908598 DOI: 10.1186/s12893-022-01540-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 02/07/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The introduction of energy devices has significantly expanded the scope of surgical expedition. The LigaSure™ vessel sealing system is a bipolar electrosurgical device, recently introduced to our practice. Its impact on peri-operative outcomes in a variety of major operations was evaluated in this study. METHODS A retrospective review of operations performed following the adoption of the LigaSure™ vessel sealing device was carried out. Five categories of operations were evaluated (Thyroidectomies, Gastrectomies, Colectomies, Pancreaticoduodenectomies, and Anterior/Abdomino-perineal resection [A/APR of the rectum). Peri-operative outcomes (duration of operation, intra-operative blood loss, blood transfusion rates) were compared with a cohort of similar operations performed using conventional techniques. Data analysis and comparisons were done on a subgroup basis. RESULTS A total of 117 operations were performed using the LigaSure™ device with thyroidectomies being the most common (66/117-56.4%). Compared to cases done using conventional techniques of suture and knot with electrocautery (120 cases), the use of LigaSure™ was associated with a significant reduction in operation time in all categories of operations. Intraoperative blood loss was also lower in all categories of cases, but this was only statistically significant following A/APR and Thyroidectomies. Generally, there was a trend towards a reduction in blood transfusion rates. CONCLUSIONS The use of energy devices for surgical operations is feasible in a resource-limited setting. It has the potential of improving outcomes.
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Affiliation(s)
- Olalekan Olasehinde
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria.
| | - Afolabi Owojuyigbe
- Department of Anaesthesia, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Adekunle Adeyemo
- Department of Otorhinolaryngology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Arinzechukwu Mosanya
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - Olurotimi Aaron
- Department of Anaesthesia, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Funmilola Wuraola
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - Temitope Owoniya
- Department of Anaesthesia, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Temilola Owojuyigbe
- Department of Haematology, Obafemi Awolowo University Teaching Hospitals Complex, Ile- Ife, Nigeria
| | - Olusegun Alatise
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - Adewale Adisa
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
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Brinkmann F, Hüttner R, Mehner PJ, Henkel K, Paschew G, Herzog M, Martens N, Richter A, Hinz S, Groß J, Schafmayer C, Hampe J, Hendricks A, Schwandner F. Temperature profile and residual heat of monopolar laparoscopic and endoscopic dissection instruments. Surg Endosc 2022; 36:4507-4517. [PMID: 34708296 PMCID: PMC9085678 DOI: 10.1007/s00464-021-08804-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/17/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Endoscopic and laparoscopic electrosurgical devices (ED) are of great importance in modern medicine but can cause adverse events such as tissue injuries and burns from residual heat. While laparoscopic tools are well investigated, detailed insights about the temperature profile of endoscopic knives are lacking. Our aim is to investigate the temperature and the residual heat of laparoscopic and endoscopic monopolar instruments to increase the safety in handling ED. METHODS An infrared camera was used to measure the temperature of laparoscopic and endoscopic instruments during energy application and to determine the cooling time to below 50 °C at a porcine stomach. Different power levels and cutting intervals were studied to investigate their impact on the temperature profile. RESULTS During activation, the laparoscopic hook exceeded 120 °C regularly for an up to 10 mm shaft length. With regards to endoknives, only the Dual Tip Knife showed a shaft temperature of above 50 °C. The residual heat of the laparoscopic hook remained above 50 °C for at least 15 s after activation. Endoknives cooled to below 50 °C in 4 s. A higher power level and longer cutting duration significantly increased the shaft temperature and prolonged the cooling time (p < 0.001). CONCLUSION Residual heat and maximum temperature during energy application depend strongly on the chosen effect and cutting duration. To avoid potential injuries, the user should not touch any tissue with the laparoscopic hook for at least 15 s and with the endoknives for at least 4 s after energy application. As the shaft also heats up to over 120 °C, the user should be careful to avoid tissue contact during activation with the shaft. These results should be strongly considered for safety reasons when handling monopolar ED.
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Affiliation(s)
- Franz Brinkmann
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Chair of Microsystems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Department of Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden (TU Dresden), Fetscherstr. 74, 01307 Dresden, Germany
| | - Ronny Hüttner
- Chair of Microsystems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Philipp J. Mehner
- Chair of Microsystems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Konrad Henkel
- Chair of Microsystems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Georgi Paschew
- Chair of Microsystems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Moritz Herzog
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Nora Martens
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Andreas Richter
- Chair of Microsystems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Sebastian Hinz
- Department of General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
| | - Justus Groß
- Department of General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
| | - Clemens Schafmayer
- Department of General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
| | - Jochen Hampe
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany ,Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Alexander Hendricks
- Department of General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
| | - Frank Schwandner
- Department of General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
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Fang G, Chow MCK, Ho JDL, He Z, Wang K, Ng TC, Tsoi JKH, Chan PL, Chang HC, Chan DTM, Liu YH, Holsinger FC, Chan JYK, Kwok KW. Soft robotic manipulator for intraoperative MRI-guided transoral laser microsurgery. Sci Robot 2021; 6:6/57/eabg5575. [PMID: 34408096 DOI: 10.1126/scirobotics.abg5575] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/27/2021] [Indexed: 01/14/2023]
Abstract
Magnetic resonance (MR) imaging (MRI) provides compelling features for the guidance of interventional procedures, including high-contrast soft tissue imaging, detailed visualization of physiological changes, and thermometry. Laser-based tumor ablation stands to benefit greatly from MRI guidance because 3D resection margins alongside thermal distributions can be evaluated in real time to protect critical structures while ensuring adequate resection margins. However, few studies have investigated the use of projection-based lasers like those for transoral laser microsurgery, potentially because dexterous laser steering is required at the ablation site, raising substantial challenges in the confined MRI bore and its strong magnetic field. Here, we propose an MR-safe soft robotic system for MRI-guided transoral laser microsurgery. Owing to its miniature size (Ø12 × 100 mm), inherent compliance, and five degrees of freedom, the soft robot ensures zero electromagnetic interference with MRI and enables safe and dexterous operation within the confined oral and pharyngeal cavities. The laser manipulator is rapidly fabricated with hybrid soft and hard structures and is powered by microvolume (<0.004 milliter) fluid flow to enable laser steering with enhanced stiffness and lowered hysteresis. A learning-based controller accommodates the inherent nonlinear robot actuation, which was validated with laser path-following tests. Submillimeter laser steering accuracy was demonstrated with a mean error < 0.20 mm. MRI compatibility testing demonstrated zero observable image artifacts during robot operation. Ex vivo tissue ablation and a cadaveric head-and-neck trial were carried out under MRI, where we employed MR thermometry to monitor the tissue ablation margin and thermal diffusion intraoperatively.
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Affiliation(s)
- Ge Fang
- Department of Mechanical Engineering, University of Hong Kong, Hong Kong, China
| | - Marco C K Chow
- Department of Mechanical Engineering, University of Hong Kong, Hong Kong, China
| | - Justin D L Ho
- Department of Mechanical Engineering, University of Hong Kong, Hong Kong, China
| | - Zhuoliang He
- Department of Mechanical Engineering, University of Hong Kong, Hong Kong, China
| | - Kui Wang
- Department of Mechanical Engineering, University of Hong Kong, Hong Kong, China
| | - T C Ng
- Faculty of Dentistry, University of Hong Kong, Hong Kong, China
| | - James K H Tsoi
- Faculty of Dentistry, University of Hong Kong, Hong Kong, China
| | - Po-Ling Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, Chinese University of Hong Kong, Hong Kong, China
| | - Hing-Chiu Chang
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong, China.,Department of Biomedical Engineering, Chinese University of Hong Kong, Hong Kong, China
| | | | - Yun-Hui Liu
- Department of Mechanical and Automation Engineering, Chinese University of Hong Kong, Hong Kong, China
| | | | - Jason Ying-Kuen Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, Chinese University of Hong Kong, Hong Kong, China.
| | - Ka-Wai Kwok
- Department of Mechanical Engineering, University of Hong Kong, Hong Kong, China.
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19
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Knowledge Assessment among Surgeons about Energy Devices safe use: A Multicenter Cross Sectional Study. Int Surg 2021. [DOI: 10.9738/intsurg-d-21-00016.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To assess General Surgery trainee’s knowledge about safe use of energy devices in two tertiary hospitals in Riyadh, Saudi Arabia Background: Electro surgery is the use of high-frequency electrical energy to achieve cutting, and coagulation. This method has become ubiquitous worldwide for the purpose of achieving rapid hemostasis and rapid dissection of tissues Methods: Participants completed a 35-item multiple choice question examination, testing critical knowledge of ES. The examination was developed according to the objectives and blueprints of SAGES’ Fundamental Use of Surgical Energy curriculum. Sections of the examination included: principles of ES, ES-related adverse events, monopolar and bipolar devices, and pediatric considerations and interference with implantable devices.’’ Scores were compared between juniors and seniors participants. Results: A total of 51 general surgical trainees from two academic hospitals completed the assessment. 15.69% of the participants correctly answered 30 questions out of 35 questions, 39.22% of the participants responded correctly to 20 questions out of 35 answers, and 45.09 who responded correctly to less than 20 questions. It was found that 52.2% of the individuals with a low level of understanding were junior residents as opposed to 87.5% of the participants with the highest level of understanding were senior residents with a significant P-value of 0.04. Conclusions: majority of general surgery residents enrolled in the Saudi Arabian board of surgery lack adequate knowledge about the safe and efficient use of surgical energy devices. The level of understanding is lower among the junior residents than seniors.
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20
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Complications associated with energy-based devices during thyroidectomy from 2010–2020. World J Otorhinolaryngol Head Neck Surg 2021; 9:35-44. [PMID: 37006740 PMCID: PMC10050967 DOI: 10.1016/j.wjorl.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/27/2021] [Indexed: 12/12/2022] Open
Abstract
Objective Harmonic Focus (Ethicon, Johnson and Johnson, Cincinnati, OH, USA), LigaSure Small Jaw (Medtronic, Covidien Products, Minneapolis, MN, USA), and Thunderbeat Open Fine Jaw (Olympus, Japan) are electrosurgical instruments used widely in head and neck surgery. The study aims to compare device malfunctions, adverse events to patients, operative injuries, and interventions related to Harmonic, LigaSure, and Thunderbeat use during thyroidectomy. Methods The US Food and Drug Administration's Manufacture and User Facility Device Experience (MAUDE) database was queried for adverse events associated with Harmonic, LigaSure, and Thunderbeat from January 2005 to August 2020. Data were extracted from reports pertaining to thyroidectomy. Results Of the 620 adverse events extracted, 394 (63.5%) involved Harmonic, 134 (21.6%) LigaSure, and 92 (14.8%) Thunderbeat. The reported device malfunctions most frequently associated with Harmonic was damage to the blade (110 (27.9%)), LigaSure was inappropriate function (47 (43.1%)), Thunderbeat was damage to the tissue or Teflon pad (27 (30.7%)), respectively. Burn injury and incomplete hemostasis were the most commonly reported adverse events. The operative injury reported most frequently when using Harmonic and LigaSure was burn injury. No operator injuries were reported with Thunderbeat use. Conclusion The most frequently reported device malfunctions were damage to the blade, inappropriate function, and damage to the tissue or Teflon pad. The most frequently reported adverse events to patients was a burn injury and incomplete hemostasis. Interventions aimed at improving physician education may help reduce adverse events attributed to improper use.
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21
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Beyersdorffer P, Kunert W, Jansen K, Miller J, Wilhelm P, Burgert O, Kirschniak A, Rolinger J. Detection of adverse events leading to inadvertent injury during laparoscopic cholecystectomy using convolutional neural networks. ACTA ACUST UNITED AC 2021; 66:413-421. [PMID: 33655738 DOI: 10.1515/bmt-2020-0106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 02/16/2021] [Indexed: 01/17/2023]
Abstract
Uncontrolled movements of laparoscopic instruments can lead to inadvertent injury of adjacent structures. The risk becomes evident when the dissecting instrument is located outside the field of view of the laparoscopic camera. Technical solutions to ensure patient safety are appreciated. The present work evaluated the feasibility of an automated binary classification of laparoscopic image data using Convolutional Neural Networks (CNN) to determine whether the dissecting instrument is located within the laparoscopic image section. A unique record of images was generated from six laparoscopic cholecystectomies in a surgical training environment to configure and train the CNN. By using a temporary version of the neural network, the annotation of the training image files could be automated and accelerated. A combination of oversampling and selective data augmentation was used to enlarge the fully labeled image data set and prevent loss of accuracy due to imbalanced class volumes. Subsequently the same approach was applied to the comprehensive, fully annotated Cholec80 database. The described process led to the generation of extensive and balanced training image data sets. The performance of the CNN-based binary classifiers was evaluated on separate test records from both databases. On our recorded data, an accuracy of 0.88 with regard to the safety-relevant classification was achieved. The subsequent evaluation on the Cholec80 data set yielded an accuracy of 0.84. The presented results demonstrate the feasibility of a binary classification of laparoscopic image data for the detection of adverse events in a surgical training environment using a specifically configured CNN architecture.
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Affiliation(s)
| | - Wolfgang Kunert
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Kai Jansen
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Johanna Miller
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Peter Wilhelm
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Oliver Burgert
- Department of Medical Informatics, Reutlingen University, Reutlingen, Germany
| | - Andreas Kirschniak
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Jens Rolinger
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
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22
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Gualniera P, Scurria S, Sapienza D, Asmundo A. Electrosurgical unit: Iatrogenic injuries and medico-legal aspect. Italian legal rules, experience and article review. Ann Med Surg (Lond) 2021; 62:26-30. [PMID: 33489112 PMCID: PMC7808912 DOI: 10.1016/j.amsu.2020.12.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/19/2020] [Accepted: 12/20/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The use of the electrosurgical unit (ESU) is well-established in the surgical practice. The Authors, to better understand the genesis of injuries connected to the use of electrosurgical instruments, conducted an in-depth literature review pertaining to this topic. MATERIALS AND METHOD Using the most important medical databases, a research of experimental studies in the last 20 years was conducted. RESULTS The analysis of the mechanisms responsible for the lesions showed that high energy devices remain as the most common cause of injury. Adverse events are mainly given by thermal injuries; cases of electromagnetic interference are also described in patients with pacemakers or sacral nerve stimulator and spinal stimulators as well as cases of fire of the endotracheal tube in the course of tracheostomy for the use of the electrosurgical unit in an environment with a high concentration of oxygen or anesthetic gases. Also reported in the literature are individual cases of fires caused by sparks from the electrosurgical handpiece also for the use of disinfectants and/or in relation to surgical drapes. CONCLUSION In order to clearly define the medical-legal aspects, focusing on the professional responsibility of the surgical and nursing staff, the authors' attention was brought to the need for an effective prevention plan that highlights not only the importance of an accurate procedural knowledge in order to safety use the electrosurgical instruments, but also the need for a system that monitors any complications or adverse events resulting from the use of such instruments.
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Affiliation(s)
- Patrizia Gualniera
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, A.O.U. “G. Martino” Via Consolare Valeria n. 1, 98124, Messina, Italy
| | - Serena Scurria
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, A.O.U. “G. Martino” Via Consolare Valeria n. 1, 98124, Messina, Italy
| | - Daniela Sapienza
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, A.O.U. “G. Martino” Via Consolare Valeria n. 1, 98124, Messina, Italy
| | - Alessio Asmundo
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, A.O.U. “G. Martino” Via Consolare Valeria n. 1, 98124, Messina, Italy
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23
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York PA, Peña R, Kent D, Wood RJ. Microrobotic laser steering for minimally invasive surgery. Sci Robot 2021; 6:6/50/eabd5476. [PMID: 34043580 DOI: 10.1126/scirobotics.abd5476] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/25/2020] [Indexed: 12/16/2022]
Abstract
The creation of multiarticulated mechanisms for use with minimally invasive surgical tools is difficult because of fabrication, assembly, and actuation challenges on the millimeter scale of these devices. Nevertheless, such mechanisms are desirable for granting surgeons greater precision and dexterity to manipulate and visualize tissue at the surgical site. Here, we describe the construction of a complex optoelectromechanical device that can be integrated with existing surgical tools to control the position of a fiber-delivered laser. By using modular assembly and a laminate fabrication method, we are able to create a smaller and higher-bandwidth device than the current state of the art while achieving a range of motion similar to existing tools. The device we present is 6 millimeters in diameter and 16 millimeters in length and is capable of focusing and steering a fiber-delivered laser beam at high speed (1.2-kilohertz bandwidth) over a large range (over ±10 degrees in both of two axes) with excellent static repeatability (200 micrometers).
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Affiliation(s)
- Peter A York
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, 150 Western Ave., Boston, MA, USA. .,Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Boston, MA, USA
| | - Rut Peña
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, 150 Western Ave., Boston, MA, USA.,Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Boston, MA, USA
| | - Daniel Kent
- Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Boston, MA, USA.,Beth Israel Deaconess Medical Center, 110 Francis St., Boston, MA, USA
| | - Robert J Wood
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, 150 Western Ave., Boston, MA, USA.,Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Boston, MA, USA
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24
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Friebel TR, Narayan N, Ramakrishnan V, Morgan M, Cellek S, Griffiths M. Comparison of PEAK PlasmaBlade™ to conventional diathermy in abdominal-based free-flap breast reconstruction surgery-A single-centre double-blinded randomised controlled trial. J Plast Reconstr Aesthet Surg 2020; 74:1731-1742. [PMID: 33422499 DOI: 10.1016/j.bjps.2020.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/08/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Electrosurgery makes dissection with simultaneous haemostasis possible. The produced heat can cause injury to the surrounding tissue. The PEAK PlasmaBlade™(PPB) is a new electrosurgery device which may overcome this by having the ability to operate on a lower temperature, therefore reducing collateral thermal damage. METHOD A single-centre, double-blinded, randomised controlled trial (RCT) was conducted which included 108 abdominal-based free-flap breast reconstruction patients who had their flap raise performed using either the PPB (n = 56) or the conventional diathermy (n = 52). Data were collected during their in-patient stay and out-patient appointments. The primary outcome value was the number of days the abdominal drains were required. RESULTS Baseline characteristics were similar between the groups, except a significantly lower flap weight in the PPB group. The median number of days the drains were required did not differ significantly (p = 0.48; 6.0 days for the diathermy and 5.0 days for the PPB). The total drain output (p = 0.68), the inflammatory cytokine in the drain fluid (p>0.054) and complications (p>0.24) did not differ significantly between the two groups. At the 2-week follow-up appointment, there was a trend towards less abdominal seromas on abdominal ultrasound (p = 0.09) in the PPB group which were significantly smaller (p = 0.04). CONCLUSION The use of the PPB did not result in a significant reduction of drain requirement, total drain output or inflammatory cytokines but did reduce the size of seroma collections at the 2-week follow-up appointment. Therefore, the use of the PPB device could reduce early seroma formation after drain removal.
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Affiliation(s)
- T R Friebel
- St. Andrews Centre for Plastics and Burns, Court Road, Broomfield, Chelmsford CM17ET, United-Kingdom; Anglia Ruskin University, Bishop Hall Ln, Chelmsford CM11SQ, United Kingdom.
| | - N Narayan
- St. Andrews Centre for Plastics and Burns, Court Road, Broomfield, Chelmsford CM17ET, United-Kingdom
| | - V Ramakrishnan
- St. Andrews Centre for Plastics and Burns, Court Road, Broomfield, Chelmsford CM17ET, United-Kingdom
| | - M Morgan
- St. Andrews Centre for Plastics and Burns, Court Road, Broomfield, Chelmsford CM17ET, United-Kingdom
| | - S Cellek
- Anglia Ruskin University, Bishop Hall Ln, Chelmsford CM11SQ, United Kingdom
| | - M Griffiths
- St. Andrews Centre for Plastics and Burns, Court Road, Broomfield, Chelmsford CM17ET, United-Kingdom
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25
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Arnold L, Kennel C, Gov-Ari E. Fiber optic CO 2-laser induced emphysema of the supraglottis. Int J Pediatr Otorhinolaryngol 2020; 138:110279. [PMID: 32810687 DOI: 10.1016/j.ijporl.2020.110279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/26/2020] [Accepted: 07/26/2020] [Indexed: 11/30/2022]
Abstract
Subcutaneous emphysema is a rare but well-defined surgical complication. However, emphysema of the supraglottic mucosa has not been described in the literature. We present a case of a 2-year-old male who suffered supraglottic emphysema secondary to fiber optic CO2-laser use during laryngeal cleft repair. The patient required preemptive postoperative intubation; however, there were no long-lasting adverse effects at 6 and 12 weeks follow up. This report illustrates a rare CO2-laser complication and describes its sequela.
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Affiliation(s)
- Lauren Arnold
- University of Missouri School of Medicine, One Hospital Dr MA204G, Columbia, MO, 65212, United States.
| | - Christopher Kennel
- Department of Otolaryngology, University of Missouri School of Medicine, One Hospital Dr MA314, Columbia, MO, 65212, United States.
| | - Eliav Gov-Ari
- Department of Otolaryngology, University of Missouri School of Medicine, One Hospital Dr MA314, Columbia, MO, 65212, United States.
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26
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Takeyama H, Danno K, Nishigaki T, Yamashita M, Oka Y. Surgical technique for mesorectal division during robot-assisted laparoscopic tumor-specific mesorectal excision (TSME) for rectal cancer using da Vinci Si surgical system: the simple switching technique (SST). Updates Surg 2020; 73:1093-1102. [PMID: 33079354 DOI: 10.1007/s13304-020-00901-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/08/2020] [Indexed: 01/05/2023]
Abstract
In a narrow pelvic cavity, performing sufficient tumor-specific mesorectal excision (TSME) is difficult. Even in robot-assisted laparoscopic surgery (RALS), mesorectal division is difficult in a narrow pelvic cavity. To overcome this difficulty, we invented a novel method of mesorectal division. In this new approach, we switched the fenestrated bipolar forceps and the double-fenestrated forceps with each other so that both instruments were placed on the same (right) side of the patient. After the mesorectal fat and vessels were coagulated using the fenestrated bipolar forceps, coagulated tissues were divided using the monopolar scissors in the same direction. We named this technique the "simple switching technique (SST)". We retrospectively collected data and evaluated the usefulness of SST in 24 consecutive patients who underwent RALS TSME between July 2018 and January 2020. Twelve patients underwent SST, and 12 patients underwent other conventional surgical methods (non-SST). The median operation time for mesorectal division was 809.5 s (range 395-1491 s) in the SST group and 985.5 s (range 493-2353 s) in the non-SST group. The coefficient of variation for non-SST was 0.545, which was > 1.5 times the coefficient of 0.360 for SST. Although no significant differences were found for operation time for mesorectal division, the operation time for mesorectal division by SST tended to be shorter than by non-SST (P = 0.157). No significant differences were found regarding short-term outcomes between the groups. SST is feasible and can be an optional method of mesorectal division in RALS TSME.
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Affiliation(s)
- Hiroshi Takeyama
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan.
| | - Katsuki Danno
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan
| | - Takahiko Nishigaki
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan
| | - Masafumi Yamashita
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan
| | - Yoshio Oka
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan
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27
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A new method using a vessel-sealing system provides coagulation effects to various types of bleeding with less thermal damage. Surg Endosc 2020; 35:1453-1464. [PMID: 33063194 PMCID: PMC7886768 DOI: 10.1007/s00464-020-08043-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 09/22/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hemostasis is very important for a safe surgery, particularly in endoscopic surgery. Accordingly, in the last decade, vessel-sealing systems became popular as hemostatic devices. However, their use is limited due to thermal damage to organs, such as intestines and nerves. We developed a new method for safe coagulation using a vessel-sealing system, termed flat coagulation (FC). This study aimed to evaluate the efficacy of this new FC method compared to conventional coagulation methods. METHODS We evaluated the thermal damage caused by various energy devices, such as the vessel-sealing system (FC method using LigaSure™), ultrasonic scissors (Sonicision™), and monopolar electrosurgery (cut/coagulation/spray/soft coagulation (SC) mode), on porcine organs, including the small intestine and liver. Furthermore, we compared the hemostasis time between the FC method and conventional methods in the superficial bleeding model using porcine mesentery. RESULTS FC caused less thermal damage than monopolar electrosurgery's SC mode in the porcine liver and small intestine (liver: mean depth of thermal damage, 1.91 ± 0.35 vs 3.37 ± 0.28 mm; p = 0.0015). In the superficial bleeding model, the hemostasis time of FC was significantly shorter than that of electrosurgery's SC mode (mean, 19.54 ± 22.51 s vs 44.99 ± 21.18 s; p = 0.0046). CONCLUSION This study showed that the FC method caused less thermal damage to porcine small intestine and liver than conventional methods. This FC method could provide easier and faster coagulation of superficial bleeds compared to that achieved by electrosurgery's SC mode. Therefore, this study motivates for the use of this new method to achieve hemostasis with various types of bleeds involving internal organs during endoscopic surgeries.
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28
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Karaki W, Rahul, Lopez CA, Borca Tasciuc DA, De S. A continuum thermomechanical model for the electrosurgery of soft hydrated tissues using a moving electrode. Comput Methods Biomech Biomed Engin 2020; 23:1317-1335. [PMID: 32744457 DOI: 10.1080/10255842.2020.1798415] [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: 10/23/2022]
Abstract
Electrosurgical radio-frequency heating of tissue is widely applied in minimally invasive surgical procedures to dissect tissue with simultaneous coagulation to obtain hemostasis. The tissue effect depends on the cumulative heating that occurs in the vicinity of the moving blade electrode. In this work, a continuum thermomechanical model based on mixture theory, which accounts for the multiphase nature of soft hydrated tissues and includes transport and evaporation losses, is used to capture the transient heating effect of a moving electrode. The model takes into account the dependence of electrical conductivity and the evaporation rate on the water content in the tissue, as it changes in response to heating. Temperature prediction is validated with mean experimental temperature measured during in situ experiments performed on porcine liver tissue at different power settings of the electrosurgical unit. The model is shown to closely capture the temperature variation in the tissue for three distinct scenarios; with no visible cutting or coagulation damage at a low 10 W power setting, with coagulation damage but no tissue cutting at an intermediate power setting of 25 W, and with both coagulation and tissue cutting at a higher power setting of 50 W. Furthermore, an Arrhenius model is shown to capture tissue damage observed in the experiments. Increase in applied power was found to correlate with tissue cutting and concentrated damage near the electrode, but had little effect on the observed coagulation damage width. The proposed model provides, for the first time, an accurate tool for predicting temperature rise and evolving damage resulting from a moving electrode in pure-cut electrosurgery.
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Affiliation(s)
- Wafaa Karaki
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Rahul
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Carlos A Lopez
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Diana-Andra Borca Tasciuc
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
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29
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Robotic liver surgery—advantages and limitations. Eur Surg 2020. [DOI: 10.1007/s10353-020-00650-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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30
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Wikiel KJ, Overbey DM, Carmichael H, Chapman BC, Moore JT, Barnett CC, Jones TS, Robinson TN, Jones EL. Stray energy transfer in single-incision robotic surgery. Surg Endosc 2020; 35:2981-2985. [PMID: 32591940 DOI: 10.1007/s00464-020-07742-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/12/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Stray energy transfer from surgical monopolar radiofrequency energy instruments can cause unintended thermal injuries during laparoscopic surgery. Single-incision laparoscopic surgery transfers more stray energy than traditional laparoscopic surgery. There is paucity of published data concerning stray energy during single-incision robotic surgery. The purpose of this study was to quantify stray energy transfer during traditional, multiport robotic surgery (TRS) compared to single-incision robotic surgery (SIRS). METHODS An in vivo porcine model was used to simulate a multiport or single-incision robotic cholecystectomy (DaVinci Si, Intuitive Surgical, Sunnyvale, CA). A 5 s, open air activation of the monopolar scissors was done on 30 W and 60 W coag mode (ForceTriad, Covidien-Medtronic, Boulder, CO) and Swift Coag effect 3, max power 180 W (VIO 300D, ERBE USA, Marietta, GA). Temperature of the tissue (°C) adjacent to the tip of the assistant grasper or the camera was measured with a thermal camera (E95, FLIR Systems, Wilsonville, OR) to quantify stray energy transfer. RESULTS Stray energy transfer was greater in the SIRS setup compared to TRS setup at the assistant grasper (11.6 ± 3.3 °C vs. 8.4 ± 1.6 °C, p = 0.013). Reducing power from 60 to 30 W significantly reduced stray energy transfer in SIRS (15.3 ± 3.4 °C vs. 11.6 ± 3.3 °C, p = 0.023), but not significantly for TRS (9.4 ± 2.5 °C vs. 8.4 ± 1.6 °C, p = 0.278). The use of a constant voltage regulating generator also minimized stray energy transfer for both SIRS (0.7 ± 0.4 °C, p < 0.001) and TRS (0.7 ± 0.4 °C, p < 0.001). CONCLUSIONS More stray energy transfer occurs during single-incision robotic surgery than multiport robotic surgery. Utilizing a constant voltage regulating generator minimized stray energy transfer for both setups. These data can be used to guide robotic surgeons in their use of safe, surgical energy.
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Affiliation(s)
- Krzysztof J Wikiel
- Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA.
- Rocky Mountain Regional Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA.
| | - Douglas M Overbey
- Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA
- Department of Surgery, Duke University, Durham, NC, USA
| | - Heather Carmichael
- Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA
| | - Brandon C Chapman
- Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, TN, USA
| | - John T Moore
- Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Carlton C Barnett
- Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Teresa S Jones
- Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Thomas N Robinson
- Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Edward L Jones
- Department of Surgery, the University of Colorado School of Medicine & the Denver Veterans Affairs Medical Center, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
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Overbey DM, Carmichael H, Wikiel KJ, Hirth DA, Chapman BC, Moore JT, Barnett CC, Jones TS, Robinson TN, Jones EL. Monopolar stray energy in robotic surgery. Surg Endosc 2020; 35:2084-2090. [PMID: 32385708 DOI: 10.1007/s00464-020-07605-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/28/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Stray energy transfer from monopolar radiofrequency energy during laparoscopy can be potentially catastrophic. Robotic surgery is increasing in popularity; however, the risk of stray energy transfer during robotic surgery is unknown. The purpose of this study was to (1) quantify stray energy transfer using robotic instrumentation, (2) determine strategies to minimize the transfer of energy, and (3) compare robotic stray energy transfer to laparoscopy. METHODS In a laparoscopic trainer, a monopolar instrument (L-hook) was activated with DaVinci Si (Intuitive, Sunnyvale, CA) robotic instruments. A camera and assistant grasper were inserted to mimic a minimally invasive cholecystectomy. During activation of the L-hook, the non-electric tips of the camera and grasper were placed adjacent to simulated tissue (saline-soaked sponge). The primary outcome was change in temperature from baseline (°C) measured nearest the tip of the non-electric instrument. RESULTS Simulated tissue nearest the robotic grasper increased an average of 18.3 ± 5.8 °C; p < 0.001 from baseline. Tissue nearest the robotic camera tip increased (9.0 ± 2.1 °C; p < 0.001). Decreasing the power from 30 to 15 W (18.3 ± 5.8 vs. 2.6 ± 2.7 °C, p < 0.001) or using low-voltage cut mode (18.3 ± 5.8 vs. 3.1 ± 2.1 °C, p < 0.001) reduced stray energy transfer to the robotic grasper. Desiccating tissue, in contrast to open air activation, also significantly reduced stray energy transfer for the grasper (18.3 ± 5.8 vs. 0.15 ± 0.21 °C, p < 0.001) and camera (9.0 ± 2.1 vs. 0.24 ± 0.34 °C, p < 0.001). CONCLUSIONS Stray energy transfer occurs during robotic surgery. The assistant grasper carries the highest risk for thermal injury. Similar to laparoscopy, stray energy transfer can be reduced by lowering the power setting, utilizing a low-voltage cut mode instead of coagulation mode and avoiding open air activation. These practical findings can aid surgeons performing robotic surgery to reduce injuries from stray energy.
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Affiliation(s)
| | - Heather Carmichael
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Krzysztof J Wikiel
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Douglas A Hirth
- General Surgeons of Western Colorado, Grand Junction, CO, USA
| | - Brandon C Chapman
- General Surgeons of Western Colorado, Grand Junction, CO, USA
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, TN, USA
| | - John T Moore
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Carlton C Barnett
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Teresa S Jones
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Thomas N Robinson
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Edward L Jones
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA.
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Altieri MS, Carmichael H, Jones E, Robinson T, Pryor A, Madani A. Educational value of telementoring for a simulation-based fundamental use of surgical energy™ (FUSE) curriculum: a randomized controlled trial in surgical trainees. Surg Endosc 2020; 34:3650-3655. [DOI: 10.1007/s00464-020-07609-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
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Utilization of low-temperature helium plasma (J-Plasma) for dissection and hemostasis during carotid endarterectomy. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:152-155. [PMID: 32154472 PMCID: PMC7056604 DOI: 10.1016/j.jvscit.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/20/2020] [Indexed: 02/05/2023]
Abstract
Herein we report nine cases of carotid endarterectomy in which we used a cold atmospheric helium plasma device (J-Plasma; Apyx Medical Corporation, Clearwater, Fla). Although clinical reports are limited, experimental data indicate that this technology could be used for dissection and coagulation during surgery, yielding limited adjacent tissue damage. As a result, it could be extremely useful in procedures like carotid endarterectomy that necessitate careful dissection and coagulation with limited damage of adjacent neurovascular structures.
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Yang CH, Li W, Chen RK. Determination of Tissue Thermal Conductivity as a Function of Thermal Dose and Its Application in Finite Element Modeling of Electrosurgical Vessel Sealing. IEEE Trans Biomed Eng 2020; 67:2862-2869. [PMID: 32054566 DOI: 10.1109/tbme.2020.2972465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Electrosurgical vessel sealing is a process commonly used to control bleeding during surgical procedures. Finite element (FE) modeling is often performed to obtain a better understanding of thermal spread during this process. The accuracy of the FE model depends on the implemented material properties. Thermal conductivity is one of the most important properties that affect temperature distribution. The goal of this study is to determine the tissue thermal conductivity as a function of thermal dose. Methods: We developed an iterative approach to correlating tissue thermal conductivity to more accurately calculated thermal dose, which cannot be experimentally measured. The resulting regression model was then implemented into an electrosurgical vessel sealing FE model to examine the accuracy of this FE model. Results: The results show that with the regression model, more reasonable temperature and thermal dose prediction can be achieved at the center of the sealed vessel tissue. The resulting electrical current and impedance from the FE model match with the experimental results. Conclusion: The developed approach can be used to determine the correlation between thermal dose and thermal conductivity. Describing the thermal conductivity as a function of thermal dose allows modeling of irreversible changes in tissue properties. Significance: By having a more accurate temperature estimation at the center of the sealed vessel, more insight is provided into how the tissue reacts during the vessel sealing process.
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Abstract
Robotic surgery has rapidly evolved. It is particularly attractive as an alternative minimally invasive approach in liver surgery because of improvements in visualization and articulated instruments. Limitations include increased operative times and lack of tactile feedback, but these have not been shown in studies. Considerations unique to robotic surgery, including safety protocols, must be put in place and be reviewed at the beginning of every procedure to ensure safety in the event of an emergent conversion. Despite the lack of early adoption by many hepatobiliary surgeons, robotic liver surgery continues to evolve and find its place within hepatobiliary surgery.
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Affiliation(s)
- Kelly J Lafaro
- Department of Surgery, Johns Hopkins University School of Medicine, Blalock Building, 600 N. Wolfe St, Baltimore, MD 21205, USA
| | - Camille Stewart
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Abigail Fong
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA; Department of Surgery, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
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Malik AA, Khan RS, Khan RN, Shakeel O, Ahmed HH, Rahid U, Fatima A, Afzal MF, Khattak S, Syed AA. Lack of awareness among surgeons regarding safe use of electrosurgery. A cross sectional survey of surgeons in Pakistan. Ann Med Surg (Lond) 2020; 50:24-27. [PMID: 31938542 PMCID: PMC6953526 DOI: 10.1016/j.amsu.2019.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 11/16/2022] Open
Abstract
Objective To assess our surgeons perceptive regarding the safe usage of electrosurgical devices. Method ology: This cross sectional survey was carried out at two hospitals, A cancer hospital and a public sector general hospital. Consultants, fellows and senior residents (Resident year 3rd and year 4th) on the surgical floor were requested to fill up the questionnaire. Calculations were performed with Statistical Package for the Social Sciences (SPSS 20) for Windows version 20 statistical software. Data was described using median with minimum and maximum value for quantitative variables. For categorical variables, number of observations and percentages were reported. The study is complied with hospital guidelines on research involving human subjects. Results Out of 80 questionnaires 52 were filled and returned. 12 consultants, 16 fellows/Senior registrars and 24 senior residents filled their questionnaires. For the sake of anonymity no information was obtained regarding the level of training and experience. Total 12 questions were asked. An expert level was set for a score above 10/12. A moderate level was set at 8/12. A score of less than 8 was considered unsafe for using electrosurgical devices. Only 6 (11.5%) participants had an expert level of understanding. 16 (30.7%) had moderate understanding. 30 (57.7%) were considered unsafe regarding use of electrosurgical devices. 85% participants were not aware of the correct mode of current to use for coagulating vessels. 69% of surgeons would use electrocautery to control staple line bleeds. 67% participants weren't aware of the correct placement of dispersive electrode. 60% couldn't identify a safe device for use in patients with a pacemaker. 46% of surgeons would cut a dispersive electrode to fit it on a child. 69% believed that harmonic scalpel was a bipolar cautery. 61% couldn't differentiate between RFA and Microwave Ablation. 63% didn't know how to handle an operating room fire. Conclusion In these two hospitals, high level of ignorance noticed regarding the procedure and indications of basic electrosurgical equipment which needs raising awareness and further training. The first study to show the lack of understanding of electrosurgical devices among surgeons in Pakistan. Study was performed in 2 hospitals and included consultants, fellows and residents A survey was distributed and questions pertinent to the use of electrosurgical devices were asked. Surgical residents, fellows and consultants were equally unaware of how these devices work. Study highlights the need to start training courses for these devices.
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Han Z, Rahul, De S. A deep learning-based hybrid approach for the solution of multiphysics problems in electrosurgery. COMPUTER METHODS IN APPLIED MECHANICS AND ENGINEERING 2019; 357:112603. [PMID: 32863455 PMCID: PMC7448691 DOI: 10.1016/j.cma.2019.112603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Multiphysics modeling of evolving topology in the electrosurgical dissection of soft hydrated tissues is a challenging problem, requiring heavy computational resources. In this paper, we propose a hybrid approach that leverages the regressive capabilities of deep convolutional neural networks (CNN) with the precision of conventional solvers to accelerate Multiphysics computations. The electro-thermal problem is solved using a finite element method (FEM) with a Krylov subspace-based iterative solver and a deflation-based block preconditioner. The mechanical deformation induced by evaporation of intra- and extracellular water is obtained using a CNN model. The CNN is trained using a supervised learning framework that maps the nonlinear relationship between the micropore pressure and deformation field for a given tissue topology. The simulation results show that the hybrid approach is significantly more computationally efficient than a FEM-based solution approach using a block-preconditioned Krylov subspace solver and a parametric solution approach using a proper generalized decomposition (PGD) based reduced order model. The accuracy of the hybrid approach is comparable to the ground truth obtained using a standard multiphysics solver. The hydrid approach overcomes the limitations of end-to-end learning including the need for massive datasets for training the network.
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Affiliation(s)
- Zhongqing Han
- Department of Mechanical, Aerospace, and Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, New York, 12180, USA
- Center for Modeling, Simulation, & Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, New York, 12180, USA
| | - Rahul
- Center for Modeling, Simulation, & Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, New York, 12180, USA
| | - Suvranu De
- Department of Mechanical, Aerospace, and Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, New York, 12180, USA
- Center for Modeling, Simulation, & Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, New York, 12180, USA
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Madhukar A, Park Y, Kim W, Sunaryanto HJ, Berlin R, Chamorro LP, Bentsman J, Ostoja-Starzewski M. Heat conduction in porcine muscle and blood: experiments and time-fractional telegraph equation model. J R Soc Interface 2019; 16:20190726. [PMID: 31771452 DOI: 10.1098/rsif.2019.0726] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
This paper presents experimental evidence for the damped-hyperbolic nature of transient heat conduction in porcine muscle tissue and blood. An examination of integer order and Maxwell-Cattaneo heat conduction models indicates that the latter, in effect resulting in a time-fractional telegraph (TFT) equation, provides the best fit to transient heat phenomena in such materials. The numerical method is verified on Dirichlet and Neumann initial boundary value problems using existing analytical results. Overall, the TFT equation captures the wave-like nature of heat conduction and temperature profiles obtained in experiments, while reducing the need for further tunable parameters.
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Affiliation(s)
- Amit Madhukar
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Yeonsoo Park
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Woojae Kim
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Hans Julian Sunaryanto
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Richard Berlin
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.,Carle Foundation Hospital, Urbana, IL 61801, USA
| | - Leonardo P Chamorro
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Joseph Bentsman
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Martin Ostoja-Starzewski
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.,Beckman Institute and Institute for Condensed Matter Theory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
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Fraga TS, Köhler HF, Chulam TC, Kowalski LP. Impact of scalpel type on operative time and acute complications in thyroidectomies. Braz J Otorhinolaryngol 2019; 87:205-209. [PMID: 31668788 PMCID: PMC9422565 DOI: 10.1016/j.bjorl.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/01/2019] [Accepted: 08/13/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Thyroidectomy is the most common surgery in the cervical region. Currently, several techniques are available for intraoperative hemostasis. OBJECTIVE To compare the performance of three techniques (monopolar and bipolar electrical and ultrasonic) on operative time and postoperative complications. METHODS Patients submitted to total thyroidectomy without prior treatment were included in this prospective series study, using a scientific design. RESULTS A total of 834 patients were included; 661 women (79.3%) and 173 men (20.7%). The diagnosis was malignant neoplasia in 528 patients (63.3%) and benign disease in 306 patients (36.7%). The monopolar electric scalpel was used in 280 patients (33.6%), bipolar scalpel in 210 patients (25.2%) and ultrasonic scalpel in 344 patients (41.3%). The operative time was significantly shorter with the ultrasonic or bipolar scalpel when compared to the electric scalpel. In a linear regression model, gender, malignancy diagnosis and power energy type were significant for the procedure duration. Patients who underwent surgery with an ultrasound or bipolar scalpel had a significantly lower incidence of hypoparathyroidism. CONCLUSION The use of ultrasonic or bipolar scalpel significantly reduces operative time and the incidence of transient hypoparathyroidism.
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Affiliation(s)
- Tamires Santos Fraga
- A.C. Camargo Câncer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brazil
| | - Hugo Fontan Köhler
- A.C. Camargo Câncer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brazil.
| | - Thiago Celestino Chulam
- A.C. Camargo Câncer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brazil
| | - Luiz Paulo Kowalski
- A.C. Camargo Câncer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brazil
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Gugenheim J, Debs T, Gravié JF, Deleuze A, Millat B, Borie F, Mathonnet M. Results of the FUSE Evaluation Project in France. Surg Endosc 2019; 34:1819-1822. [PMID: 31218424 DOI: 10.1007/s00464-019-06938-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/13/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The Federation of Visceral and Digestive Surgery (FCVD) is in charge in France of the continuing medical education of digestive surgeons. Since 2016 and in collaboration with SAGES, it has offered the Fundamental Use of Surgical Energy (FUSE) program as part of the continuing education for surgeons including eLearning and hands-on workshops. METHODS The aim of this study was to evaluate the impact of the FUSE program on the participants by participating in a knowledge test and completing a survey. RESULTS 485 participants fully completed the knowledge test of 18 questions. Post-test assessment showed an increase in the mean score with respect to pre-test assessment, and the surgeons who have participated to the hands-on workshops had a better score. 304 participants filled the survey of 6 questions. The majority were satisfied by the FUSE program and felt that the objectives were achieved. CONCLUSIONS The FUSE program developed by SAGES and adopted by the FCVD in France was very much appreciated by the participants and achieved its educational objectives. Our goal is to spread it as widely as possible to all members of the operating room team.
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Affiliation(s)
- Jean Gugenheim
- Federation of Visceral and Digestive Surgery, 15 Rue Bayard, 31000, Toulouse, France. .,Department of Digestive Surgery, Archet Hospital, University of Nice-Sophia Antipolis, 151 Route St Antoine de Ginestière, 06200, Nice, France.
| | - Tarek Debs
- Department of Digestive Surgery, Archet Hospital, University of Nice-Sophia Antipolis, 151 Route St Antoine de Ginestière, 06200, Nice, France
| | - Jean-François Gravié
- Federation of Visceral and Digestive Surgery, 15 Rue Bayard, 31000, Toulouse, France.,Department of General and Visceral Surgery, Clinique St Jean Languedoc, 20 Route de Revel, 31400, Toulouse, France
| | - Alain Deleuze
- Federation of Visceral and Digestive Surgery, 15 Rue Bayard, 31000, Toulouse, France
| | - Bertrand Millat
- Federation of Visceral and Digestive Surgery, 15 Rue Bayard, 31000, Toulouse, France
| | - Frédéric Borie
- Federation of Visceral and Digestive Surgery, 15 Rue Bayard, 31000, Toulouse, France.,Department of Digestive Surgery, Carémeau Hospital, University of Montpellier, Place du Professeur Debré, 30900, Nîmes, France
| | - Muriel Mathonnet
- Federation of Visceral and Digestive Surgery, 15 Rue Bayard, 31000, Toulouse, France.,Department of Digestive and Endocrine Surgery, University Hospital of Limoges, 2 Avenue Martin Luther King, 87042, Limoges, France
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Electrosurgery and clinical applications of electrosurgical devices in gynecologic procedures. Med J Islam Repub Iran 2019; 32:90. [PMID: 30788327 PMCID: PMC6377004 DOI: 10.14196/mjiri.32.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Indexed: 12/12/2022] Open
Abstract
Background: Electrosurgery is widely used in reproductive related surgeries and technological advancements to improve efficacy and reduce potential complications. However, some reports have indicated lack of sufficient knowledge and training about basic principles and technical aspects of electrosurgery among obstetricians and gynecologists.
Methods: In this paper we present a summary on basic concepts and principles of electrosurgery and review the recent evidence on the use of electrosurgical devices in gynecologic procedures including endometrial ablation, gynecologic malignancies, loop electrode excision procedure (LEEP), and infertility.
Result: Considering the extensive use of these technologies in reproductive related surgeries, procedures including laparoscopy, hysteroscopy, and loop procedures further highlights the importance of more detailed training in this field. Gynecologists must learn the basics in more detail and update their knowledge on the growing body of evidence regarding the advancements of these technologies to reduce potential complications and select the most cost-effective treatment options for each patient.
Conclusion: Try to understanding the underlying biophysical principles and more in-depth familiarity with various electrosurgical devices could lead to less complications and optimize evidence-based gynecological practice.
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Karaki W, Lopez C, Rahul F, Borca-Tasciuc DDA, De S. Waveform Dependent Electrosurgical Effects on Soft Hydrated Tissues. J Biomech Eng 2019; 141:2725822. [PMID: 30778563 DOI: 10.1115/1.4042898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Indexed: 11/08/2022]
Abstract
Electrosurgical procedures are ubiquitously used in surgery. The commonly used power modes, including the coagulation and blend modes, utilize non-sinusoidal or modulated current waveforms. For the same power setting, the coagulation, blend and pure cutting modes have different heating and thermal damage outcomes due to the frequency dependence of electrical conductivity of soft hydrated tissues. In this paper, we propose a multi-physics model of soft tissues to account for the effects of multi-frequency electrosurgical power modes within the framework of a continuum thermomechanical model based on mixture theory. Electrical and frequency spectrum results from different power modes at low and high power settings are presented. Model predictions are compared with in vivo electrosurgical heating experiments on porcine liver tissue. The accuracy of the model in predicting experimentally observed temperature profiles is found to be overall greater when frequency-dependence is included. An Arrhenius type model indicates that more tissue damage is correlated with larger duty cycles in multi-frequency modes.
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Affiliation(s)
- Wafaa Karaki
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Carlos Lopez
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Fnu Rahul
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
| | | | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
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Parwal C, Choudhary L, Pandey A, Kumar V, Singh P, Ragi J. Harmonic Devices: The Workhorse for Surgical Resection of Vascular Malformations. J Cutan Aesthet Surg 2018; 11:157-160. [PMID: 30533994 PMCID: PMC6243827 DOI: 10.4103/jcas.jcas_52_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Management of vascular malformations is multimodal with documented role of surgical resection in specific facets of this condition. Surgical resection of these lesions is technically challenging owing to diffuse and relatively ill-defined extent with involvement of multiple tissue planes limitation of access and excessive intra-operative bleeding. An observational study was conducted in 24 cases taken up for surgical resection of vascular malformations. The cases were divided into two groups based on the hemostasis technique used: Group A: Harmonic shears (n = 12) (Ethicon Inc. Somerville, New Jersey, United States). Group B: Electrosurgery (monopolar/bipolar) with standard knot tying (n = 12). We conclude that use of harmonic scalpel in surgical resection causes less parallel tissue damage, secures haemostasis promptly, does not impede vision and aids surgical dissection thereby significantly reducing the operative time and improving the surgical outcome, typically in large vascular malformations of head and neck region.
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Affiliation(s)
- Chirayu Parwal
- Department of Plastic and Cosmetic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Lalit Choudhary
- Department of Plastic and Cosmetic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Anurag Pandey
- Department of Plastic and Cosmetic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Vivek Kumar
- Department of Plastic and Cosmetic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Puran Singh
- Department of Plastic and Cosmetic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Jessy Ragi
- Department of Plastic and Cosmetic Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Karaki W, Lopez CA, Borca-Tasciuc DA, De S. A continuum thermomechanical model of in vivo electrosurgical heating of hydrated soft biological tissues. INTERNATIONAL JOURNAL OF HEAT AND MASS TRANSFER 2018; 127:961-974. [PMID: 30739950 PMCID: PMC6366672 DOI: 10.1016/j.ijheatmasstransfer.2018.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Radio-frequency (RF) heating of soft biological tissues during electrosurgical procedures is a fast process that involves phase change through evaporation and transport of intra- and extra-cellular water, and where variations in physical properties with temperature and water content play significant role. Accurately predicting and capturing these effects would improve the modeling of temperature change in the tissue allowing the development of improved instrument design and better understanding of tissue damage and necrosis. Previous models based on the Pennes' bioheat model neglect both evaporation and transport or consider evaporation through numerical correlations, however, do not account for changes in physical properties due to mass transport or phase change, nor capture the pressure increase due to evaporation within the tissue. While a porous media approach can capture the effects of evaporation, transport, pressure and changes in physical properties, the model assumes free diffusion of liquid and gas without a careful examination of assumptions on transport parameters in intact tissue resulting in significant under prediction of temperature. These different approaches have therefore been associated with errors in temperature prediction exceeding 20% when compared to experiments due to inaccuracies in capturing the effects of evaporation losses and transport. Here, we present a model of RF heating of hydrated soft tissue based on mixture theory where the multiphase nature of tissue is captured within a continuum thermomechanics framework, simultaneously considering the transport, deformation and phase change losses due to evaporation that occur during electrosurgical heating. The model predictions are validated against data obtained for in vivo ablation of porcine liver tissue at various power settings of the electrosurgical unit. The model is able to match the mean experimental temperature data with sharp gradients in the vicinity of the electrode during rapid low and high power ablation procedures with errors less than 7.9%. Additionally, the model is able to capture fast vaporization losses and the corresponding increase in pressure due to vapor buildup which have a significant effect on temperature prediction beyond 100 °C.
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Affiliation(s)
- Wafaa Karaki
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Carlos A Lopez
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Diana-Andra Borca-Tasciuc
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
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Adank MW, Fleischer JC, Dankelman J, Hendriks BHW. Real-time oncological guidance using diffuse reflectance spectroscopy in electrosurgery: the effect of coagulation on tissue discrimination. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-10. [PMID: 30447060 DOI: 10.1117/1.jbo.23.11.115004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 10/15/2018] [Indexed: 05/15/2023]
Abstract
In breast surgery, a lack of knowledge about what is below the tissue surface may lead to positive tumor margins and iatrogenic damage. Diffuse reflectance spectroscopy (DRS) is a spectroscopic technique that can distinguish between healthy and tumor tissue making it a suitable technology for intraoperative guidance. However, because tumor surgeries are often performed with an electrosurgical knife, the effect of a coagulated tissue layer on DRS measurements must be taken into account. It is evaluated whether real-time DRS measurements obtained with a photonic electrosurgical knife could provide useful information of tissue properties also when tissue is coagulated and cut. The size of the coagulated area is determined and the effect of its presence on DR spectra is studied using ex vivo porcine adipose and muscle tissue. A coagulated tissue layer with a depth of 0.1 to 0.4 mm is observed after coagulating muscle with an electrosurgical knife. The results show that the effect of coagulating adipose tissue is negligible. Using the fat/water ratio's calculated from the measured spectra of the photonic electrosurgical knife, it was possible to determine the distance from the instrument tip to a tissue transition during cutting. In conclusion, the photonic electrosurgical knife can determine tissue properties of coagulated and cut tissue and has, therefore, the potential to provide real-time feedback about the presence of breast tumor margins during cutting, helping surgeons to establish negative margins and improve patient outcome.
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Affiliation(s)
- Maartje W Adank
- Delft University of Technology, Biomechanical Engineering Department, Delft, The Netherlands
| | - Julie C Fleischer
- Delft University of Technology, Biomechanical Engineering Department, Delft, The Netherlands
| | - Jenny Dankelman
- Delft University of Technology, Biomechanical Engineering Department, Delft, The Netherlands
| | - Benno H W Hendriks
- Delft University of Technology, Biomechanical Engineering Department, Delft, The Netherlands
- Philips Research, In-Body Systems Department, Eindhoven, The Netherlands
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Han Z, Rahul SD. A Multiphysics Model for Radiofrequency Activation of Soft Hydrated Tissues. COMPUTER METHODS IN APPLIED MECHANICS AND ENGINEERING 2018; 337:527-548. [PMID: 30349148 PMCID: PMC6195327 DOI: 10.1016/j.cma.2018.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A multi-physics model has been developed to investigate the effects of cellular level mechanisms on the electro-thermo-mechanical response of hydrated soft tissues with radiofrequency (RF) activation. A micromechanical model generates an equation of state (EOS) that provides the additional pressure arising from evaporation of intra- and extracellular water as well as temperature to the continuum level thermo-mechanical model. A level set method is used to capture the interfacial evolution of tissue damage with the level set evolution equation derived from the second law of thermodynamics, which is consistent with Griffith's fracture evolution criterion. The discretized equations are solved simultaneously using a Krylov subspace based iterative solver (GMRES) with block preconditioning that effectively deflates the spectrum of the system matrix, resulting in exponential convergence of the Arnoldi iterations. Example problems, including experimental validation, illustrate the computational accuracy and efficiency of the technique.
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Affiliation(s)
- Zhongqing Han
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, 110 8 Street, Troy, NY 12180, USA
| | - Suvranu De Rahul
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, 110 8 Street, Troy, NY 12180, USA
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Karacan T, Usta T, Ozkaynak A, Onur Cakir O, Kahraman A, Ozyurek E. Comparison of the Thermal Spread of Three Different Electrosurgical Generators on Rat Uterus: A Preliminary Experimental Study. Gynecol Obstet Invest 2018; 83:388-396. [PMID: 29791906 DOI: 10.1159/000488675] [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: 04/20/2017] [Accepted: 03/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The objective of this study was to compare the depth and width of thermal spread caused on rat uterine tissue after application of 3 different electrosurgical generators. METHODS Alsa Excell 350 MCDSe (Unit A), Meditom DT-400P (Unit M), and ERBE Erbotom VIO 300 D (Unit E) electrosurgical units (ESUs) were used. The number of Wistar Hannover rats required to obtain valid results was 10. The primary objective of the study was to compare the 3 ESUs using the same instrument and the same waveform. The secondary objective of the study was to compare the differences between monopolar and bipolar systems of each ESU separately using the same waveform. RESULTS The thermal spread caused by each ESU using monopolar instruments with continuous and interrupted waveforms was significantly different. Among the 3 devices, Unit A caused the largest thermal uterine tissue spread. On the other hand, Unit E caused the most superficial thermal tissue spread, and the smallest thermal spread among all ESUs. CONCLUSIONS Surgeons should note that different ESUs used with the same power output might create different thermal effects especially in the monopolar configuration within the same waveform, for the same duration, and with the same instrument.
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Affiliation(s)
- Tolga Karacan
- Department of Obstetrics and Gynecology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Taner Usta
- Department of Obstetrics and Gynecology, University of Acibadem, Altunizade Hospital, Istanbul, Turkey
| | - Aysel Ozkaynak
- Department of Obstetrics and Gynecology, University of Acibadem, Altunizade Hospital, Istanbul, Turkey
| | - Omer Onur Cakir
- Department of Urology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Aslı Kahraman
- Department of Pathology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Eser Ozyurek
- Department of Obstetrics and Gynecology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
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The safe use of surgical energy devices by surgeons may be overestimated. Surg Endosc 2018; 32:3861-3867. [PMID: 29497829 DOI: 10.1007/s00464-018-6116-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 02/07/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Surgical energy injuries are an underappreciated phenomenon. Improper use of surgical energy or poor attention to patient safety can result in operating room fires, tissue injuries, and interferences with other electronic devices, while rare complications can be devastatingly severe. Despite this, there is no current standard requirement for educating surgeons on the safe use of energy-based devices or evaluation of electrosurgery (ES) education in residency training, credentialing, or practice. The study aimed to assess the current baseline knowledge of surgeons and surgical trainees with regards to ES across varying experiences at a tertiary level care center. METHODS Surgeons and surgical trainees from seven surgical specialties (General Surgery, Cardiothoracic Surgery, Vascular Surgery, Obstetrics/Gynecology, Orthopedic Surgery, Urology, and Otorhinolaryngology) at a tertiary level care hospital were tested. Testing included an evaluation regarding their background training and experiences with ES-related adverse events and a 15 multiple-choice-question exam testing critical knowledge of ES. RESULTS A total of 134 surveys were sent out with 72 responses (53.7%). The mean quiz score was 51.5 ± 15.5% (passing score was 80%). Of staff surgeons, 33/65 (50.8%) completed the survey with mean and median scores of 54.9 and 53.3%, respectively (range 33.3-86.7%). Of surgical trainees, 39/69 (56.5%) completed the survey with mean and median scores of 48.6 and 46.7%, respectively (range 13.3-80.0%). There were no statistically significant differences based on training status (p = 0.08), previous training (p = 0.24), number of cases (p = 0.06), or specialty (p = 0.689). CONCLUSION Surgeons and surgical trainees both have a significant knowledge gap in the safe and effective use of surgical energy devices, regardless of surgical specialty and despite what they feel was adequate training. The knowledge gap is not improved with experience. A formal surgical energy education program should be a requirement for residency training or credentialing.
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Dombek M, Lopez CA, Han Z, Lungarini A, Santos N, Schwaitzberg S, Cao C, Jones DB, De S, Olasky J. FUSE certification enhances performance on a virtual computer based simulator for dispersive electrode placement. Surg Endosc 2018; 32:3640-3645. [PMID: 29442242 DOI: 10.1007/s00464-018-6095-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 02/07/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has developed the fundamental use of surgical energy (FUSE) didactic curriculum in order to further understanding of the safe use of surgical energy. The virtual electrosurgical skill trainer (VEST) is being developed as a complementary simulation-based curriculum, with several modules already existing. Subsequently, a new VEST module has been developed about dispersive electrode placement. The purpose of this study is to assess knowledge about dispersive electrode placement in surgeons and surgical trainees in addition to describing a new VEST module. METHODS Forty-six subjects (n = 46) were recruited for participation at the 2016 SAGES conference Learning Center. Subjects were asked to complete demographic surveys, a five-question pre-test, and a five-question post-test after completing the VEST dispersive electrode module. Subjects were then asked to rate different aspects of the module using a five-point Likert scale questionnaire. RESULTS Mean pre-simulator and post-simulator assessment scores were 1.5 and 3.4, respectively, with Wilcoxon signed rank analysis showing a significant difference in the means (p < 0.05). Subjects were grouped by the presence (n = 12) or absence (n = 31) of prior FUSE experience and by training level. Mann-Whitney U testing showed no significant difference in pre-simulator assessment scores between attending surgeons and trainees (p > 0.05). In those with and without FUSE exposure, a significant difference (p < 0.05) was seen in pre-simulator assessment scores, and no significant difference in Likert scale assessment scores was seen. CONCLUSIONS This study demonstrated a new VEST educational module. Consistently high Likert assessment scores showed that users felt that the VEST module helped their understanding of dispersive electrode placement. Additionally, the study reflected a potential knowledge deficit in the safe use of dispersive electrodes in the surgical community, also demonstrating that even some exposure to the FUSE curriculum developed by SAGES provides increased awareness about dispersive electrode use.
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Affiliation(s)
- Michael Dombek
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA.
| | - Carlos A Lopez
- Department of BioMedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Zhongqing Han
- Department of BioMedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Alyssa Lungarini
- Department of Surgery, Cambridge Health Alliance, Cambridge, MA, USA
| | - Nicole Santos
- Department of Surgery, Cambridge Health Alliance, Cambridge, MA, USA
| | | | - Caroline Cao
- College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Daniel B Jones
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Suvranu De
- Department of BioMedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Jaisa Olasky
- Department of Surgery, Mount Auburn Hospital, Cambridge, MA, USA
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Borie F, Mathonnet M, Deleuze A, Millat B, Gravié JF, Johanet H, Lesage JP, Gugenheim J. Risk management for surgical energy-driven devices used in the operating room. J Visc Surg 2018; 155:259-264. [PMID: 29289460 DOI: 10.1016/j.jviscsurg.2017.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Complications related to energy sources in the operating room are not well-recognized or published, despite occasionally dramatic consequences for the patient and the responsible surgeon. The goal of this study was to evaluate the risks and consequences related to use of energy sources in the operating room. PATIENTS AND METHODS Between 2009 and 2015, 876 adverse events related to health care (AERHC) linked to energy sources in the operating room were declared in the French experience feedback data base "REX". We performed a descriptive analysis of these AERHC and analyzed the root causes of these events and of the indications for non-elective repeat operations, for each energy source. RESULTS Five different energy sources were used, producing 876 declared AERHC: monopolar electrocoagulation: 614 (70%) AERHC, advanced bipolar coagulation (thermofusion): 137 (16%) AERHC, ultrasonic devices: 69 (8%) AERHC, traditional bipolar electrocoagulation: 32 AERHC, and cold light: 24 AERHC. The adverse events reported were skin burns (27.5% of AERHC), insulation defects (16% of AERHC), visceral burns or perforation (30% of AERHC), fires (11% of AERHC), bleeding (7.5% of AERHC) and misuse or miscellaneous causes (8% of AERHC). For the five energy sources, the root causes were essentially misuse, imperfect training and/or cost-related reasons regarding equipment purchase or maintenance. One hundred and forty-six non-elective procedures (17% of AERHC) were performed for complications related to the use of energy sources in the operating room. CONCLUSION This study illustrates the risks related to the use of energy sources on the OR and their consequences. Most cases were related to persistent misunderstanding of appropriate usage within the medical and paramedical teams, but complications are also related to administrative decisions concerning the purchase and maintenance of these devices.
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Affiliation(s)
- F Borie
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France.
| | - M Mathonnet
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
| | - A Deleuze
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
| | - B Millat
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
| | - J-F Gravié
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
| | - H Johanet
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
| | - J-P Lesage
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
| | - J Gugenheim
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
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