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Detection of the Lateral Thermal Spread during Bipolar Vessel Sealing in an Ex Vivo Model-Preliminary Results. Diagnostics (Basel) 2022; 12:diagnostics12051217. [PMID: 35626371 PMCID: PMC9141216 DOI: 10.3390/diagnostics12051217] [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: 04/14/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 02/01/2023] Open
Abstract
Background: As an unwanted side effect, lateral thermal expansion in bipolar tissue sealing may lead to collateral tissue damage. Materials and Methods: Our investigations were carried out on an ex vivo model of porcine carotid arteries. Lateral thermal expansion was measured and a calculated index, based on thermographic recording and histologic examination, was designed to describe the risk of tissue damage. Results: For instrument 1, the mean extent of the critical zone > 50 °C was 2315 ± 509.2 µm above and 1700 ± 331.3 µm below the branches. The width of the necrosis zone was 412.5 ± 79.0 µm above and 426.7 ± 100.7µm below the branches. For instrument 2, the mean extent of the zone > 50 °C was 2032 ± 592.4 µm above and 1182 ± 386.9 µm below the branches. The width of the necrosis zone was 642.6 ± 158.2 µm above and 645.3 ± 111.9 µm below the branches. Our risk index indicated a low risk of damage for instrument 1 and a moderate to high risk for instrument 2. Conclusion: Thermography is a suitable method to estimate lateral heat propagation, and a validated risk index may lead to improved surgical handling.
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Marwah V, Dutta S, Kedia S, Mittal P. Total laparoscopic hysterectomy (TLH) with endosuturing compared with conventional technique using energy sources. Facts Views Vis Obgyn 2021; 13:149-158. [PMID: 34184844 PMCID: PMC8291987 DOI: 10.52054/fvvo.13.2.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The aim of the study was to demonstrate the technique of total laparoscopic hysterectomy (TLH) with intra-corporeal endosuturing using simple sutures and basic surgical instruments and compare with TLH using electric coagulation equipment i.e. energy sources with regard to operative time, blood loss, postoperative stay and pain scores. Methods A retrospective study was undertaken, in Max Super Specialty Hospital Saket, from June 2015 to May 2018, which included 586 cases of TLH (for benign gynecological conditions), of which 287 were performed using intra-corporeal endosuturing (Group 1) and 299 were performed using energy sources (Group 2). To avoid bias, baseline matching was done for body mass index (BMI), indications for surgery, size of uterus, previous abdominal surgeries and comorbidities like diabetes and hypertension after which there were 172 patients in each group. Results The mean age of patients was 48.24 ± 6.76 years. All operative outcomes including operative time (104.1 ± 22.6 vs 107.6 ± 32.6 mins, p=0.25), blood loss (78.9 ± 101.6 vs 99.7 ± 177.6 ml, p=0.19), pain score (2.5 ± 1.3 vs 2.7 ± 1.2, p=0.13) and post-operative stay (2.05 ± 0.2 vs 2.07 ± 0.3 days, p=0.36) were similar between the two groups. Uterine size was the major determinant of operative time and operative blood loss. Conclusion TLH with intracorporeal endosuturing can be performed safely and gives results comparable with TLH performed using energy sources. Advancement in suturing devices can decrease operative time further and potentially make it easier and more acceptable.
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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: 3] [Impact Index Per Article: 0.8] [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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Vidinov KN, Stoinov Y. Do we really Need Lugol Solution in the Era of Energy Devices for the Preoperative Management of Patients with Graves’ Disease? JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2019. [DOI: 10.5799/jcei/5904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Cosentino F, Turco LC, Fagotti A, Cianci S, Gallotta V, Rosati A, Corbisiero F, Scambia G, Ferrandina G. Arterial-enteric fistula after pelvic lymphadenectomy in secondary cytoreductive surgery for recurrent ovarian cancer. J OBSTET GYNAECOL 2019; 39:1049-1056. [PMID: 31195870 DOI: 10.1080/01443615.2019.1586856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In 6.2% of gynaecologic malignancies, vascular involvement is reported. Cytoreductive surgery presents in those cases a higher rate of major complications. Arterial-enteric fistula is a very rare post-surgical complication with serious repercussions on the patient's life due to intestinal haemorrhage and the overlapping sepsis. This is the first case report about iliac-colonic fistula formation in recurrent ovarian cancer with lymph-node metastasis after laparoscopic secondary cytoreductive surgery in a 75-year-old woman and its successful surgical management. A literature review about arterial-enteric fistula formation in gynaecologic cancer treatment, specifically ovarian cancer, is also reported, hypothesising the risk factors of this severe postoperative complication and possible surgical solutions.
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Affiliation(s)
- Francesco Cosentino
- Division of Gynecologic Oncology, Fondazione di Ricerca e Cura Giovanni Paolo II, Università Cattolica del Sacro Cuore , Campobasso , Italia
| | - Luigi Carlo Turco
- Division of Gynecologic Oncology, Fondazione di Ricerca e Cura Giovanni Paolo II, Università Cattolica del Sacro Cuore , Campobasso , Italia
| | - Anna Fagotti
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Roma , Italia
| | - Stefano Cianci
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Roma , Italia
| | - Valerio Gallotta
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Roma , Italia
| | - Andrea Rosati
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Roma , Italia
| | - Francesco Corbisiero
- Division of Gynecologic Oncology, Fondazione di Ricerca e Cura Giovanni Paolo II, Università Cattolica del Sacro Cuore , Campobasso , Italia
| | - Giovanni Scambia
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Roma , Italia
| | - Gabriella Ferrandina
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Roma , Italia
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Devassy R, Hanif S, Krentel H, Verhoeven HC, la Roche LATD, De Wilde RL. Laparoscopic ultrasonic dissectors: technology update by a review of literature. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 12:1-7. [PMID: 30643470 PMCID: PMC6311332 DOI: 10.2147/mder.s113262] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The evolution of minimally invasive surgery has brought forward the appearance of new advances in the course of the most recent couple of years and has introduced energy-based devices. The newest among them today are the ultrasonically activated devices, which are utilized with a great deal of components in-play, including ergonomics and financial aspects amid surgery. The methodology embraced was finding significant investigations through studies from PubMed, Medline and Google Scholar on current ultrasonic dissectors, which are Ethicon’s Harmonic Scalpel (ACE®), Covidien’s Sonicision™ (SNC), Conmed’s SonoSurg® (SS) and Olympus’s Thunderbeat®, to describe their efficacy in terms of vessel sealing speed, vessel burst pressure, visibility, operation time and thermal speed. We found postmarketing evidence to determine which device exhibits the better performance. Animal studies showed that emissivity values and maximum temperatures for coagulation are similar among devices but maximum cutting temperatures are significantly different: ACE = 191.1°C, SNC = 227.1°C, SS = 184.8°C (p < 0.001). Cooling times are significantly different among devices: 35.7 s for ACE, 38.7 s for SNC and 27.4 s for SS (p < 0.001). Cooling times of passive jaws to reach 60°C after activation were also significantly different: 25.4 s for ACE, 5.7 s for SNC, and 15.4 s for SS (p < 0.001). The perfect device would unify brilliant hemostatic outcomes with visual sharpness while permitting none or insignificant thermal damage at the place of use.
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Affiliation(s)
| | - Sadaf Hanif
- Dubai London Clinic & Specialty Hospital, Dubai, UAE
| | - Harald Krentel
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Carl von Ossietzky University, Pius-Hospital Oldenburg, Oldenburg, Germany,
| | - Hugo C Verhoeven
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Carl von Ossietzky University, Pius-Hospital Oldenburg, Oldenburg, Germany,
| | - Luz Angela Torres-de la Roche
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Carl von Ossietzky University, Pius-Hospital Oldenburg, Oldenburg, Germany,
| | - Rudy Leon De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Carl von Ossietzky University, Pius-Hospital Oldenburg, Oldenburg, Germany,
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Müller PC, Steinemann DC, Chinczewski L, Hatiboglu G, Nickel F, Z'graggen K, Müller-Stich BP. Transpapillary endopancreatic surgery: decompression of duct system and comparison of greenlight laser with monopolar electrosurgical device in ex vivo and in vivo animal models. Surg Endosc 2018; 32:3393-3400. [PMID: 29717373 DOI: 10.1007/s00464-018-6198-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 04/21/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Endopancreatic surgery (EPS) is an experimental minimally invasive technique for resection of pancreatic tissue from inside the pancreatic duct, accessed via the duodenum and papilla. It is proposed as an alternative to duodenum-preserving pancreatic head resection in benign diseases such as chronic pancreatitis (CP). This study evaluated the use of EPS for resection of pancreatic duct stenoses. Moreover, greenlight laser (GLL) and monopolar electrosurgical device (MES) were compared as resection tools for EPS. METHODS The suitability of EPS for resection of stenoses was evaluated in ex vivo bovine pancreas (n = 8). Artificially created stenoses in the pancreatic head were accessed via the duodenal papilla and resected from inside the organ with MES through a rigid endoscope. Furthermore, standardized pancreatic resections were performed in an in vivo porcine model using either GLL (n = 18) or MES (n = 18) to compare blood loss, operating time, and complications. Thermal damage to the surrounding tissue was assessed using a standardized histological classification. RESULTS Stenosis resection by EPS was feasible in 8/8 bovine pancreases, with a procedure time of 17 (12-24) min. No perforation of the organ occurred. Resection by GLL was associated with reduced blood loss [median 1.7 (interquartile range 0.6-2.6) ml vs. 5.1 (3.8-13.2) ml; p < 0.01] and shorter operating time [109 (81-127) s vs. 390 (337-555) s; p < 0.01] compared with MES. The zone of thermal tissue damage was more extensive when using GLL than with MES [4.12 (3.48-4.89) mm vs. 1.33 (1.09-1.48) mm; p < 0.01]. CONCLUSION Transduodenal-transpapillary EPS can be used to resect stenoses and decompress the pancreatic duct system. Both GLL and MES are feasible resection methods for EPS. However, GLL showed better hemostatic characteristics than MES in an in vivo porcine model. Safety measures such as temperature control and image-guided navigation should be employed to monitor the resection and tissue heating.
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Affiliation(s)
- Philip C Müller
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Daniel C Steinemann
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Lukas Chinczewski
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Gencay Hatiboglu
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Kaspar Z'graggen
- Department of Surgery, Clinic Beau-Site, Hirslanden, Schänzlihalde 11, 3013, Bern, Switzerland
| | - Beat P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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