1
|
Chen C, Tang Y, Ren W, Wang Y, Guo J, Lin S. Acoustic black hole ultrasonic scalpel. ULTRASONICS 2024; 143:107417. [PMID: 39106661 DOI: 10.1016/j.ultras.2024.107417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/03/2024] [Accepted: 07/22/2024] [Indexed: 08/09/2024]
Abstract
Ultrasonic scalpels (USs), as the preferred energy instruments, are facing a growing need to exhibit enhanced performance with the diversification of modern surgical challenges. Hence, we proposed an acoustic black hole ultrasonic scalpel (ABHUS) in longitudinal-bending coupled vibration for efficient surgical cutting. By incorporating an acoustic black hole profile, the local bending wave velocity is reduced and the amplitude is amplified cumulatively, thus creating a high-energy region near the blade tip to enhance the cutting performance of the ABHUS. The precise physical analysis model is established for systematic design of the ABHUS and quick estimation of its frequency characteristics. The vibration simulation and experiments demonstrate that compared with the conventional ultrasonic scalpel (CUS), the output amplitude of the ABHUS significantly increases, particularly a 425% increase in bending vibration displacement. The in-vitro cutting experiment confirms that ABHUS exhibits superior cutting performance. Our design presents vast possibilities and potential for the development of high-performance ultrasonic surgical instruments, serving as an innovative supplement with extraordinary significance for application of acoustic black holes.
Collapse
Affiliation(s)
- Cheng Chen
- Shaanxi Key Laboratory of Ultrasonics, Institute of Applied Acoustics, Shaanxi Normal University, Xi'an 710119, China
| | - Yifan Tang
- Shaanxi Key Laboratory of Ultrasonics, Institute of Applied Acoustics, Shaanxi Normal University, Xi'an 710119, China
| | - Wenbo Ren
- Shaanxi Key Laboratory of Ultrasonics, Institute of Applied Acoustics, Shaanxi Normal University, Xi'an 710119, China
| | - Yi Wang
- Shaanxi Key Laboratory of Ultrasonics, Institute of Applied Acoustics, Shaanxi Normal University, Xi'an 710119, China
| | - Jianzhong Guo
- Shaanxi Key Laboratory of Ultrasonics, Institute of Applied Acoustics, Shaanxi Normal University, Xi'an 710119, China
| | - Shuyu Lin
- Shaanxi Key Laboratory of Ultrasonics, Institute of Applied Acoustics, Shaanxi Normal University, Xi'an 710119, China
| |
Collapse
|
2
|
Wu CH, Chen CH, Ho TW, Shih MC, Wu JM, Kuo TC, Yang CY, Tien YW. Pancreatic neck transection using a harmonic scalpel increases risk of biochemical leak but not postoperative pancreatic fistula after pancreaticoduodenectomy. HPB (Oxford) 2021; 23:301-308. [PMID: 32998842 DOI: 10.1016/j.hpb.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 06/06/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The effect of a harmonic scalpel on postoperative pancreatic fistula (POPF) has not been addressed. This study assessed the effect of pancreatic neck transection using a harmonic scalpel on rate and severity of POPF after pancreaticoduodenectomy (PD). METHODS This retrospective analysis included patients who underwent PD at National Taiwan University Hospital between July 2015 and March 2019. We compared rate and severity of POPF between patients who underwent pancreatic neck transection using a harmonic scalpel versus electrosurgical unit. RESULTS Of 422 consecutive PDs, the pancreatic neck was transected using a harmonic scalpel or electrosurgical unit in 144 and 278 patients, respectively. Use of a harmonic scalpel significantly increased risk of biochemical leak (25.7% versus [vs] 10.8%; P < 0.05) but not clinically relevant POPF (CR-POPF; 30.2% vs 26.4%; P = 0.41). Harmonic transection was an independent predictor of biochemical leak (odds ratio [OR] = 2.93; P < 0.05) but not CR-POPF (OR = 0.83; P = 0.41) or other major complications (OR = 0.72; P = 0.27). There was no significant intergroup difference in postoperative hospital stay. CONCLUSION Pancreatic neck transection using a harmonic scalpel increased risk of biochemical leak but not CR-POPF or other major complications.
Collapse
Affiliation(s)
- Chien-Hui Wu
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Institute of Epidemiology and Preventive Medicine, Department of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ching-Hsuan Chen
- Institute of Epidemiology and Preventive Medicine, Department of Public Health, National Taiwan University, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan
| | - Te-Wei Ho
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Chieh Shih
- Institute of Epidemiology and Preventive Medicine, Department of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jin-Ming Wu
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ting-Chun Kuo
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ching-Yao Yang
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Wen Tien
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| |
Collapse
|
3
|
Abstract
Cardiac surgery accounts for the majority of blood transfusions in a hospital. Blood transfusion has been associated with complications and major adverse events after cardiac surgery. Compared to adults it is more difficult to avoid blood transfusion in children after cardiac surgery. This article takes into account the challenges and emphasizes on the various strategies that could be implemented, to conserve blood during pediatric cardiac surgery.
Collapse
Affiliation(s)
- Sarvesh Pal Singh
- Department of CTVS, Cardiac Surgical Intensive Care Unit, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
4
|
Tanemoto K, Furukawa H. Repeated valve replacement surgery: technical tips and pitfalls. Gen Thorac Cardiovasc Surg 2014; 62:639-44. [PMID: 25236505 DOI: 10.1007/s11748-014-0473-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Indexed: 10/24/2022]
Abstract
For successful repeated valve replacement surgery, it is essential issue that the preoperative evaluation includes an assessment of the previous operation record, computed tomography (CT: including 3D-CT), ultrasound cardiography, coronary artery angiography, and so on. Although it is especially needed for repeated valve replacement surgery, setting up of the external defibrillation pads is the most important preparation just prior to the surgery. In regard to the approach, re-sternotomy is frequently employed as a standard fashion because it allows us to re-entry any part of the heart. As alternative approaches, partial sternotomy, right thoracotomy for minimally invasive cardiac surgery approach have also been highlighted recently. Myocardial protection is another important consideration in repeated valve replacement surgery, especially in post-coronary artery bypass grafting cases with a patent internal thoracic artery. In repeated valve replacement surgery, special and unique techniques are required both for taking the affected prosthetic valve out and for implanting a new valve, which is dependent on the types of the previous prosthetic valve and the condition of the affected prosthetic valve. Therefore, for performing repeated valve replacement surgeries, surgeons should be highly skilled in these special techniques.
Collapse
Affiliation(s)
- Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan,
| | | |
Collapse
|
5
|
Furukawa H, Tanemoto K. Redo Valve Surgery—Current Status and Future Perspectives. Ann Thorac Cardiovasc Surg 2014; 20:267-75. [DOI: 10.5761/atcs.ra.13-00380] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
6
|
Tsiouris A, Brewer RJ, Borgi J, Hodari A, Nemeh HW, Cogan CM, Paone G, Morgan JA. Is resternotomy a risk for continuous-flow left ventricular assist device outcomes? J Card Surg 2012; 28:82-7. [PMID: 23240608 DOI: 10.1111/jocs.12048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The number of patients undergoing resternotomy continues to rise. Although catastrophic hemorrhage remains a dreaded complication, most published data suggest that sternal reentrance is safe, with negligible postoperative morbidity and mortality. A significant proportion of left ventricular assist device (LVAD) implantations are reoperative cardiac procedures. The aim of our study was to compare outcomes between first time sternotomy and resternotomy patients receiving continuous-flow LVADs, as a bridge to transplantation or destination therapy. METHODS AND MATERIALS From March 2006 through February 2012, 100 patients underwent implantation of a HeartMate II or HeartWare LVAD at our institution. Patients were stratified into two groups, primary sternotomy and resternotomy. Variables were compared using two-sided t-tests, chi-square tests, Cox proportional hazards models, and log-rank tests to determine whether there was a difference between the two groups and if resternotomy was a significant independent predictor of outcome. RESULTS We identified 29 patients (29%) who had resternotomy and 71 patients (71%) who had first time sternotomy. The resternotomy group was significantly older (56 years vs. 51 years, p = 0.05), was more likely to have ischemic cardiomyopathy (ICM) (69% vs. 30%, p < 0.001), chronic obstructive pulmonary disease (COPD) (31% vs. 14%, p = 0.05) and had longer cardiopulmonary bypass times (135 min vs. 100 min, p = 0.011). Survival rates at 30 days (93.1% vs. 95.8%, p = 0.564), 180 days (82.8% vs. 93%, p = 0.131), and 360 days (82.8% vs. 88.7%, p = 0.398) were similar for the resternotomy and primary sternotomy groups, respectively. Postoperative complications were also comparable, except for re-exploration for bleeding which was higher for the resternotomy group (17.2% vs. 4.2%, p = 0.029), although blood transfusion requirements were not significantly different (1.4 units vs. 1.2 units, p = 0.815). Left and right heart catheterization measurements and echocardiographic (ECHO) findings after 1 and 6 months of LVAD therapy were similar between the two groups. CONCLUSIONS Survival at 30, 180, and 360 days after LVAD implantation is similar between the resternotomy and primary sternotomy group. No major differences in complications or hemodynamic measurements were observed. Although a limited observational study, our findings agree with previously published resternotomy outcomes.
Collapse
Affiliation(s)
- Athanasios Tsiouris
- Division of Cardiothoracic Surgery, Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan, USA.
| | | | | | | | | | | | | | | |
Collapse
|
7
|
ten Broek RPG, Wilbers J, van Goor H. Electrocautery causes more ischemic peritoneal tissue damage than ultrasonic dissection. Surg Endosc 2010; 25:1827-34. [PMID: 21140171 PMCID: PMC3109994 DOI: 10.1007/s00464-010-1474-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 11/11/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND Minimizing peritoneal tissue injury during abdominal surgery has the benefit of reducing postoperative inflammatory response, pain, and adhesion formation. Ultrasonic dissection seems to reduce tissue damage. This study aimed to compare electrocautery and ultrasonic dissection in terms of peritoneal tissue ischemia measured by microdialysis. METHODS In this study, 18 Wistar rats underwent a median laparotomy and had a peritoneal microdialysis catheter implanted in the left lateral sidewall. The animals were randomly assigned to receive two standard peritoneal incisions parallel to the catheter by either ultrasonic dissection or electrocautery. After the operation, samples of microdialysis dialysate were taken every 2 h until 72 h postoperatively for measurements of pyruvate, lactate, glucose, and glycerol, and ratios were calculated. RESULTS The mean lactate-pyruvate ratio (LPR), lactate-glucose ratio (LGR), and glycerol concentration were significantly higher in the electrocautery group than in the ultrasonic dissection group until respectively 34, 48, and 48 h after surgery. The mean areas under the curve (AUC) of LPR, LGR, and glycerol concentration also were higher in the electrocautery group than in the ultrasonic dissection group (4,387 vs. 1,639, P=0.011; 59 vs. 21, P=0.008; 7,438 vs. 4,169, P=0.008, respectively). CONCLUSION Electrosurgery causes more ischemic peritoneal tissue damage than ultrasonic dissection.
Collapse
Affiliation(s)
- Richard P. G. ten Broek
- Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Joyce Wilbers
- Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| |
Collapse
|
8
|
Morales D, Williams E, John R. Is resternotomy in cardiac surgery still a problem? Interact Cardiovasc Thorac Surg 2010; 11:277-86. [PMID: 20525761 DOI: 10.1510/icvts.2009.232090] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Multiple factors contribute to the growing number of reoperations for congenital and acquired cardiovascular diseases in the United States. Although the hazards are well-recognized, the health economic burden of resternotomy (RS) remains unclear and may be difficult to quantify. Contrary to published studies citing low frequencies of catastrophic hemorrhage and mortality, survey responses from practicing surgeons disclose higher rates of complications. Safety strategies in cardiac reoperation have generally involved efforts to maximize visualization during dissection, specialized surgical maneuvers and instrumentation, customized methods for establishing extracorporeal circulation, and techniques to prevent or avoid retrosternal adhesions. Yet, the relative cost-effectiveness of these strategies is largely unexplored. With the ongoing constraints in healthcare budgets, differentiating the value of existing and future approaches in terms of relative clinical benefits, costs, and impact on resource utilization will become increasingly important. We reviewed the relevant published literature in order to survey the morbidity and resource utilization associated with RS in cardiac reoperation and to identify key issues relevant for future studies.
Collapse
Affiliation(s)
- David Morales
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St, MC-WT 19345H, Houston, TX 77030, USA.
| | | | | |
Collapse
|
9
|
Weksler B, Pollice M, Souza ZBB, Gavina R. Comparison of ultrasonic scalpel to electrocautery in patients undergoing endoscopic thoracic sympathectomy. Ann Thorac Surg 2009; 88:1138-41. [PMID: 19766797 DOI: 10.1016/j.athoracsur.2009.06.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 06/16/2009] [Accepted: 06/19/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sympathectomy is an effective treatment for hyperhidrosis. The ultrasonic scalpel and electrocautery have been used for the procedure, but the use of the ultrasonic scalpel has been promoted as superior to that of electrocautery. This study explored whether a reusable electrocautery probe was equally as effective and safe as the ultrasonic scalpel for sympathectomy. METHODS We retrospectively analyzed 140 consecutive patients. The ultrasonic scalpel (HDH 05, Ethicon Endo-Surgery, Cincinnati, OH) was used in 70 patients (group 1) and a reusable 5-mm cautery hook (Edlo, Canoas, Brazil) was used in 70 patients (group 2). End points were improvement in symptoms (% improvement score), length of stay, return to work, and complications. Data were analyzed using two-tailed t test and the chi(2) (p = 0.05 was significant). Data are mean +/- standard deviation. RESULTS Follow-up was 27.2 +/- 8.4 months. Groups were similar in demographics, disease site, and level of sympathectomy. There was no significant difference in improvement score by site. The feet had the least improvement score (36.5% +/- 32.3%), and the hands the highest improvement score (97.0% +/- 11.3%). Length of stay was similar, 11.4 +/- 5.9 (group 1) vs 10.1 +/- 5.4 hours (group 2). Return to work in group 1 was 4.8 +/- 2.7 vs 5.7 +/- 3.6 days (p = 0.09). Group 1 had 14 complications and group 2 had 7 (p = 0.16). CONCLUSIONS We could not demonstrate a clear advantage in the use of the ultrasonic scalpel.
Collapse
Affiliation(s)
- Benny Weksler
- Division of Cardiothoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
| | | | | | | |
Collapse
|
10
|
Luciani N, Anselmi A, De Geest R, Martinelli L, Perisano M, Possati G. Extracorporeal circulation by peripheral cannulation before redo sternotomy: Indications and results. J Thorac Cardiovasc Surg 2008; 136:572-7. [DOI: 10.1016/j.jtcvs.2008.02.071] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 12/05/2007] [Accepted: 02/25/2008] [Indexed: 12/01/2022]
|
11
|
Laje P, Martínez-Ferro M. Thoracoscopic double aortic arch division with Harmonic scalpel: a case report. J Thorac Cardiovasc Surg 2007; 133:819-20. [PMID: 17320599 DOI: 10.1016/j.jtcvs.2006.10.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Accepted: 10/30/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Pablo Laje
- Division of General Pediatric Surgery, National Pediatric Hospital JP Garrahan, Buenos Aires, Argentina.
| | | |
Collapse
|
12
|
Luciani N, Nasso G, Anselmi A, Glieca F, Gaudino M, Girola F, Piscitelli M, Perisano M, Martinelli L, Possati G. Repeat Valvular Operations: Bench Optimization of Conventional Surgery. Ann Thorac Surg 2006; 81:1279-83. [PMID: 16564258 DOI: 10.1016/j.athoracsur.2005.11.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Revised: 11/06/2005] [Accepted: 11/08/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND Repeat heart valve operations have become a quite common procedure. We reviewed our experience with reoperative valvular surgery during a 6-year period to assess the risk factors affecting in-hospital mortality and medium-term survival. METHODS A series of 316 redo procedures performed on a total of 290 patients in the period between 1997 and 2002 at our institution was retrospectively analyzed. Univariate and multivariable analyses were performed. RESULTS In-hospital mortality was 3.8%; overall mortality at the end of a 30-month follow-up was 9.3%. We identified advanced New York Heart Association class, advanced age, depressed ejection fraction, emergent or urgent presentation, impairment of renal function, and involvement of tricuspid valve as predictors of mortality. In contrast, duration of cardiopulmonary bypass and multiple valve procedure were not associated with increased short-term risk. CONCLUSIONS The present study is characterized by particular attention in reducing confounding variables and biases correlated to heterogeneities. The main determinants of mortality are related to the degree of patients' illness rather than to inherent technical factors of reoperations. Although highest-risk individuals (previous coronary artery bypass grafting or coexistence of aortic aneurysm) were excluded from the study, our data suggest that patients undergoing isolated redo valvular procedures now face operative risks that are comparable to primary intervention.
Collapse
Affiliation(s)
- Nicola Luciani
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Harding J, Sebag F, Sierra M, Palazzo FF, Henry JF. Thyroid surgery: postoperative hematoma--prevention and treatment. Langenbecks Arch Surg 2006; 391:169-73. [PMID: 16555087 DOI: 10.1007/s00423-006-0028-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Accepted: 12/22/2005] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Postoperative haematoma formation is a fortunately rare but potentially life-threatening complication of thyroid surgery. This paper aims to identify potential aetiological factors, describe surgical techniques and newer haemostatic agents that may be used to minimise the risk of haematoma formation and propose surgical strategies to deal with haematoma formation. MATERIALS AND METHODS An extensive literature search as well as own considerable experience in a tertiary referral centre endocrine surgical unit was drawn upon to review this topic. CONCLUSIONS Postoperative haematoma may have a multifactorial aetiology. Numerous manoeuvres and surgical haemostatic agents may be employed to minimise the risk of haematoma formation but are no substitute for meticulous haemostasis. In the event of haematoma formation, early surgical re-intervention is strongly advocated with due care given to at risk structures.
Collapse
Affiliation(s)
- Jane Harding
- Department of General and Endocrine Surgery, Hôpital de la Timone, Boulevard Jean Moulin, 13385, Marseille Cedex 5, France
| | | | | | | | | |
Collapse
|