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Zorzato PC, Ferrari FA, Garzon S, Franchi M, Cianci S, Laganà AS, Chiantera V, Casarin J, Ghezzi F, Uccella S. Advanced bipolar vessel sealing devices vs conventional bipolar energy in minimally invasive hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309:1165-1174. [PMID: 37955717 PMCID: PMC10894136 DOI: 10.1007/s00404-023-07270-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE To compare conventional bipolar electrosurgery with advanced bipolar vessel sealing (ABVS) devices for total laparoscopic hysterectomy (TLH). METHODS A systematic review was conducted by searching Scopus, PubMed/MEDLINE, ScienceDirect, and Cochrane Library from January 1989 to November 2021. We identified all studies comparing ABVS devices with conventional bipolar electrosurgery in TLH and reporting at least one of the following outcomes: total blood loss, total operative time, hospital stay, perioperative complications, or costs. Meta-analysis was conducted with a random effect model reporting pooled mean differences and odds ratios (ORs) with related 95% confidence intervals (CIs). RESULTS Two randomized controlled trials and two retrospective studies encompassing 314 patients were included out of 615 manuscripts. The pooled estimated total blood loss in the ABVS devices group was lower than conventional bipolar electrosurgery of 39 mL (95% CI - 65.8 to - 12.6 mL; p = .004). The use of ABVS devices significantly reduced the total operative time by 8 min (95% CI - 16.7 to - 0.8 min; p = .033). Hospital stay length did not differ between the two groups, and a comparable overall surgical complication rate was observed [OR of 0.9 (95% CI 0.256 - 3.200; p = .878]. CONCLUSIONS High-quality evidence comparing ABVS devices with conventional bipolar electrosurgery for TLH is lacking. ABVS devices were associated with reduced total blood loss and operative time; however, observed differences seem clinically irrelevant. Further research is required to clarify the advantages of ABVS devices over conventional bipolar electrosurgery and to identify cases that may benefit more from their use.
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Affiliation(s)
- Pier Carlo Zorzato
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, AOUI Verona, Verona, Italy
| | - Filippo Alberto Ferrari
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, AOUI Verona, Verona, Italy
| | - Simone Garzon
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, AOUI Verona, Verona, Italy.
| | - Massimo Franchi
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, AOUI Verona, Verona, Italy
| | - Stefano Cianci
- Department of Obstetrics and Gynecology, University of Messina, Messina, Italy
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Obstetrics and Gynecology, Paolo Giaccone Hospital, Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Stefano Uccella
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, AOUI Verona, Verona, Italy
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Xue FS, Li XT, Wan L. A double-blinded, randomized trial comparing surgeon-administered transversus abdominis plane block with placebo after midline laparotomy in gynecologic oncology surgery: a comment. Am J Obstet Gynecol 2024; 230:275-276. [PMID: 37777146 DOI: 10.1016/j.ajog.2023.09.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, 95 Yong-An Rd., Xi-Cheng District, Beijing 100050, People's Republic of China.
| | - Xin-Tao Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, 95 Yong-An Rd., Xi-Cheng District, Beijing 100050, People's Republic of China
| | - Lei Wan
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, 95 Yong-An Rd., Xi-Cheng District, Beijing 100050, People's Republic of China
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3
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Abi Antoun M, Etrusco A, Chiantera V, Laganà AS, Feghali E, Khazzaka A, Stabile G, Della Corte L, Dellino M, Sleiman Z. Outcomes of conventional and advanced energy devices in laparoscopic surgery: a systematic review. MINIM INVASIV THER 2024; 33:1-12. [PMID: 38164811 DOI: 10.1080/13645706.2023.2274396] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/04/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Hemostasis is an important step in all surgical procedures. Mechanical methods of hemostasis have been gradually abandoned in favor of electrosurgery. The aim of this systematic review was to evaluate the effectiveness of electrosurgical instruments utilized in minimally invasive gynecological procedures. MATERIAL AND METHODS We performed a systematic review, including randomized controlled trials, prospective and retrospective studies, comparing the outcomes of different energy devices (EDs) used in laparoscopic gynecologic surgeries. We extracted data about blood loss (BL), mean operative time, post-operative pain, hospital stay and complications associated with each electrosurgical device. RESULTS We included 30 studies reporting comparative outcomes concerning conventional (bipolar and monopolar) and innovative EDs (Harmonic scalpel, LigaSure, Plasma kinetic gyrus, Thunderbeat, EnSeal, Marseal, Caiman and ALAN). New EDs were found to be more efficient in complex surgeries due to less intraoperative BL and shorter operative time. No significant decrease in hospital stay, post-operative pain or complications was found with the use of new energy instruments. CONCLUSIONS Although new electrosurgical devices seem an appealing and safer option, there is still insufficient evidence for one vessel-sealing technology to be considered superior to another. Therefore, monopolar and conventional bipolar (CB) are still widely used in laparoscopic gynecology.
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Affiliation(s)
- Melissa Abi Antoun
- Obstetrics and gynecology department, Saint Joseph University, Beirut, Lebanon
| | - Andrea Etrusco
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Edwin Feghali
- Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Aline Khazzaka
- Surgical Research Lab, Saint Joseph University, Beirut, Lebanon
| | - Guglielmo Stabile
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Miriam Dellino
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Zaki Sleiman
- Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
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Xue FS, He N, Cheng Y. Correspondence on 'Thoracic epidural analgesia as part of an enhanced recovery program in gynecologic oncology: a prospective cohort study' by Pandraklakis et al. Int J Gynecol Cancer 2023; 33:1836. [PMID: 37890876 DOI: 10.1136/ijgc-2023-004979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023] Open
Affiliation(s)
- Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Nong He
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yi Cheng
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Zhang YF, Fan Y, Zhang P, Ruan JY, Mu Y, Li JK. Cervical Cancer Recurrence and Patient Survival After Radical Hysterectomy Followed by Either Adjuvant Chemotherapy or Adjuvant Radiotherapy With Optional Concurrent Chemotherapy: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:823064. [PMID: 35311123 PMCID: PMC8931664 DOI: 10.3389/fonc.2022.823064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/01/2022] [Indexed: 12/31/2022] Open
Abstract
Objective To compare cervical cancer recurrence and patient survival after radical hysterectomy followed by either adjuvant chemotherapy (AC) or adjuvant radiotherapy with or without concurrent chemotherapy (AR/CCRT). Methods We systematically searched PubMed, EMBASE, the Cochrane Library and clinicaltrials.gov to identify studies reporting recurrence or survival of cervical cancer patients who received AC or AR/CCRT after radical hysterectomy. Data were meta-analyzed using a random-effects model, and heterogeneity was evaluated using the I2 test. Subgroup and sensitivity analyses were performed to identify potential sources of heterogeneity. Results The meta-analysis included 14 non-randomized studies and two randomized controlled trials, altogether involving 5,052 cervical cancer patients. AC and AR/CCRT groups did not differ significantly in rates of total or local recurrence or mortality. Nevertheless, AC was associated with significantly lower risk of distant recurrence [odds ratio (OR) 0.67, 95% confidence interval (CI) 0.55-0.81] and higher rates of overall survival [hazard ratio (HR) 0.69, 95%CI 0.54-0.85] and disease-free survival rate (HR 0.77, 95%CI 0.62-0.92). Conclusions AC may be an effective alternative to AR/CCRT for cervical cancer patients after radical hysterectomy, especially younger women who wish to preserve their ovaries and protect them from radiation damage. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier PROSPERO (CRD42021252518).
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Affiliation(s)
- Yu-fei Zhang
- Department of Gynaecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yu Fan
- Department of Gynaecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Peng Zhang
- Department of Gynaecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Jia-ying Ruan
- Department of Gynaecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yi Mu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Jin-ke Li
- Department of Gynaecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, China
- *Correspondence: Jin-ke Li,
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6
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Jing H, Yang Y, Liu Y, Zou P, Li Z. Trends in Surgical Morbidity and Survival Outcomes for Radical Hysterectomy in West China: An 11-Year Retrospective Cohort Study. Front Oncol 2022; 12:836481. [PMID: 35223516 PMCID: PMC8866646 DOI: 10.3389/fonc.2022.836481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To vertically analyze the trend of surgical approaches, demographics, surgical morbidity, and long-term survival outcomes of early-stage cervical cancer over the past 11 years and to determine whether there have been any significant changes. Methods A total of 851 patients with consecutive International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA–IIA cervical cancer diagnosed between January 2008 and June 2018 at a single center in China were included in this retrospective study. Trends in the rate of minimally invasive surgery (MIS), demographics, surgical morbidities, and long-term survival outcomes were determined. We categorized patients into two groups according to their year of operation. The demographics, pathological factors, surgical morbidity, and long-term survival outcomes were compared between these two groups. Results Regarding the surgical approach, there was a significant increase in the rate of laparoscopic radical hysterectomy (LRH) performed over the study period, from 7.8% in 2008 to 72.5% in 2018 (p < 0.0001). The mean age of patients who underwent abdominal radical hysterectomy (ARH) has increased slightly from 2008 to 2018, and those who underwent ARH in the second half of the study period (2014–2018) were significantly older (45.01 vs. 47.50 years; p = 0.001). The most impressive changes over the past 11 years have occurred in the surgical morbidity in both the ARH and LRH groups. The overall surgical morbidity decreased from 29.2% in 2008 to 11.9% in 2018, with an annual rate of 1.57%. The median estimated blood loss volume of the ARH group was 500 ml (range 50–2,000) in the first few years compared to 400 ml (30–2500) in the last few years of the study period (p < 0.0001), which in the LRH group was 350 ml (range 150–800) and 150 ml (range 5–1,000), respectively (p < 0.0001). Similarly, allogeneic blood transfusions and hospital stay have all decreased dramatically over time in both approaches. On the other hand, our study did not reveal any significant statistical changes in long-term survival outcomes over the follow-up period in either group. Conclusions The findings of our study demonstrate that great progress in surgically managed cervical cancer has been made over the last decade in West China. Our retrospective study demonstrated that the year of operation does not appear to influence the long-term survival, but the surgical morbidity impressively decreased over the study period in both the ARH and LRH groups, which reflects that the higher hospital surgical volume for radical hysterectomy (RH) was not associated with lower survival outcomes but related to the reduction of surgical morbidity.
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Affiliation(s)
- Huining Jing
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Ying Yang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yinxia Liu
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Peijun Zou
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhengyu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
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Wang M, Wang D, Zuo J, Liu T, Niu Z, Xie J, Qi D. A Dose-Response Relationship Study of Prophylactic Nalbuphine to Reduce Pain During the Awakening Period in Patients Undergoing Laparoscopic Total Hysterectomy: A Randomized, Controlled, Double-Blind Clinical Study. Drug Des Devel Ther 2022; 16:981-990. [PMID: 35386854 PMCID: PMC8979566 DOI: 10.2147/dddt.s356582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/19/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Min Wang
- Department of Anesthesiology, Jinshan Hospital of Fudan University, Shanghai, People’s Republic of China
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Dongyue Wang
- Department of Anesthesiology, Jinshan Hospital of Fudan University, Shanghai, People’s Republic of China
| | - Jingzhi Zuo
- Emergency Department, Yichang Central People’s Hospital, Yichang, Hubei, People’s Republic of China
| | - Tianyu Liu
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Zheng Niu
- Department of Anesthesiology, Zhangjiagang First People’s Hospital, Zhangjiagang, Jiangsu, People’s Republic of China
| | - Juan Xie
- Department of Anesthesiology, Jinshan Hospital of Fudan University, Shanghai, People’s Republic of China
| | - Dunyi Qi
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Correspondence: Dunyi Qi, Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China, Email
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Song WJ, Bae SU, Jeong WK, Baek SK. A propensity score-matched analysis of advanced energy devices and conventional monopolar device for colorectal cancer surgery: comparison of clinical and oncologic outcomes. Ann Surg Treat Res 2022; 103:290-296. [DOI: 10.4174/astr.2022.103.5.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/23/2022] [Accepted: 09/14/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Woo Jin Song
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Sung Uk Bae
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Woon Kyung Jeong
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Seong Kyu Baek
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Batra S, Bhardwaj P, Dagar M. Comparative analysis of peri-operative outcomes following total laparoscopic hysterectomy with conventional bipolar-electrosurgery versus high-pressure pulsed LigaSure use. Gynecol Minim Invasive Ther 2022; 11:105-109. [PMID: 35746909 PMCID: PMC9212175 DOI: 10.4103/gmit.gmit_69_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/14/2021] [Accepted: 08/19/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives: Materials and Methods: Results: Conclusion:
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10
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Melemeni A, Tympa Grigoriadou A, Tsaroucha A. Postoperative abdominal free air: How much and when is enough? Report of two cases. SAGE Open Med Case Rep 2021; 9:2050313X211022427. [PMID: 34221403 PMCID: PMC8221662 DOI: 10.1177/2050313x211022427] [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: 03/04/2021] [Accepted: 05/16/2021] [Indexed: 11/30/2022] Open
Abstract
Postoperative intraperitoneal or ectopic free air may occur after abdominal surgery, gynecologic surgery, laparoscopic surgery, or endoscopic procedures and, in rare cases, represent gastrointestinal perforation, requiring emergency laparotomy. Evaluating patients with postoperative signs of bowel perforation may be difficult, especially when day-case laparoscopic or endoscopic surgery is performed, with the patient readily discharged from hospital. Delayed diagnosis of gastrointestinal perforation due to underestimation of postoperative free air is associated with a high morbidity and mortality rate. We report two cases of patients presenting with postoperative free air along with the clinical presentation and management.
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Affiliation(s)
- Aikaterini Melemeni
- 1st Department of Anesthesiology, Aretaieion University Hospital, Athens, Greece
| | | | - Athanasia Tsaroucha
- 1st Department of Anesthesiology, Aretaieion University Hospital, Athens, Greece
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11
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Wang J, Sun L, Ni T, Huang Y, Wang L, Yuan J, Fan Q, Li Y, Wang Y. A practical method of using the anatomical space of the vesicouterine ligament for laparoscopic radical hysterectomy: a retrospective cohort study. J Int Med Res 2021; 48:300060520926857. [PMID: 32600083 PMCID: PMC7328497 DOI: 10.1177/0300060520926857] [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] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the practicality of a new method using anatomical spaces for performing standard laparoscopic radical hysterectomy (LRH) without ureteral injury in patients with cervical cancer. Methods Clinicopathological characteristics and perioperative complications were retrospectively analysed in 440 patients with stages IB1 to IIB cervical cancer. The patients were assigned to two of the following groups: LRH by our method of using anatomical landmarks (anatomical space group, n = 217) and the traditional method (traditional group, n = 223). Results The mean operative duration and time of vesicouterine ligament (VUL) dissection were significantly shorter (173.87 ± 30.39 vs. 210.83 ± 44.55 minutes; 32.75 ± 7.23 vs. 43.48 ± 11.22 minutes), and blood loss was less in the anatomical space group compared with the traditional group. The rate of the intraoperative complication of ureteral injury was also significantly lower in the anatomical space group compared with the traditional group (0 vs. 5). Conclusions LRH by the anatomical method, using the axillary space and other potential spaces as anatomical landmarks, results in less blood loss and reduced ureteral injury compared with the traditional method. This method is safe and practical for separating the ureter from the VUL in patients with cervical cancer.
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Affiliation(s)
- Jing Wang
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Lulu Sun
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Obstetrics and Gynecology, Shijiazhuang Obstetrics and Gynecology Hospital, Shijiazhuang, Hebei Province, China
| | - Ting Ni
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Yong Huang
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Lihua Wang
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Jiangjing Yuan
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Qiong Fan
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Yuhong Li
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Yudong Wang
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
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12
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A comparison of the Thunderbeat and standard electrocautery devices in head and neck surgery: a prospective randomized controlled trial. Eur Arch Otorhinolaryngol 2021; 278:4987-4996. [PMID: 33740084 PMCID: PMC8553711 DOI: 10.1007/s00405-021-06739-z] [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: 12/13/2020] [Accepted: 03/05/2021] [Indexed: 11/22/2022]
Abstract
Purpose New energy-based sutureless vessel ligation devices, such as the Thunderbeat (Olympus Medical Systems Corp., Tokyo, Japan), could reduce operative time and limit blood loss in head and neck surgery; however, efficacy and safety in major head and neck surgery have not been investigated in a prospective, randomized study. Methods This prospective, double-arm, randomized controlled trial consisted of two parts: total laryngectomy (TL) and neck dissection (ND). Thirty patients planned for TL were randomized in two groups. For the ND part, forty-two operative sides were likewise randomized. In both parts, Thunderbeat was used in addition to the standard instrumentation in the intervention groups, while only standard instrumentation was used in the control groups. Primary outcome values were blood loss, operative time and complication rate. Results For the TL part there was no difference in mean blood loss (p = 0.062), operative time (p = 0.512) and complications (p = 0.662) between both hemostatic techniques. For the neck dissection part, there was a reduction in blood loss (mean 210 mL versus 431 mL, p = 0.046) and in operative time (median 101 (IQR 85–130) minutes versus 150 (IQR 130–199) minutes, p = 0.014) when Thunderbeat was used. There was no difference in complication rate between both hemostatic systems (p = 0.261). Conclusion The Thunderbeat hemostatic device significantly reduces operative blood loss and operative time for neck dissections, without increase in complications. In TL, blood loss using Thunderbeat was comparable with the standard technique, but the operative time tended to be shorter. Trial registration UMCG Research Register, Reg. no. 201700041, date of registration: 18/1/2017
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Perrone E, Rossitto C, Fanfani F, Cianci S, Fagotti A, Uccella S, Vizzielli G, Vascone C, Restaino S, Fedele C, Saleh FL, Scambia G, Gueli Alletti S. Percutaneous-Assisted versus Laparoscopic Hysterectomy: A Prospective Comparison. Gynecol Obstet Invest 2020; 85:318-326. [PMID: 32920558 DOI: 10.1159/000509877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/22/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the feasibility of percutaneous approach, we prospectively compared our experience in percutaneous-assisted hysterectomy (PSS-H) with that in a series of laparoscopic hysterectomies (LPS-Hs). METHODS In this multicentric cohort study, from May 2015 to October 2017, 160 patients affected by benign and malignant gynecological conditions were considered eligible for minimally invasive surgery (MIS): 80 patients received PSS-H and 80 LPS-H. In each group, 30 cases of low-/intermediate-risk endometrial cancer were enrolled. For both groups, we documented preoperative outcomes, postoperative pain, and cosmetic outcomes. RESULTS No statistically significant differences were noted in baseline characteristics or operative time. We observed significant differences in estimated blood loss: median of 50 cc (PSS-H) and 100 cc (LPS-H) (p = 0.0001). In LPS-H, we reported 4 (5.0%) intraoperative complications and 1 (1.3%) in PSS-H. Thirty-day complications were 4 (5%) in PSS-H and 11 (13.8%) in LPS-H (p = 0.058). No significative differences were found in visual analog scale score, despite a relevant disparity in cosmetic outcome (p = 0.0001). For oncological cases, the 2 techniques had comparable intra- and postoperative outcomes and oncological accuracy. CONCLUSIONS In this study, we reported that PSS-H is comparable to LPS-H for intra- and perioperative outcomes and postoperative pain, while PSS-H seems to be superior in cosmetic outcomes and patient satisfaction. PSS-H may represent a valid alternative in ultra-MIS for benign gynecological conditions and low-/intermediate-risk endometrial cancer.
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Affiliation(s)
- Emanuele Perrone
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy,
| | - Cristiano Rossitto
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Fanfani
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Cianci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Anna Fagotti
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Uccella
- Division of Obstetrics and Gynecology, Ospedale degli Infermi, Biella, Italy
| | - Giuseppe Vizzielli
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmine Vascone
- Department of Obstetrics and Gynecology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Stefano Restaino
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Camilla Fedele
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Farrah Layla Saleh
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Salvatore Gueli Alletti
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
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Kim WW, Cho J, Jeon YS, Kim I, Jeong YJ, Choi J, Lee MH, Lee J, Kang JG, Tufano RP, Kang SH. Prospective, Randomized, Comparative, Multicenter Study of the Hybrid Ultrasonic Advanced Bipolar Device and the Ultrasonic Coagulating Shears in Open Thyroidectomy. Surg Innov 2020; 28:41-47. [PMID: 32757879 DOI: 10.1177/1553350620949000] [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] [Indexed: 11/15/2022]
Abstract
Background. The hybrid ultrasonic advanced bipolar device (HUB) that integrates ultrasonic energy and advanced bipolar energy was recently developed and applied to thyroid surgery. The purpose of this study was to compare the efficacy and safety of HUB and ultrasonic coagulating shears for open thyroidectomy. Methods. A total of 200 patients were enrolled from April to September 2017 in this prospective, randomized, multicenter study. Patients were randomly assigned to an ultrasonic group (n = 101) or a hybrid group (n = 99). Results. Operation times were similar in the 2 study groups, that is, 54.2 ± 25.2 minutes in the ultrasonic group and 50.2 ± 21.6 minutes in the hybrid group. Postoperative surgical results and morbidities were no different in the 2 groups. However, the total amount of bleeding was significantly less in the hybrid group (13.0 ± 17.7 mg vs 8.6 ± 11.5 mg; P = .042). Conclusions. Our study showed that there was no significant difference between the 2 groups in postoperative surgical results and morbidity. The total bleeding amount was significantly less in the hybrid group. The study shows that HUB is comparable to the ultrasonic coagulating shears in terms of efficacy and safety during thyroid surgery.
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Affiliation(s)
- Wan Wook Kim
- Department of Surgery, School of Medicine, 65672Kyungpook National University, Daegu, Republic of Korea
| | - Jihyoung Cho
- Department of Surgery, School of Medicine, 37976Keimyung University, Daegu, Republic of Korea
| | - Young San Jeon
- Department of Surgery, Goo Hospital, Daegu, Republic of Korea
| | - Insoo Kim
- Department of Surgery, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Young Ju Jeong
- Department of Surgery, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Jungeun Choi
- Department of Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Moo Hyun Lee
- Department of Surgery, School of Medicine, 37976Keimyung University, Daegu, Republic of Korea
| | - Jehyung Lee
- Department of Surgery, Goo Hospital, Daegu, Republic of Korea
| | - Jin Gu Kang
- Department of Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Su Hwan Kang
- Department of Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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15
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Chang JW, Na G, Shin SH, Kim YS, Koo BS, Ahn SH, Chang Choi E, Kim WS. Is an Ultrasonic and Bipolar Integrated Energy Device More Useful Than a Conventional Electric Device in Head and Neck Free Flap Reconstruction? A Prospective Comparison. J Oral Maxillofac Surg 2020; 78:1437.e1-1437.e9. [DOI: 10.1016/j.joms.2020.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/01/2020] [Accepted: 02/09/2020] [Indexed: 11/28/2022]
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16
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Gueli Alletti S, Perrone E, Cretì A, Cianci S, Uccella S, Fedele C, Fanfani F, Palmieri S, Fagotti A, Scambia G, Rossitto C. Feasibility and perioperative outcomes of percutaneous-assisted laparoscopic hysterectomy: A multicentric Italian experience. Eur J Obstet Gynecol Reprod Biol 2020; 245:181-185. [DOI: 10.1016/j.ejogrb.2019.12.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 01/25/2023]
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17
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Surgical outcomes according to the type of monopolar electrocautery device used in laparoscopic surgery for right colon cancer: a comparison of endo-hook versus endo-shears. Surg Endosc 2019; 34:1070-1076. [PMID: 31147824 DOI: 10.1007/s00464-019-06854-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/18/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although monopolar electrocautery is preferred by many laparoscopic surgeons and is more cost-effective than bipolar or ultrasonic scissors, few studies have compared these outcomes between different monopolar electrocautery devices used in laparoscopic surgery. Therefore, this study compared the surgical outcomes between monopolar endo-hook versus endo-shears during laparoscopic right hemicolectomy for right colon cancer. METHODS Using a prospective database of patients treated at our institute, we analyzed the surgical outcomes of 358 consecutive patients with right colon cancer who underwent curative laparoscopic surgery with a monopolar endo-hook (n = 164) or endo-shears (n = 194) between March 2009 and March 2017. RESULTS There were no differences in age, sex, body mass index, American Society of Anesthesiologists' grade, previous operative history, or clinical stage between the endo-hook and endo-shears groups. The estimated blood loss was similar between the endo-hook and endo-shears groups (90.9 ± 60.3 vs. 92.0 ± 89.3 mL; P = 0.893). The number of harvested lymph nodes was greater in the endo-hook group (53.5 ± 20.3 vs. 48.1 ± 18.5; P = 0.008). Hospital stay was shorter in the endo-hook group (6.8 ± 2.2 vs. 7.8 ± 4.8 days; P = 0.013). Although chylous ascites was more frequent in the endo-hook group (21.3% vs. 7.7%, P < 0.001), the postoperative morbidity rate was lower in this group (9.8% vs. 18.0%; P = 0.025). All instances of chylous ascites healed spontaneously without intervention. CONCLUSIONS This study showed that the use of a monopolar endo-hook during laparoscopic right hemicolectomy might permit more meticulous lymph-node dissection and reduce morbidity compared with the use of monopolar endo-shears. Therefore, we suggest that the outcomes of laparoscopic surgery might be associated with the type of electrocautery device used.
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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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19
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Lirk P, Thiry J, Bonnet MP, Joshi GP, Bonnet F. Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations. Reg Anesth Pain Med 2019; 44:425-436. [DOI: 10.1136/rapm-2018-100024] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/23/2018] [Accepted: 12/31/2018] [Indexed: 11/03/2022]
Abstract
Background and objectivesLaparoscopic hysterectomy is increasingly performed because it is associated with less postoperative pain and earlier recovery as compared with open abdominal hysterectomy. The aim of this systematic review was to evaluate the available literature regarding the management of pain after laparoscopic hysterectomy.Strategy and selection criteriaRandomized controlled trials evaluating postoperative pain after laparoscopic hysterectomy published between January 1996 and May 2018 were retrieved, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, from the EMBASE and MEDLINE databases and the Cochrane Register of Controlled Trials. Efficacy and adverse effects of analgesic techniques were assessed.ResultsOf the 281 studies initially identified, 56 were included. Of these, 31 assessed analgesic or anesthetic interventions and 25 assessed surgical interventions. Acetaminophen, non-steroidal anti-inflammatory drugs, and dexamethasone reduced opioid consumption. Limited evidence hindered recommendations on alpha-2-agonists. Inconsistent evidence was found in the studies investigating pregabalin and transversus abdominis plane block, and no evidence was found for intraperitoneal local anesthetics, port site infiltration, or single-port laparoscopy. Measures to lower peritoneal insufflation pressure or humidify or heat insufflated gas seem to reduce the incidence of shoulder pain, but not abdominal pain.ConclusionsThe baseline analgesic regimen for laparoscopic hysterectomy should include acetaminophen, a non-steroidal anti-inflammatory drug, dexamethasone, and opioids as rescue analgesics.
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20
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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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21
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Aryal B, Komokata T, Yasumura H, Kamiimabeppu D, Inoue M, Yoshikawa K, Kaieda M, Imoto Y. Evaluation of THUNDERBEAT® in open liver resection- a single-center experience. BMC Surg 2018; 18:86. [PMID: 30326866 PMCID: PMC6192096 DOI: 10.1186/s12893-018-0423-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/05/2018] [Indexed: 01/26/2023] Open
Abstract
Background THUNDERBEAT® (TB) (Olympus Medical Systems Corp., Tokyo, Japan) is a dynamic energy system device that simultaneously delivers ultrasonically generated frictional heat energy and electrically generated bipolar energy. TB is being routinely used in various operative procedures, however, less is known about its utility in liver resection. We, herein, report our early experience of using TB in open liver resection particularly in patients with normal or near-normal liver parenchyma. Methods We retrospectively reviewed the clinical characteristics, and evaluated the perioperative outcome of twenty-eight patients who underwent liver resection with TB, and twenty-four patients who underwent liver resection with basic procedure in our institution. The resection type was stratified into: major hepatectomy; resection of 3 or more than 3 Couinauds segments, and minor hepatectomy; resection of less than 3 Couinauds segments. Results Liver resection time (mean ± SD) in TB group with major hepatectomy was significantly shorter: 16.7 ± 8.8 compared to 62.8 ± 39.4 min in basic procedure group (P < 0.0001). Accordingly, the liver resection time (mean ± SD) in TB group with minor hepatectomy was also significantly shorter, 8.3 ± 2.9 min compared to 45.2 ± 23.9 min in liver resection with basic procedure (P < 0.001). No significant difference was observed between the groups in terms of intraoperative blood transfusion ratio, postoperative complication and postoperative liver dysfunction. Conclusion TB as a new energy device can offer a safe, reliable and substantially rapid liver resection particularly in patients with normal or near-normal liver parenchyma.
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Affiliation(s)
- Bibek Aryal
- Department of Surgery, Kagoshima Medical Center, National Hospital Organization, 8-1 Shiroyamacho, Kagoshima-shi, Kagoshima, 892-0853, Japan.,Cardiovascular and Gastroenterological Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Teruo Komokata
- Department of Surgery, Kagoshima Medical Center, National Hospital Organization, 8-1 Shiroyamacho, Kagoshima-shi, Kagoshima, 892-0853, Japan.
| | - Hiroto Yasumura
- Department of Surgery, Kagoshima Medical Center, National Hospital Organization, 8-1 Shiroyamacho, Kagoshima-shi, Kagoshima, 892-0853, Japan
| | - Daisaku Kamiimabeppu
- Department of Surgery, Kagoshima Medical Center, National Hospital Organization, 8-1 Shiroyamacho, Kagoshima-shi, Kagoshima, 892-0853, Japan
| | - Maki Inoue
- Department of Surgery, Kagoshima Medical Center, National Hospital Organization, 8-1 Shiroyamacho, Kagoshima-shi, Kagoshima, 892-0853, Japan
| | - Kota Yoshikawa
- Department of Surgery, Kagoshima Medical Center, National Hospital Organization, 8-1 Shiroyamacho, Kagoshima-shi, Kagoshima, 892-0853, Japan
| | - Mamoru Kaieda
- Department of Surgery, Kagoshima Medical Center, National Hospital Organization, 8-1 Shiroyamacho, Kagoshima-shi, Kagoshima, 892-0853, Japan
| | - Yutaka Imoto
- Cardiovascular and Gastroenterological Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Suhardja TS, Norhadi S, Ee E, Hodgkins B. Comparison of the Thunderbeat and Other Energy Devices in Laparoscopic Colorectal Resection: A Single-Center Experience. J Laparoendosc Adv Surg Tech A 2018; 28:1417-1421. [PMID: 29870293 DOI: 10.1089/lap.2018.0208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The THUNDERBEAT (TB) is a relatively novel energy device that is used in laparoscopic colorectal resection (LCR), which integrates both ultrasonic and bipolar energy. There are limited data on its use in LCR, compared with bipolar diathermy (LigaSure™ [LS]) or ultrasonically generated heat (Harmonic ACE [HA]). The aim of this study was to compare outcomes in patients undergoing LCR with TB versus LS or HA, for both benign and malignant colorectal diseases. Methods: This study is a prospective trial using retrospective controls in patients undergoing LCR. The study period was over 6 months from June 2015, during which all elective laparoscopic colonic resections were performed using TB only. The retrospective control population included all consecutive patients who underwent LCR during the preceding 6 months, using either LS or HA. The primary outcome measure was the total operative time. Secondary outcome measures evaluated were rates of postoperative surgical complications, mortality, and length of stay. Results: A total of 114 patients were included in the study. Median operative time was not significantly different between LS/HA and TB arms (246 versus 240 minutes, P = .779). Both arms showed no device failure. There was equivalent rate of intraoperative complications (P = .755) and conversion to open surgery (P = .075). There were no statistically significant differences in postoperative morbidity (P = .938) and mortality (P = .392) observed between the two arms. There was also no difference in the length of stay between LS/HA and TB arms (6 versus 7 days, P = .085). Conclusions: Our dataset has the largest number of cases comparing TB and other energy devices in laparoscopic colorectal cancer surgery. They all appear to be equally safe and effective. Operating the TB device does not require a steep learning curve and utilizes similar techniques transferable from the use of other conventional energy devices.
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Affiliation(s)
- Thomas Surya Suhardja
- Department of Colorectal Surgery, Dandenong Hospital, Monash Health, Dandenong, Australia
| | - Shana Norhadi
- Department of Colorectal Surgery, Dandenong Hospital, Monash Health, Dandenong, Australia
| | - Eric Ee
- Department of Colorectal Surgery, Dandenong Hospital, Monash Health, Dandenong, Australia
| | - Brian Hodgkins
- Department of Colorectal Surgery, Dandenong Hospital, Monash Health, Dandenong, Australia
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Badawy A, Seo S, Toda R, Fuji H, Ishii T, Taura K, Yasuchika K, Kaido T, Uemoto S. Evaluation of a new energy device for parenchymal transection in laparoscopic liver resection. Asian J Endosc Surg 2018; 11:123-128. [PMID: 29027381 DOI: 10.1111/ases.12432] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/08/2017] [Accepted: 08/20/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION THUNDERBEAT (TB) is a novel device that uses both ultrasonic and advanced bipolar energies for hemostasis. Several recent human studies have proved the safety and efficacy of TB in different surgical procedures, but there have been no similar studies about its efficacy in hepatic parenchymal transection. Therefore, the aim of the study was to assess the safety and efficacy of the TB device in laparoscopic liver resection. METHODS This retrospective study compared TB and ultrasonic Harmonic devices in 80 patients who underwent laparoscopic liver resection from 2010 to 2016 in our institution. To reduce the selection bias, the two groups were matched in a 1-to-2 ratio on the basis of propensity scores. RESULTS There were no differences in the preoperative patient characteristics between the two groups. The extent of liver resection was comparable between the groups. Although the Harmonic group's intraoperative blood loss and operative time were less than that of the TB group, the differences were not statistically significant (P = 0.08, P = 0.32, respectively). Postoperative complications, mortality within 90 days, and hospital stay were comparable between the two groups. CONCLUSION TB is as safe and effective for parenchymal transection in laparoscopic hepatectomy as ultrasonic devices, but it is not a superior alternative.
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Affiliation(s)
- Amr Badawy
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,General Surgery Department, Alexandria University, Alexandria, Egypt
| | - Satoru Seo
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Rei Toda
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroaki Fuji
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takamichi Ishii
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kojiro Taura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kentaro Yasuchika
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshimi Kaido
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Taşkın S, Şükür YE, Altın D, Turgay B, Varlı B, Baytaş V, Ortaç F. Bipolar Energy Instruments in Laparoscopic Uterine Cancer Surgery: A Randomized Study. J Laparoendosc Adv Surg Tech A 2018; 28:645-649. [PMID: 29323616 DOI: 10.1089/lap.2017.0639] [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] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare the perioperative outcomes of patients with uterine cancer, who were operated using advanced or conventional bipolar instruments. MATERIALS AND METHODS Patients with clinically early-stage endometrial cancer were randomized to advanced (LigaSure) or conventional (Robi forceps) bipolar groups. Surgeries were performed by laparoscopy. Hysterectomy and bilateral salpingo-oophorectomy with retroperitoneal lymphadenectomy were done in all cases. Primary endpoint of the study was to compare operation time for 2 groups. Other perioperative outcomes were also compared. ClinicalTrials.gov identifier number of the study was NCT02822820. RESULTS Sixty-eight cases with endometrial cancer were randomized to 2 groups and each group included 34 subjects. Mean age and body mass index of all cases were 56.8 ± 10.4 years and 31.1 ± 5.3 kg/m2, respectively. Mean operation time was found significantly shorter in advanced bipolar group (134.2 ± 29.7 minutes versus 163.5 ± 27.7 minutes, P < .001). The other variables investigated such as intraoperative blood loss, duration of hospital stay, and postoperative pain scores did not show statistically significant difference between the groups. CONCLUSION Operation time was shorter in advanced bipolar group, however, advanced and conventional bipolar energy instruments were comparable for other perioperative outcomes in laparoscopic endometrial cancer surgery.
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Affiliation(s)
- Salih Taşkın
- 1 Department of Obstetrics and Gynecology, Ankara University School of Medicine , Ankara, Turkey
| | - Yavuz Emre Şükür
- 1 Department of Obstetrics and Gynecology, Ankara University School of Medicine , Ankara, Turkey
| | - Duygu Altın
- 1 Department of Obstetrics and Gynecology, Ankara University School of Medicine , Ankara, Turkey
| | - Batuhan Turgay
- 1 Department of Obstetrics and Gynecology, Ankara University School of Medicine , Ankara, Turkey
| | - Bulut Varlı
- 1 Department of Obstetrics and Gynecology, Ankara University School of Medicine , Ankara, Turkey
| | - Volkan Baytaş
- 2 Department of Anesthesiology and Reanimation, Ankara University School of Medicine , Ankara, Turkey
| | - Fırat Ortaç
- 1 Department of Obstetrics and Gynecology, Ankara University School of Medicine , Ankara, Turkey
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Bogani G, Rossetti DO, Ditto A, Signorelli M, Martinelli F, Mosca L, Scaffa C, Leone Roberti Maggiore U, Chiappa V, Sabatucci I, Lorusso D, Raspagliesi F. Nerve-Sparing Approach Improves Outcomes of Patients Undergoing Minimally Invasive Radical Hysterectomy: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2017; 25:402-410. [PMID: 29191471 DOI: 10.1016/j.jmig.2017.11.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 12/23/2022]
Abstract
Few studies have investigated the efficacy and safety of the nerve-sparing approach via minimally invasive surgery for the treatment of cervical cancer. We aimed to review the current evidence comparing nerve-sparing minimally invasive radical hysterectomy (NS-MRH) with conventional minimally invasive radical hysterectomy (MRH). This systematic review was registered in the International Prospective Register of Systematic Reviews (CRD#57655). Overall, 675 patients were included: 350 (51.9%) and 325 (48.1%) patients undergoing MRH and NS-MRH, respectively. MRH was associated with a shorter operative time in comparison with NS-MRH (mean difference = 32.57 minutes; 95% CI, 22.87-42.48). The estimated blood loss (mean difference = 97.14 mL, 20.01-214.29) and transfusion rate (odds ratio [OR] = 0.67; 95% confidence interval [CI], 0.15-3.01) did not differ statistically between the 2 groups. The risk of developing intraoperative (OR = 0.43; 95% CI, 0.08-2.23) and severe postoperative (OR = 0.63; 95% CI, 0.17-2.39) complications was similar between NS-MRH and MRH. Patients undergoing NS-MRH experienced lower voiding (OR = 0.39; 95% CI, 0.19-0.81) dysfunction rates than patients undergoing MRH. Moreover, a trend toward lower sexual (OR = 0.25; 95% CI, 0.06-1.07) and rectal (OR = 0.12; 95% CI, 0.01-1.02) issues was observed for patients having NS-MRH compared with patients undergoing MRH. Survival outcomes are not influenced by the type of surgical approach (recurrence [OR = 1.27; 95% CI, 0.49-3.28] and death [OR = 1.01; 95% CI, 0.36-2.83]) rates. The pooled data suggested that NS-MRH is equivalent to MRH for the treatment of cervical cancer and may be superior in reducing pelvic floor dysfunction rates. However, because of the low level of evidence of the included studies, further randomized trials are warranted.
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Affiliation(s)
- Giorgio Bogani
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
| | | | - Antonino Ditto
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Mauro Signorelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Fabio Martinelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Lavinia Mosca
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Cono Scaffa
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | | | - Valentina Chiappa
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Ilaria Sabatucci
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Domenica Lorusso
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
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Misirlioglu S, Turkgeldi E, Boza A, Oktem O, Ata B, Urman B, Taskiran C. The Clinical Utility of a Pulsed Bipolar System and Its Electrosurgical Device During Total Laparoscopic Hysterectomy. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2016.0107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Selim Misirlioglu
- Department of Obstetrics and Gynecology, VKF Koc University Hospital, Istanbul, Turkey
| | - Engin Turkgeldi
- Department of Obstetrics and Gynecology, VKF Koc University Hospital, Istanbul, Turkey
| | - Aysen Boza
- Women's Health Center, VKF Koc University Hospital, Istanbul, Turkey
| | - Ozgur Oktem
- Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey
| | - Baris Ata
- Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey
| | - Bulent Urman
- Women's Health Center, VKF Koc University Hospital, Istanbul, Turkey
- Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey
| | - Cagatay Taskiran
- Women's Health Center, VKF Koc University Hospital, Istanbul, Turkey
- Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey
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Jaiswal A, Huang KG. "Energy devices in gynecological laparoscopy - Archaic to modern era". Gynecol Minim Invasive Ther 2017; 6:147-151. [PMID: 30254903 PMCID: PMC6135185 DOI: 10.1016/j.gmit.2017.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 07/21/2017] [Accepted: 08/01/2017] [Indexed: 02/08/2023] Open
Abstract
The introduction of newer vessel sealing systems has revolutionized techniques of hemostasis during laparoscopic surgery. These devices allow for rapid sequential tissue and vessel sealing, coagulation, and transection. Despite of widespread use of newer advanced bipolar and ultrasonic devices, monopolar and conventional bipolar electro-surgery still carry weightage due to wider range of tissue effect, dissection capabilities, cost effectiveness, and ease of availability. Here in we discussed different types of commonly available energy sources in terms of mechanism, efficacy and safety as thorough knowledge is utmost important for surgeon to choose appropriate instrument for surgical procedure.
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Affiliation(s)
- Amruta Jaiswal
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan
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Rossitto C, Cianci S, Gueli Alletti S, Perrone E, Pizzacalla S, Scambia G. Laparoscopic, minilaparoscopic, single-port and percutaneous hysterectomy: Comparison of perioperative outcomes of minimally invasive approaches in gynecologic surgery. Eur J Obstet Gynecol Reprod Biol 2017; 216:125-129. [DOI: 10.1016/j.ejogrb.2017.07.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/08/2017] [Accepted: 07/17/2017] [Indexed: 11/15/2022]
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Ceccanti S, Falconi I, Frediani S, Boscarelli A, Catani M, Cozzi DA. The THUNDERBEAT system for tissue dissection and vascular control in laparoscopic splenectomy. MINIM INVASIV THER 2017; 26:249-252. [PMID: 28145160 DOI: 10.1080/13645706.2017.1281314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The advent of new energy sources for hemostasis has greatly facilitated advanced laparoscopic procedures. We describe a straightforward technique of laparoscopic splenectomy (LS) accomplished using the THUNDERBEAT™ system (TS) (Olympus Medical Systems Corp., Tokyo, Japan) as the sole means of tissue dissection and hemostasis in two patients aged 19 and 6 years, respectively. The specimens were removed intact via a Pfannenstiel incision. Total operative time was 165 and 150 min, and length of hospital stay was three and 4 d, respectively. The TS is an appealing and reliable alternative to currently available energy devices, allowing fast dissection and secure hemostasis during laparoscopic splenectomy.
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Affiliation(s)
- Silvia Ceccanti
- a Pediatric Surgery Unit , Policlinico Umberto, Sapienza University of Rome , Rome , Italy
| | - Ilaria Falconi
- a Pediatric Surgery Unit , Policlinico Umberto, Sapienza University of Rome , Rome , Italy
| | - Simone Frediani
- a Pediatric Surgery Unit , Policlinico Umberto, Sapienza University of Rome , Rome , Italy
| | - Alessandro Boscarelli
- a Pediatric Surgery Unit , Policlinico Umberto, Sapienza University of Rome , Rome , Italy
| | - Marco Catani
- b Emergency Department , Policlinico Umberto I, Sapienza University of Rome , Rome , Italy
| | - Denis A Cozzi
- a Pediatric Surgery Unit , Policlinico Umberto, Sapienza University of Rome , Rome , Italy
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Experience and dissection device are more relevant than patient-related factors for operation time in laparoscopic sigmoid resection-a retrospective 8-year observational study. Int J Colorectal Dis 2017; 32:1703-1710. [PMID: 28879419 PMCID: PMC5691094 DOI: 10.1007/s00384-017-2896-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Surgical outcome is influenced by multiple patient-specific factors and operative expertise of the surgeon. Clinical relevance of medical technical innovations often remains unclear even though laparoscopic surgical procedures are characterized by continual advancement of various devices. Lately, in dissection and sealing technology, fast-cutting ultrasonic scissors are combined with simultaneous bipolar coagulation (bimodal dissection device (BDD)). We investigated how this new technology, operative expertise, and patient-specific factors (body mass index, age) influence operation time in laparoscopic-assisted sigmoid resection. METHODS Between 2008 and 2016, 161 laparoscopic sigmoid resections (52% conventional dissection device (CDD); 48% BDD) performed in a single center were retrospectively evaluated. Biometric patient data, complication rates, and surgery duration, reflecting the learning curve, were analyzed. Operations were performed by experienced surgeons (n = 3) and trainees (n = 4). RESULTS Minor postoperative complications (e.g., impaired wound healing, non-revisional secondary bleeding) occurred in 11 cases (6.8%). Major complications (e.g., bleeding requiring revision, anastomotic leakage) were observed in 3.7%. No heat-related coagulation damage was observed. BDD reduced operation time for both experienced (CDD 150 min, BDD 125 min; p < 0.001) and trainee surgeons (CDD 169 min, BDD 135 min; p = 0.036). Reduction of operation time (indicative of a learning curve in progress) was observed for all surgeons. The curve was steeper using BDD. CONCLUSIONS Patient-specific factors did not have a significant effect on operation time. Even taking the learning curve into account, a combination of ultrasonic dissection and simultaneous bipolar coagulation reduces operation time of laparoscopic-assisted sigmoid resection, regardless of surgeon's expertise.
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Excision of a scalp arteriovenous malformation using Thunderbeat™: The safe way forward? J Plast Reconstr Aesthet Surg 2016; 69:1572-1574. [DOI: 10.1016/j.bjps.2016.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 06/23/2016] [Indexed: 11/19/2022]
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Efficacy and Safety of Combined Ultrasonic and Bipolar Energy Source in Laparoscopic Surgery. J Gastrointest Surg 2016; 20:1760-8. [PMID: 27456017 DOI: 10.1007/s11605-016-3217-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/13/2016] [Indexed: 01/31/2023]
Abstract
AIM Energy devices represent an alternative to clips and staplers for vessel sealing. Outcome data of patients undergoing laparoscopic surgery with use of a novel combined ultrasonic and bipolar energy device (TB, Thunderbeat™) was gathered. METHODS Consecutive patients undergoing laparoscopic surgery using TB were prospectively included between November 2011 and January 2016. Large vessels were dissected using the energy device without additional clips or staplers. The type of procedure, operative time, length of stay, complications, blood transfusions, number and type of vessels being dissected, and need for additional clips were noted. RESULTS Six hundred eighty-three patients underwent 758 procedures with dissection of 1310 large vessels. No additional hemoclips or vascular staplers were used. There were 0.7 % (5/758) intraoperative and 2.6 % (20/758) postoperative bleeding complications. Eleven bleeding occurred at the stapler line of anastomosis, leaving 1.8 % (14/758) bleeding that were potentially related to inadequate hemostasis. Failure of large vessel dissection occurred in two cases (0.15 %, 2/1310) and device-related complications in 1.1 % (8/758). Two of 42 conversions (5.5 %) were bleeding-related. CONCLUSION TB provides a reliable and effective hemostasis. However, ligation failure may occur. As with any kind of electrosurgery, the hot tip of the instruments bears the risk of potentially fatal thermal injuries.
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Total laparoscopic hysterectomy using a percutaneous surgical system: a pilot study towards scarless surgery. Eur J Obstet Gynecol Reprod Biol 2016; 203:132-5. [DOI: 10.1016/j.ejogrb.2016.05.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 05/08/2016] [Accepted: 05/13/2016] [Indexed: 11/19/2022]
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Allaix ME, Arezzo A, Giraudo G, Arolfo S, Mistrangelo M, Morino M. The Thunderbeat and Other Energy Devices in Laparoscopic Colorectal Resections: Analysis of Outcomes and Costs. J Laparoendosc Adv Surg Tech A 2016; 27:1225-1229. [PMID: 27420752 DOI: 10.1089/lap.2016.0317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The THUNDERBEAT™ (TB) is a recently developed energy-based device. To date, there are no clinical studies comparing TB and other energy sources, such as standard electrosurgery (ES), ultrasonic coagulating shears (US) and electrothermal bipolar vessel sealers (EBVS) in patients undergoing laparoscopic colorectal resection (LCR). The aim of this study was to compare outcomes and costs in patients undergoing LCR with TB, US, EBVS, or ES for both benign and malignant colorectal diseases. METHODS This study is a retrospective analysis of a prospective database of patients undergoing LCR. Unselected consecutive patients who had the laparoscopic dissection conducted by using TB were compared with consecutive patients undergoing LCR with US, EBVS, or ES. RESULTS Mean operative time did not significantly differ between the groups (P = .947). Estimated blood loss was significantly higher in the ES group (P < .001). Device-related complications occurred in 2.5% of ES patients, in 2.5% of US patients, and in 5% of EBVS patients, while no complications occurred in TB patients (P = .768). No significant differences were observed in postoperative complication rates between the groups. Mean postoperative hospital stay was similar in the groups. Cost analysis showed no significant differences between US (1519.1 ± 303 €), EBVS (1474.4 ± 372.8 €), and TB (1474.3 ± 176.3 €) (P = .737). CONCLUSION This is the first clinical study comparing TB and other energy-based devices in LCR. They all appear to be equally safe and effective. Costs of surgery are very similar. Further large randomized controlled trials are needed to confirm these data.
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Affiliation(s)
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino , Torino, Italy
| | - Giuseppe Giraudo
- Department of Surgical Sciences, University of Torino , Torino, Italy
| | - Simone Arolfo
- Department of Surgical Sciences, University of Torino , Torino, Italy
| | | | - Mario Morino
- Department of Surgical Sciences, University of Torino , Torino, Italy
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Van Slycke S, Gillardin JP, Van Den Heede K, Minguet J, Vermeersch H, Brusselaers N. Comparison of the harmonic focus and the thunderbeat for open thyroidectomy. Langenbecks Arch Surg 2016; 401:851-9. [DOI: 10.1007/s00423-016-1448-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 05/11/2016] [Indexed: 02/04/2023]
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Abstract
In the past 10 years, laparoscopy has been challenged by robotic surgery; nevertheless, laparoscopic techniques are subject to continuous change. Ultrahigh definition is the next development in video technology, it delivers fourfold more detail than full high definition resulting in improved fine detail, increased texture, and an almost photographic emulsion of smoothness of the image. New 4K ultrahigh-definition technology might remove the current need for the use of polarized glasses. New devices for laparoscopy include advanced sealing devices, instruments with six degrees of freedom, ergonomic platforms with armrests and a chest support, and camera holders. A manually manipulated robot-like device is still at the experimental stage. Robot-assisted surgery has substantially revolutionized laparoscopy, increasing its distribution; however, robot-assisted surgery is associated with considerable costs. All technical improvements of laparoscopic surgery are extremely valuable to further simplify the use of classical laparoscopy.
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Tanaka R, Gitelis M, Meiselman D, Abar B, Zapf M, Carbray J, Vigneswaran Y, Zhao JC, Ujiki M. Evaluation of Vessel Sealing Performance Among Ultrasonic Devices in a Porcine Model. Surg Innov 2015; 22:338-43. [PMID: 25851145 DOI: 10.1177/1553350615579730] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As new technologies emerge, it is imperative to define which new devices are most likely to provide a reproducible, effective result for the patient and surgeon. The purpose of our study was to analyze 3 commercially available ultrasonic energy devices; the Sonicision (SC), the Harmonic ACE (HA), and the THUNDERBEAT (TB). MATERIAL AND METHODS Eight female Yorkshire pigs were used for data collection and vessel harvest. Three devices were evaluated and compared with each other with respect to seal failure and cutting speed in vivo. After vessel harvest, one end of the fragment was sent for histological evaluation, and the other was used for burst pressure measurement testing in a blinded fashion. The coagulation and cut levels of all the generators were set up at a similar and constant level. RESULTS Eighty-four vessels (47 arteries and 37 veins) were tested. Mean vessel diameter was equal among the groups. Cutting speed was significantly faster with TB (3.4 ± 0.7 seconds) than SC or HA (5.8 ± 2.4 and 6.1 ± 3.1 seconds; P < .0001). Burst pressure trended higher after ligation with TB (505.4 ± 349.4 mm Hg) than SC and HA (435.8 ± 403.0 and 437.6 ± 291.3 mm Hg). There were 2 seal failures in the SC group and HA group and none in the TB group. Histologically, the perpendicular width of tissue seal with TB (1.250 ± 0.55 mm) was significantly longer than that of the SC and the HA (0.772 ± 0.23 and 0.686 ± 0.23 mm; P < .0001). CONCLUSIONS TB has proven to provide the most rapid and reliable seal. Therefore, TB may be safer and may decrease time during surgical procedures.
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Affiliation(s)
- Ryota Tanaka
- NorthShore University HealthSystem, Evanston, IL, USA University of Chicago Pritzker School of Medicine, Chicago, IL, USA Kyorin University School of Medicine, Tokyo, Japan
| | - Matthew Gitelis
- NorthShore University HealthSystem, Evanston, IL, USA University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Danny Meiselman
- NorthShore University HealthSystem, Evanston, IL, USA University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Bijan Abar
- NorthShore University HealthSystem, Evanston, IL, USA University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Matthew Zapf
- NorthShore University HealthSystem, Evanston, IL, USA University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - JoAnn Carbray
- NorthShore University HealthSystem, Evanston, IL, USA University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Yalini Vigneswaran
- NorthShore University HealthSystem, Evanston, IL, USA University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Jin-Cheng Zhao
- NorthShore University HealthSystem, Evanston, IL, USA University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Michael Ujiki
- NorthShore University HealthSystem, Evanston, IL, USA University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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Pandey D, Yen CF, Lee CL, Wu MP. Electrosurgical technology: Quintessence of the laparoscopic armamentarium. Gynecol Minim Invasive Ther 2014. [DOI: 10.1016/j.gmit.2014.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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