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Weber TC, Jewell M, Schulman CI, Morgan J, Lee AM, Olivier AK, Swanson EA. Minimally Invasive Beaded Electrosurgical Dissectors, Basic Science, and Pilot Studies. Aesthet Surg J Open Forum 2024; 6:ojae034. [PMID: 38938927 PMCID: PMC11210070 DOI: 10.1093/asjof/ojae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Background Minimally invasive beaded electrosurgical dissectors ("BEED devices") provide simultaneous sharp dissection, blunt dissection, and electrosurgical coagulation while performing 100 cm2 porcine tissue plane dissections in 0.8 to 3 min with minimal bleeding and no perforations. Objectives The aim of the study was to report the basic science and potential clinical applications and to video document the speed and quality of planar dissections in in vivo and ex vivo porcine models with thermal damage quantified by thermal and histopathologic measurements. Additionally, in vivo porcine specimens were followed for 90 days to show whether adverse events occurred on a gross or macroscopic basis, as evidenced by photography, videography, physical examination, and dual ultrasonography. Methods Ex vivo porcine models were subjected to 20, 30, and 50 W in single-stroke passages with BEED dissectors (granted FDA 510(k) clearance (K233002)) with multichannel thermocouple, 3 s delay recordation combined with matching hematoxylin and eosin (H&E) histopathology. In vivo porcine models were subjected to eight 10 × 10 cm dissections in each of 2 subjects at 20, 30, and 50 W and evaluated periodically until 90 days, wherein histopathology for H&E, collagen, and elastin was taken plus standard and Doppler ultrasounds prior to euthanasia. Results Five to 8 mm width dissectors were passed at 1 to 2 cm/s in ex vivo models (1-10 cm/s in vivo models) with an average temperature rise of 5°C at 50 W. Clinically evidenced seromas occurred in the undressed, unprotected wounds, and resolved well prior to 90 days, as documented by ultrasounds and histopathology. Conclusions In vivo and ex vivo models demonstrated thermal values that were below levels known to damage subcutaneous adipose tissue or skin. Tissue histopathology confirmed healing parameters while Doppler ultrasound demonstrated normal blood flow in posttreatment tissues. Level of Evidence 4
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Affiliation(s)
- Taiyo C Weber
- Corresponding Author: Mr Taiyo C. Weber, Otago Medical School, PO Box 56, Dunedin 9054, New Zealand. E-mail:
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Garg P, Lykins A, Alomari M, Reynolds JP, Johnson E, Sareyyupoglu B. PlasmaBlade-assisted surgical septal myectomy: technique and our experience. Front Cardiovasc Med 2024; 11:1345540. [PMID: 38357514 PMCID: PMC10864591 DOI: 10.3389/fcvm.2024.1345540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
Background The pulsed-electron avalanche knife (PEAK) PlasmaBlade provides an atraumatic, scalpel-like cutting precision and electrocautery-like hemostasis. PlasmaBlade operates near body temperature, and its long, thin, and malleable tip can overcome the limitations of a surgical knife. In this study, we aimed to evaluate our clinical experience and histopathological outcomes of septal myectomy using PlasmaBlade. Methods Electronic medical records were reviewed for preoperative, operative, and follow-up data of the patients who underwent septal myectomy using PEAK PlasmaBlade at our institute between January 2019 and December 2022. Histopathology of the myectomy specimens was reviewed for the depth of muscle necrosis and compared with the left atrial appendage (LAA) specimen. Results Twenty-nine patients underwent septal myectomy using the PEAK PlasmaBlade. No mortality was reported. The mean age was 60.6 ± 12.5 years, and 58.6% of patients were male. Peak left ventricular outflow tract (LVOT) gradients were 40.5 ± 34.9 mmHg at rest and 56.5 ± 34.9 mmHg after provocation. Concomitant procedures performed were LAA ligation in 20 (69.0%), aortic valve replacement in 5 (17.2%), and coronary artery bypass grafting in 3 (10.3%) patients. Postoperative complications were complete heart block in one (3.4%) and ventricular septal defect in two (6.9%) patients. Both the ventricular septal defects were identified intraoperatively and repaired. Histopathology of myectomy specimens demonstrated cautery artifact limited to <50 µm depth compared to >1,000 µm with conventional electrocautery. At a mean follow-up of 8.4 ± 10.3 months, the mean LVOT gradient was 4.4 ± 5.8 mmHg at rest and 9.5 ± 3.3 mmHg after provocation. All patients were alive and in New York Heart Association class I/II. No patient developed complications or required reintervention or reoperation. Conclusion Adequate septal myectomy can be precisely and safely performed using the PEAK PlasmaBlade with minimal collateral damage.
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Affiliation(s)
- Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Amy Lykins
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Mohammad Alomari
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Jordan P. Reynolds
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, United States
| | - Elizabeth Johnson
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, United States
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Alomari M, Garg P, Wadiwala I, Pham SM, Sareyyupoglu B. Septal myectomy for hypertrophic obstructive cardiomyopathy using a pulsed radiofrequency energy soft tissue dissection instrument. JTCVS Tech 2023; 22:220-222. [PMID: 38152217 PMCID: PMC10750430 DOI: 10.1016/j.xjtc.2023.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Mohammad Alomari
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla
| | - Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla
| | - Ishaq Wadiwala
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla
| | - Si M. Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla
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Sala L, Bonomi S, Fabbri A, Ciniselli CM, Bardelli A, Verderio P, Pruneri G, Cortinovis U. Use of PEAK PlasmaBlade in implant-based breast reconstruction and radiotherapy: new strategy to reduce complications. TUMORI JOURNAL 2023; 109:86-96. [PMID: 34719290 DOI: 10.1177/03008916211056072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Implant-based breast reconstruction in the setting of radiotherapy often leads to higher complications rates (mainly capsular contracture and wound dehiscence) and poor cosmetic outcomes. We hypothesized that the combination of pulsed-electron avalanche knife (PEAK) PlasmaBlade (a pulsed radiofrequency electrosurgery) and acellular dermal matrix Veritas® in postmastectomy radiotherapy implant-based breast reconstruction could result in lower complications rate, better reconstructive results, and patient satisfaction. METHODS A prospective observational study focused on the use of PEAK PlasmaBlade in implant-based breast reconstruction and radiotherapy was carried out in the Plastic Reconstructive Surgery Unit at Fondazione IRCCS Istituto Nazionale Tumori Milano between December 2017 and 2019 (2017-2018: enrollment; 2018-2019: follow-up). Patient demographics were queried and complication rates and patient and surgeon satisfaction were assessed. RESULTS A total of 88 patients were enrolled; 2 patients received bilateral reconstruction, leading to a total of 90 procedures. Sixty-two women received contralateral symmetrization. Seroma was the most frequent minor complication (8.8%); implant exposure was the most recorded among major complications (5.5%). Preoperative lipofilling was the most substantial protective factor for preventing complications (p < 0.001). A significant association between capsular thermal damage thickness and the type of electrosurgery used (traditional electrosurgery vs PEAK PlasmaBlade) was observed, with lower values with PEAK PlasmaBlade (p < 0.0001). CONCLUSIONS Our protocol results in low rates of surgical complications and a high level of patient and surgeon satisfaction although longer follow-up is needed.
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Affiliation(s)
- Laura Sala
- Plastic and Reconstructive Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Stefano Bonomi
- Plastic and Reconstructive Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessandra Fabbri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milano University of Milan, School of Medicine, Milano, Italy
| | - Chiara Maura Ciniselli
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Annalisa Bardelli
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Paolo Verderio
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Giancarlo Pruneri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milano University of Milan, School of Medicine, Milano, Italy
| | - Umberto Cortinovis
- Plastic and Reconstructive Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Shiver AL, Webber C, Sliker T, Rushford P, Shaw A. Bigger Is Not Always Better: Effects of Electrocautery Setting on Tissue Injury in a Porcine Model. Cureus 2022; 14:e26841. [PMID: 35974853 PMCID: PMC9375435 DOI: 10.7759/cureus.26841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Electrosurgery for dissection and hemostasis remains one of the foundational tools for the field of surgery as a whole. Monopolar cautery remains the most utilized modality for achieving the aforementioned goals. Given the prolonged history and pre-modern development of "Bovie" cautery, there remains a paucity of data regarding appropriate settings and intensity for various tissue types, procedures, or locales. As a result, utilized settings depend on precedent and personal preference. We aimed to determine the amount of secondary soft tissue injury by volume and depth beyond the electrocautery pen tip in the skin and subcutaneous tissue as well as skeletal muscle. Methods Porcine samples were used for experimental testing using two testing types: 1) skin and subcutaneous tissue and 2) Skeletal muscle. Sample sizes were standardized at 1 cm3 cubes. For skin samples, tissue injury was created with either a scalpel or electrocautery pen on cut setting, and tested at intensities from 10 to 150 in increments of 10. Skeletal muscle samples were similarly tested using the electrocautery pen only in either a cut or coagulation setting. Samples were tested at incremental intensities from 10 to 120 for both settings. Electrocautery was tested for a period of five seconds with a continuous current. All samples were placed in formalin and underwent histologic staining with hematoxylin and eosin staining to be assessed for the extent of tissue injury in terms of depth, radius, and volume. The measurements were recorded in millimeters. Results For skin incision, there was a positive and significant correlation with respect to the radius (R=.73, p=0.006). When considering intensity with an interval of 10-70 there was a positive and significant correlation with respect to the radius, depth, and volume. The cold knife incision had no notable soft tissue injury beyond the depth of the incision. Regarding skeletal muscle, again, a significant and positive correlation between increasing monopolar settings was noted for both the coagulation and cut functions (R=.84, p=.0005; R=0.84, p=0.0006). A positive correlation was found between increasing cut intensity and volume of soft tissue injury (R=0.73, p=.008); this was not reflected in the coagulation setting. When limited to an intensity range of 10-60, a significant relationship was noted for depth, radius and volume (R=.95, p= <0.001; R=0.98, p= <.001; R=.92, p=.001). Conclusion In all samples, apart from the cold knife skin incision, additional soft tissue injury beyond the tip of the electrocautery pen was noted. Given our findings, recommendations include using the lowest setting required for the purposes of the given surgical case as well as minimizing electrocautery use for skin incisions given its association with a larger volume of tissue injury in comparison with a scalpel. Additionally, electrocautery should be used with care in, and around neurovascular structures as soft tissue injury did occur several millimeters beyond the tip of the electrocautery pen. Further study is needed to see if these patterns are similar in living animals as well as human tissue and whether they bear any clinical impact on surgical wound healing or other surgical complications.
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Robertson MJ, Lee RC, Bergin PF, Graves ML, Russell GV. Complications of Morbid Obesity in the Treatment of Acetabular Fractures: Re-evaluating Outcomes a Decade Later. J Orthop Trauma 2022; 36:87-92. [PMID: 34620777 DOI: 10.1097/bot.0000000000002199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the rate of perioperative complications between morbidly obese (body mass index greater than 40 kg/m2) and nonmorbidly obese patients undergoing operative treatment of acetabular fractures across 2 periods (2000-2005 and 2012-2019). DESIGN Retrospective, case-control study. SETTING Level I academic trauma center. PATIENTS Four hundred thirty-five consecutive patients from 2000 to 2005 and 216 consecutive patients from 2012 to 2019 with acetabular fractures treated by a single surgeon. INTERVENTION Operative fixation of acetabular fracture. MAIN OUTCOME MEASUREMENTS Outcome variables include positioning time, operative time, estimated blood loss, hospital stay, wound complications, and perioperative complications. RESULTS Twenty-eight morbidly obese and 188 nonmorbidly obese patients from 2012 to 2019, as well as 41 morbidly obese patients and 394 nonmorbidly obese patients from 2000 to 2005 were included in the study. The relative risk (RR) of wound complications between 2012 and 2019 groups was significantly higher for morbidly obese patients (RR = 5.31, P = 0.009) but has decreased significantly for morbidly obese patients between 2000-2005 and 2012-2019 (RR = 0.31, P = 0.017). The rate of total perioperative complications was similar between morbidly obese and nonmorbidly obese groups from 2012 to 2019 (21% vs. 8%, P = 0.230). For morbidly obese patients, the rate of total perioperative complications decreased significantly between 2000-2005 and 2012-2019 (63% vs. 21% P = 0.010). CONCLUSION Acetabular fracture surgery can be safely performed in morbidly obese patients. Although obesity remains a significant risk factor for wound complications, the risk for morbidly obese patients has decreased significantly since our initial investigation because of adaptations to surgical techniques and surgeon's experience. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Michael J Robertson
- Department of Orthopedics, University of Mississippi Medical Center, Jackson, MS
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Friebel TR, Narayan N, Ramakrishnan V, Morgan M, Cellek S, Griffiths M. Comparison of PEAK PlasmaBlade™ to conventional diathermy in abdominal-based free-flap breast reconstruction surgery-A single-centre double-blinded randomised controlled trial. J Plast Reconstr Aesthet Surg 2020; 74:1731-1742. [PMID: 33422499 DOI: 10.1016/j.bjps.2020.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/08/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Electrosurgery makes dissection with simultaneous haemostasis possible. The produced heat can cause injury to the surrounding tissue. The PEAK PlasmaBlade™(PPB) is a new electrosurgery device which may overcome this by having the ability to operate on a lower temperature, therefore reducing collateral thermal damage. METHOD A single-centre, double-blinded, randomised controlled trial (RCT) was conducted which included 108 abdominal-based free-flap breast reconstruction patients who had their flap raise performed using either the PPB (n = 56) or the conventional diathermy (n = 52). Data were collected during their in-patient stay and out-patient appointments. The primary outcome value was the number of days the abdominal drains were required. RESULTS Baseline characteristics were similar between the groups, except a significantly lower flap weight in the PPB group. The median number of days the drains were required did not differ significantly (p = 0.48; 6.0 days for the diathermy and 5.0 days for the PPB). The total drain output (p = 0.68), the inflammatory cytokine in the drain fluid (p>0.054) and complications (p>0.24) did not differ significantly between the two groups. At the 2-week follow-up appointment, there was a trend towards less abdominal seromas on abdominal ultrasound (p = 0.09) in the PPB group which were significantly smaller (p = 0.04). CONCLUSION The use of the PPB did not result in a significant reduction of drain requirement, total drain output or inflammatory cytokines but did reduce the size of seroma collections at the 2-week follow-up appointment. Therefore, the use of the PPB device could reduce early seroma formation after drain removal.
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Affiliation(s)
- T R Friebel
- St. Andrews Centre for Plastics and Burns, Court Road, Broomfield, Chelmsford CM17ET, United-Kingdom; Anglia Ruskin University, Bishop Hall Ln, Chelmsford CM11SQ, United Kingdom.
| | - N Narayan
- St. Andrews Centre for Plastics and Burns, Court Road, Broomfield, Chelmsford CM17ET, United-Kingdom
| | - V Ramakrishnan
- St. Andrews Centre for Plastics and Burns, Court Road, Broomfield, Chelmsford CM17ET, United-Kingdom
| | - M Morgan
- St. Andrews Centre for Plastics and Burns, Court Road, Broomfield, Chelmsford CM17ET, United-Kingdom
| | - S Cellek
- Anglia Ruskin University, Bishop Hall Ln, Chelmsford CM11SQ, United Kingdom
| | - M Griffiths
- St. Andrews Centre for Plastics and Burns, Court Road, Broomfield, Chelmsford CM17ET, United-Kingdom
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8
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Schlosshauer T, Kiehlmann M, Riener MO, Rothenberger J, Sader R, Rieger UM. Effect of low-thermal dissection device versus conventional electrocautery in mastectomy for female-to-male transgender patients. Int Wound J 2020; 17:1239-1245. [PMID: 32368860 DOI: 10.1111/iwj.13382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022] Open
Abstract
Subcutaneous mastectomy, the first step in sexual reassignment surgery of female-to-male transsexuals, is associated with high rates of complication and revision surgery. Also, conventional electrosurgery and the associated thermal tissue damage may compromise outcome. This retrospective randomised clinical study evaluated the effect of low-thermal plasma dissection device (PEAK PlasmaBlade, Medtronic, Minneapolis, Minnesota) in comparison with conventional electrosurgery. A total of 17 female-to-male transsexuals undergoing mastectomy were randomised to PEAK PlasmaBlade on one breast side and to monopolar electrosurgery on the other side of the same patient. Wounds of 17 patients were examined histologically for acute thermal injury. Significantly less total volume of drain output (58.8 ± 37.4 mL vs 98.5 ± 76.4 mL; P = .012) was found on the PEAK PlasmaBlade side compared with the electrosurgery side. Duration of drain was significantly shorter on the PEAK PlasmaBlade side (2.5 ± 0.7 days vs 3.2 ± 0.6 days; P = .010). Furthermore, the PEAK PlasmaBlade side showed fewer thermal damages (41.2% vs 82.4%; P = .039) and thermal injury depth from PEAK PlasmaBlade side was less (3170 vs 4060 μm). PEAK PlasmaBlade appears to be superior to monopolar electrosurgery for mastectomy in female-to-male transsexuals, because it demonstrated less thermal tissue damage, less total volume of drain output, and shorter duration of drain, resulting in faster wound healing.
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Affiliation(s)
- Torsten Schlosshauer
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Frankfurt, Germany.,Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Ev. Hospital, Giessen, Germany
| | - Marcus Kiehlmann
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Frankfurt, Germany
| | - Marc-Oliver Riener
- OptiPath, Institute of Pathology, Frankfurt, Germany.,Institute of Pathology, University Hospital Erlangen, Nuremberg, Germany
| | - Jens Rothenberger
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Frankfurt, Germany
| | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrich M Rieger
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Frankfurt, Germany
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Schlosshauer T, Kiehlmann M, Riener MO, Sader R, Rieger UM. Comparative analysis on the effect of low-thermal plasma dissection device (PEAK PlasmaBlade) vs conventional electrosurgery in post-bariatric abdominoplasty: A retrospective randomised clinical study. Int Wound J 2019; 16:1494-1502. [PMID: 31531963 DOI: 10.1111/iwj.13221] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/23/2019] [Indexed: 11/30/2022] Open
Abstract
Post-bariatric patients undergoing abdominoplasty have a relatively high risk of complications due to residual obesity and major comorbidities. Also, conventional electrosurgery and the associated thermal tissue damage may compromise outcomes. This retrospective randomised clinical study evaluated the effect of low-thermal plasma dissection device (PEAK [pulsed electron avalanche knife] PlasmaBlade) in comparison with conventional electrosurgery. A total of 52 post-bariatric patients undergoing abdominoplasty were randomised to PEAK PlasmaBlade (n = 26) and to monopolar electrosurgery (n = 26). Wounds of 20 patients per group were examined histologically for acute thermal injury depth. In PEAK PlasmaBlade incisions, acute thermal damage was significantly reduced compared with standard of care (40% vs 75%; P = .035). Also, acute thermal injury depth from PEAK PlasmaBlade was less than that from electrosurgery (2780 μm vs 4090 μm). Significantly less total complication rate (30.8% vs 69.2%; P = .012) was found by PEAK PlasmaBlade compared with electrosurgery. Moreover, the PEAK PlasmaBlade showed less than half as many wound healing problems (19.2% vs 46.2%; P = .075), far fewer secondary bleeding (7.7% vs 30.8%; P = .075), and no seroma compared with four seroma with the standard of care (0% vs 15.4%; P = .11). PEAK PlasmaBlade appears to be superior to traditional monopolar electrosurgery for post-bariatric abdominoplasty, because it demonstrated significantly less tissue damage, less total complication rate, and fewer postoperative seroma resulting in faster wound healing.
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Affiliation(s)
- Torsten Schlosshauer
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Frankfurt am Main, Germany
| | - Marcus Kiehlmann
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Frankfurt am Main, Germany
| | - Marc-Oliver Riener
- OptiPath, Institute of Pathology, Frankfurt am Main, Germany.,Institute of Pathology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrich M Rieger
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Frankfurt am Main, Germany
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Schlosshauer T, Kiehlmann M, Ramirez P, Riener M, Djedovic G, Rieger UM. Comparative analysis on the effect of low-thermal plasma dissection device (PEAK PlasmaBlade) versus conventional electro surgery in post-bariatric body-contouring procedures: A retrospective randomised clinical study. Int Wound J 2019; 16:932-939. [PMID: 30938101 PMCID: PMC7949418 DOI: 10.1111/iwj.13124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/15/2019] [Accepted: 03/15/2019] [Indexed: 11/28/2022] Open
Abstract
Postoperative wound-healing problems are relatively high in post-bariatric body-contouring procedures, partly because of electrosurgery and the associated thermal tissue damage. This study is a retrospective randomised evaluation of the effect of a low-thermal plasma dissection device (PEAK PlasmaBlade, Medtronic, Minneapolis, Minnesota) in comparison with conventional electrosurgery. A total of 24 patients undergoing upper arm or medial thigh lifting were randomised to PEAK PlasmaBlade on one side and to monopolar electrosurgery on the other side of the same patient. Wounds of 10 patients were examined histologically for acute thermal injury depth. Significantly lower total volume of drain output (61,1 ± 70,2 mL versus 95,1 ± 176,0 mL; P = .04) was found on the PEAK PlasmaBlade side compared with the electrosurgery side. Furthermore, the PEAK PlasmaBlade side showed fewer seromas (no case of seroma versus three seromas in the electrosurgery group) and less thermal damage (40% versus 70%; P = .26). Acute thermal injury depth from the PEAK PlasmaBlade was less than from monopolar electrosurgery (425 ± 171 μm versus 686 ± 1037 μm; P = .631). PEAK PlasmaBlade appears to be superior to traditional monopolar electrosurgery for post-bariatric body-contouring procedures because it demonstrated less tissue damage, lower total volume of drain output, and fewer postoperative seromas resulting in faster wound healing.
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Affiliation(s)
- Torsten Schlosshauer
- Department of Plastic and AestheticReconstructive and Hand Surgery at AGAPLESION Markus HospitalFrankfurt am MainGermany
| | - Marcus Kiehlmann
- Department of Plastic and AestheticReconstructive and Hand Surgery at AGAPLESION Markus HospitalFrankfurt am MainGermany
| | - Pablo Ramirez
- Department of Plastic and AestheticReconstructive and Hand Surgery at AGAPLESION Markus HospitalFrankfurt am MainGermany
| | | | - Gabriel Djedovic
- Department of Plastic and AestheticReconstructive and Hand Surgery at AGAPLESION Markus HospitalFrankfurt am MainGermany
| | - Ulrich M. Rieger
- Department of Plastic and AestheticReconstructive and Hand Surgery at AGAPLESION Markus HospitalFrankfurt am MainGermany
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Zientara A, Komminoth P, Seifert B, Odavic D, Dzemali O, Häussler A, Genoni M. Skeletonized internal thoracic artery harvesting: a low thermal damage electrosurgical device provides improved endothelial layer and tendency to better integrity of the vessel wall compared to conventional electrosurgery. J Cardiothorac Surg 2018; 13:105. [PMID: 30305183 PMCID: PMC6180394 DOI: 10.1186/s13019-018-0797-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/27/2018] [Indexed: 11/17/2022] Open
Abstract
Background Electrosurgery is fundamental to the precise, fast and bloodless preparation of internal thoracic artery grafts in cardiac surgery. The PEAK PlasmaBlade is a monopolar electrosurgical device that uses pulsed radiofrequency energy to generate a plasma-mediated discharge along an insulated electrode, creating a cutting edge while the blade stays near body temperature. The aim of this study is to compare the histological samples, cardiac computed-tomography of graft patency, and clinical outcomes of patients after off-pump coronary artery bypass grafting with preparation of the internal thoracic arteries by a conventional electrosurgical device and the PlasmaBlade. Methods In twenty subjects one internal thoracic artery was prepared with PlasmaBlade and the other artery with a conventional electrosurgical device. Histological samples were evaluated for three factors for potential graft failure: endothelial damage, integrity of the vessel wall and adventitial hemorrhage. Five samples per artery were evaluated by a novel scoring method based on the exposed circumference of the histological sample (“0”: 0%, “1”: 1–25%, “2”: 26–50%, “3”: 51–75%, “4”: ≥76% of the circumference). The Wilcoxon signed ranks test for mean scores within subjects was performed. Six-month-follow up by cardiac computed tomography for evaluation of graft patency was completed in 16 patients. Results Histological results demonstrated significantly less endothelial damage after PlasmaBlade (83% vs 60%, absolute: 75/90 vs. 53/89 samples with score “0–1”, p = 0.04). PlasmaBlade samples demonstrated a tendency to better wall integrity (72% vs. 54%, absolute: 64/89 vs. 47/87 samples with score “0–1”, p = 0.32). There were no differences in endothelial bleeding (PlasmaBlade 46% vs. electrosurgery 53%, absolute: 41/88 vs. 48/90 samples with score “0–1”, p = 0.63). Computed tomography confirmed non-inferiority of the PlasmaBlade to conventional electrosurgery with a patency rate of 94%. Conclusion Histologically, internal thoracic arteries harvested with PlasmaBlade demonstrate a more intact endothelial layer and a tendency to better wall integrity. Computed tomography of graft patency speaks for non-inferiority to conventional electrosurgery. PlasmaBlade may be preferable to conventional electrosurgery, if further follow-up confirms patency of internal thoracic arteries. Trial registration NCT03510026, registered 4th April 2018 (retrospectively registered).
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Affiliation(s)
- Alicja Zientara
- Department of Cardiac Surgery, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zurich, Switzerland.
| | - Paul Komminoth
- Department of Pathology, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zurich, Switzerland
| | - Burkhardt Seifert
- Department of Cardiac Surgery, University Hospital Zurich, Rämistrasse 100, 8001, Zurich, Switzerland
| | - Dragan Odavic
- Department of Cardiac Surgery, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zurich, Switzerland
| | - Achim Häussler
- Department of Cardiac Surgery, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zurich, Switzerland
| | - Michele Genoni
- Department of Cardiac Surgery, University Hospital Zurich, Rämistrasse 100, 8001, Zurich, Switzerland
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12
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Radcliff K, Vijay P, Sarris RF, Speltz M, Vose JG. Preclinical Comparison of Thermal Tissue Effects from Traditional Electrosurgery and a Low-Temperature Electrosurgical Device during Anterior Cervical Discectomy and Fusion. Int J Spine Surg 2018; 12:483-489. [PMID: 30276109 DOI: 10.14444/5059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Exposure of the anterior cervical spine requires dissection in proximity to critical neurovascular structures. Monopolar electrosurgical (ES) devices generate heat in contacted tissues, resulting in thermal damage and temperature change. This study examined depth of thermal injury and temperature change associated with use of a low-temperature electrosurgical device (LTD) compared to traditional electrosurgery during a cadaveric anterior cervical discectomy and fusion (ACDF) dissection. Methods ACDF was performed, using ES or LTD, on cervical spines (C3-4 and C4-5) from 2 fresh human cadavers with intact neck soft tissues and no history of surgery. Cadavers were maintained at 22-23°C, and fiber-optic temperature sensors (Neoptix, Québec City, Québec, Canada) were placed near relevant structures to measure changes during dissection. Depth of thermal injury was assessed by hematoxylin and eosin and Masson's trichrome histology of fixed tissue specimens. Results Use of the LTD resulted in a statistically significant reduction in temperature change at platysma (3.0 ± 1.04 vs. 11.41 ± 3.10°C, P = .003), carotid sheath (7.32 ± 1.13 vs. 15.57 ± 2.56°C, P = .007), and longus colli (6.11 ± 1.32 vs. 12.9 ± 3.62°C, P = .016) compared to ES. Temperature change at the trachea was similar between groups (6.06 ± 1.99 vs. 4.96 ± 1.89°C, P = .528). Histology showed that LTD produced less mean and maximal depth of thermal injury compared to ES (mean: 0.5 vs. 1.2 mm; max: 0.9 vs. 1.8 mm; P < .05). Conclusions The results of this pilot study demonstrate that anterior cervical spine exposure using an LTD reduces tissue temperature change and depth of thermal injury compared to ES. Clinical Relevance Although exploratory, these results suggest that use of an LTD during ACDF may reduce the extent of thermal tissue injury during dissection. Future studies in live animal models are warranted to determine if thermal injury is a potential cause of common exposure-related complications, such as dysphagia and dysphonia.
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Affiliation(s)
- Kris Radcliff
- Departments of Orthopedic Surgery and Neurological Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Ruba F Sarris
- Medtronic Advanced Energy LLC, Portsmouth, New Hampshire
| | - Molly Speltz
- Medtronic Physiologic Research Laboratories, Coon Rapids, Minnesota
| | - Joshua G Vose
- Medtronic Advanced Energy LLC, Portsmouth, New Hampshire
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13
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Chiappa C, Fachinetti A, Boeri C, Arlant V, Rausei S, Dionigi G, Rovera F. Wound healing and postsurgical complications in breast cancer surgery: a comparison between PEAK PlasmaBlade and conventional electrosurgery - a preliminary report of a case series. Ann Surg Treat Res 2018; 95:129-134. [PMID: 30182018 PMCID: PMC6121169 DOI: 10.4174/astr.2018.95.3.129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/08/2017] [Accepted: 10/23/2017] [Indexed: 12/01/2022] Open
Abstract
Purpose PEAK PlasmaBlade is a recent and distinctive type of electrosurgical device. Previous studies have already documented some meaningful advantages of this device over conventional electrosurgery. This study compared the use of PEAK PlasmaBlade to standard electrosurgery in mastectomy and breast conservative surgery. The purpose was to test the impact of PEAK PlasmaBlade on the wound-healing process and on postsurgical complications in breast cancer surgery. Methods Sixty patients undergoing breast cancer surgery were enrolled. The PEAK PlasmaBlade was used for 20 of those. A standard electrosurgical device was used for the other 40 patients. The 2 groups were homogenous in age, body mass index, comorbidities and type of surgery. We recorded wound complications, serum drainage amount and duration of stay, blood loss, time of surgery, length of hospital stay, and total number of medications required. Results The 2 groups were not significantly different in terms of patient characteristics. A statistically significant reduction in incidence of seroma was observed in the PEAK group: only 10% versus 37.5% of the patients in the conventional electrosurgery group developed this complication (Fisher exact test, P = 0.034). Conclusion Seroma is the most important wound complication in breast surgery. The research of new instruments that might reduce its incidence is desirable. In order to validate or deny the results of this study, it is necessary to enroll more subjects and to consider the impact of this device on axillary lymph node dissection.
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Affiliation(s)
- Corrado Chiappa
- First Division of Surgery - Senology Research Center, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Anna Fachinetti
- First Division of Surgery - Senology Research Center, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Carlo Boeri
- First Division of Surgery - Senology Research Center, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Veronica Arlant
- First Division of Surgery - Senology Research Center, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Stefano Rausei
- First Division of Surgery - Senology Research Center, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Gianlorenzo Dionigi
- Department of Human Pathology in Adulthood and Childhood "G. Barresi" University Hospital - Policlinico "G. Martino" - The University of Messina, Messina, Italy
| | - Francesca Rovera
- First Division of Surgery - Senology Research Center, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
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Marangi GF, Pallara T, Lamberti D, Perrella E, Serra R, Stilo F, De Caridi G, Onetti Muda A, Persichetti P. An electrical plasma dissection tool for surgical treatment of chronic ulcers: Results of a prospective randomised trial. Int Wound J 2018; 15:717-721. [PMID: 29600828 DOI: 10.1111/iwj.12915] [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] [Received: 01/18/2018] [Revised: 02/08/2018] [Accepted: 02/12/2018] [Indexed: 12/01/2022] Open
Abstract
Cutaneous ulceration is a difficult medical problem and a major source of morbidity for patients. In the surgical treatment of ulcers, debridement is the first step, and it can be carried out using several surgical tools. Recently, new surgical devices have emerged using plasma-mediated electrical discharges with a lower peak temperature. A prospective single-blind trial was conducted on chronic ulcers not responsive to common non-surgical management. Patients were randomly separated into 2 groups: Group A received surgical debridement with conventional electrocautery, and Group B received surgical debridement using the plasma-mediated device. Histological samples were collected intraoperatively to evaluate the thermal damage during the surgical procedure and 2 weeks after surgery to evaluate the inflammatory response and collagen deposition. The width of coagulation necrosis at the incision margins in Group B was significantly shorter compared with Group A (P = .001). The inflammatory cell infiltration showed a cellular distribution percentage that was quite equal between the 2 groups. The granulation tissue showed an abundant deposition of dense and mature collagen in Group B, compared with Group A, where the mature collagen appeared in small quantities (P < .001). Microbial culture showed a lower incidence of postoperative infections in Group B compared with the control group (P < .05). The study demonstrated, based on the results, that the new technology with the use of a lower temperature electrosurgical device represents an effective therapeutic weapon for the surgical treatment of skin ulcers, both vascular and extravascular types.
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Affiliation(s)
- Giovanni F Marangi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
| | - Tiziano Pallara
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
| | - Daniela Lamberti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
| | - Eleonora Perrella
- Department of Pathology, Campus Bio-Medico of Rome University, Rome, Italy
| | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Francesco Stilo
- Vascular Surgery Unit, Campus Bio-Medico of Rome University, Rome, Italy
| | | | - Andrea Onetti Muda
- Department of Pathology, Campus Bio-Medico of Rome University, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
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Wang G, Li ZB, Cao CL. Methods of hemostasis in abdominal surgery. Shijie Huaren Xiaohua Zazhi 2017; 25:2866-2872. [DOI: 10.11569/wcjd.v25.i32.2866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hemorrhage is one of the common concomitant conditions during abdominal surgeries, and it is also the main cause of non-planed secondary surgery. There are various methods for abdominal surgical hemostasis. How to adopt reasonable methods to manage intraoperative bleeding promptly and effectively has bothered surgeons for a long time. With the development of minimally invasive technology and surgical instruments, laparoscopy and more hemostasis techniques have been widely used during abdominal surgery. This article summarizes the methods of hemostasis during abdominal surgery.
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Affiliation(s)
- Gang Wang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Zong-Bei Li
- Department of General Surgery, Beijing Chuiyangliu Hospital, Beijing 100022, China
| | - Cheng-Liang Cao
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
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16
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Charoenkwan K, Iheozor‐Ejiofor Z, Rerkasem K, Matovinovic E. Scalpel versus electrosurgery for major abdominal incisions. Cochrane Database Syst Rev 2017; 6:CD005987. [PMID: 28931203 PMCID: PMC6481514 DOI: 10.1002/14651858.cd005987.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Scalpels or electrosurgery can be used to make abdominal incisions. The potential benefits of electrosurgery may include reduced blood loss, dry and rapid separation of tissue, and reduced risk of cutting injury to surgeons. Postsurgery risks possibly associated with electrosurgery may include poor wound healing and complications such as surgical site infection. OBJECTIVES To assess the effects of electrosurgery compared with scalpel for major abdominal incisions. SEARCH METHODS The first version of this review included studies published up to February 2012. In October 2016, for this first update, we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase, EBSCO CINAHL Plus, and the registry for ongoing trials (www.clinicaltrials.gov). We did not apply date or language restrictions. SELECTION CRITERIA Studies considered in this analysis were randomised controlled trials (RCTs) that compared electrosurgery to scalpel for creating abdominal incisions during major open abdominal surgery. Incisions could be any orientation (vertical, oblique, or transverse) and surgical setting (elective or emergency). Electrosurgical incisions were made through major layers of the abdominal wall, including subcutaneous tissue and the musculoaponeurosis (a sheet of connective tissue that attaches muscles), regardless of the technique used to incise the skin and peritoneum. Scalpel incisions were made through major layers of abdominal wall including skin, subcutaneous tissue, and musculoaponeurosis, regardless of the technique used to incise the abdominal peritoneum. Primary outcomes analysed were wound infection, time to wound healing, and wound dehiscence. Secondary outcomes were postoperative pain, wound incision time, wound-related blood loss, and adhesion or scar formation. DATA COLLECTION AND ANALYSIS Two review authors independently carried out study selection, data extraction, and risk of bias assessment. When necessary, we contacted trial authors for missing data. We calculated risk ratios (RR) and 95% confidence intervals (CI) for dichotomous data, and mean differences (MD) and 95% CI for continuous data. MAIN RESULTS The updated search found seven additional RCTs making a total of 16 included studies (2769 participants). All studies compared electrosurgery to scalpel and were considered in one comparison. Eleven studies, analysing 2178 participants, reported on wound infection. There was no clear difference in wound infections between electrosurgery and scalpel (7.7% for electrosurgery versus 7.4% for scalpel; RR 1.07, 95% CI 0.74 to 1.54; low-certainty evidence downgraded for risk of bias and serious imprecision). None of the included studies reported time to wound healing.It is uncertain whether electrosurgery decreases wound dehiscence compared to scalpel (2.7% for electrosurgery versus 2.4% for scalpel; RR 1.21, 95% CI 0.58 to 2.50; 1064 participants; 6 studies; very low-certainty evidence downgraded for risk of bias and very serious imprecision).There was no clinically important difference in incision time between electrosurgery and scalpel (MD -45.74 seconds, 95% CI -88.41 to -3.07; 325 participants; 4 studies; moderate-certainty evidence downgraded for serious imprecision). There was no clear difference in incision time per wound area between electrosurgery and scalpel (MD -0.58 seconds/cm2, 95% CI -1.26 to 0.09; 282 participants; 3 studies; low-certainty evidence downgraded for very serious imprecision).There was no clinically important difference in mean blood loss between electrosurgery and scalpel (MD -20.10 mL, 95% CI -28.16 to -12.05; 241 participants; 3 studies; moderate-certainty evidence downgraded for serious imprecision). Two studies reported on mean wound-related blood loss per wound area; however, we were unable to pool the studies due to considerable heterogeneity. It was uncertain whether electrosurgery decreased wound-related blood loss per wound area. We could not reach a conclusion on the effects of the two interventions on pain and appearance of scars for various reasons such as small number of studies, insufficient data, the presence of conflicting data, and different measurement methods. AUTHORS' CONCLUSIONS The certainty of evidence was moderate to very low due to risk of bias and imprecise results. Low-certainty evidence shows no clear difference in wound infection between the scalpel and electrosurgery. There is a need for more research to determine the relative effectiveness of scalpel compared with electrosurgery for major abdominal incisions.
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Affiliation(s)
- Kittipat Charoenkwan
- Faculty of Medicine, Chiang Mai UniversityDepartment of Obstetrics and Gynecology110 Intawaroros RoadChiang MaiThailand50200
| | - Zipporah Iheozor‐Ejiofor
- The University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Kittipan Rerkasem
- Chiang Mai UniversityDivision of Vascular and Endovascular Surgery, Department of Surgery, Faculty of MedicineChiang MaiThailand
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Meakin LB, Murrell JC, Doran ICP, Knowles TG, Tivers MS, Chanoit GPA. Electrosurgery reduces blood loss and immediate postoperative inflammation compared to cold instruments for midline celiotomy in dogs: A randomized controlled trial. Vet Surg 2017; 46:515-519. [PMID: 28314089 PMCID: PMC5516192 DOI: 10.1111/vsu.12641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/25/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To compare the use of an electrosurgical device with traditional cold instruments (scalpel and scissors) for midline celiotomy incision. STUDY DESIGN Prospective randomized controlled clinical trial. SAMPLE POPULATION One hundred and twenty client-owned dogs undergoing abdominal surgery. METHODS Dogs were prospectively recruited and randomized to receive electroincision or cold instrument incision. For cold incision, surgeons used basic surgical instruments including scalpel and scissors. For electroincision, surgeons only used the electrosurgical device in cutting mode. Time for the approach, blood loss, and the incision length were recorded. A blinded observer assessed pain and incision redness, swelling, and discharge at 24 and 48 hours postoperative (graded 0-3). Owner assessment of incision healing was recorded by telephone interview. RESULTS Blood loss during surgery was significantly lower for electroincision (mean 0.7, SD 1.7 mL) than cold incision (mean 3.0, SD 4.3 mL, P < .0001) with no significant difference in incision length or time for approach. Electroincision was associated with significantly less incision redness (cold median 1, range 0-3; electroincision median 0, range 0-2, P = .02) and less incision discharge (cold median 0.5 range 0-3; electroincision median 0, range 0-1, P = .006) at 24 hours postoperative. There was no significant difference in pain scores or incision healing in dogs receiving the two techniques. No incisional hernias were reported. A surgical site infection occurred in 1 dog (cold incision). CONCLUSIONS Electroincision for a celiotomy approach in the dog reduces blood loss, and incision redness and discharge in the immediate postoperative period without affecting the occurrence of wound complications such as infection and dehiscence (including linea alba).
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Affiliation(s)
- Lee B Meakin
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - Jo C Murrell
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - Ivan C P Doran
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - Toby G Knowles
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - Michael S Tivers
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - Guillaume P A Chanoit
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
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18
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Bowers CA, Burns G, Salzman K, McGill L, MacDonald JD. Comparison of ferromagnetic induction and bipolar electrosurgery and suction in corticotomies in pig cerebrum. Int J Surg 2015; 16:55-59. [PMID: 25747999 DOI: 10.1016/j.ijsu.2015.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/05/2014] [Accepted: 02/16/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The effects of newer energy-based surgical dissection and coagulation modalities on cerebral tissue have not been investigated. Several instruments have been developed to address the limitations of traditional electrosurgical instruments in the nervous system. We compared the effects of standard bipolar electrocautery and suction (BPS) with those of a new ferromagnetic induction (FMI) device in corticotomies of pig cerebral tissue as assessed by magnetic resonance imaging (MRI) and histological analysis. METHODS Three adult pigs underwent bilateral corticotomies (3 cm long×1 cm deep) using both FMI and BPS. The acute cerebral tissue edema created by each method was measured on coronal volumetric T2-weighted MRI sequences immediately after surgery. A lateral thermal "damage index" was calculated by dividing the width of the visible T2 tissue edema by the measured depth. The radiographic damage indices with each method were compared statistically. Histological analysis of each incision was conducted to compare the extent of tissue damage. RESULTS MRI showed that the mean radiographic damage index of each corticotomy was significantly lower with the FMI (0.30 ± 0.02 (0.28-0.32)) than with the BPS method (0.54 ± 0.11 (0.42-0.64)) (p = 0.02). Histological analysis suggested a correlation with the radiographic findings as the FMI tissue samples demonstrated less adjacent tissue damage than BPS. CONCLUSIONS FMI appeared to cause less adjacent tissue damage than the BPS method in pig cerebral tissue based on quantitative radiographic and qualitative histological analysis. Future studies are needed to investigate the clinical implications of energy-based surgical dissection on cerebral tissue.
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Affiliation(s)
- Christian A Bowers
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Greg Burns
- Department of Research and Pathology, Office of Comparative Medicine, University of Utah, Salt Lake City, UT, USA
| | - Karen Salzman
- Department of Radiology, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Lawrence McGill
- ARUP and Department of Veterinary Pathology, University of Utah, Salt Lake City, UT, USA
| | - Joel D MacDonald
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
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Liang X, Han-Xin Z, Chang-E J, Chao W, Juan H, Guo-Quan G. Subcutaneous Suture Can Accelerate Wound Healing of Lower Midline Incision: A Randomized Controlled Trial. Am Surg 2015. [DOI: 10.1177/000313481508100117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Poor wound healing is one of the most common complications after laparotomy, especially in lower abdominal midline incisions. The aims of this trial are to assess the value of subcutaneous suture and identify risk factors to prevent poor wound healing. From October 2010 to October 2011, a total of 180 patients were randomized to the subcutaneous suture group (n = 89) or control group (n = 91) after laparotomy with a lower midline incision. Univariate and multivariate analyses were performed to determine the predictive significance of variables of poor wound healing. Patients’ demographics, preoperative laboratory values, and operative details were comparable between the two groups. The overall rate of poor wound healing was 16.7 per cent (30 of 180). Patients randomized to subcutaneous suture group (n = 89) had poor healing in 10.1 per cent (nine of 89) and those without suture (n = 91) in 23.1 per cent (21 of 91) ( P = 0.020). Multivariate logistic regression analysis revealed that American Society of Anesthesiologists (ASA) score (3 to 4) (odds ratio [OR], 2.933), subcutaneous suture (OR, 0.323), and blood loss (greater than 200 mL) (OR, 5.995) were independent risk factors for poor wound healing. Subcutaneous suture can effectively accelerate wound healing. Nonsubcutaneous suture, ASA score (3 to 4), and blood loss (greater than 200 mL) are independent risk factors for poor would healing.
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Affiliation(s)
- Xiao Liang
- Department of Surgery and Biological Therapy, Shenzhen Second People's Hospital, the First Affiliated Hospital to Shenzhen University, Shenzhen, Guangdong, China; the
- Department of Biochemistry, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Zhou Han-Xin
- Department of Surgery and Biological Therapy, Shenzhen Second People's Hospital, the First Affiliated Hospital to Shenzhen University, Shenzhen, Guangdong, China; the
| | - Jin Chang-E
- Department of Zongheke, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; and the
| | - Wang Chao
- Department of Biochemistry, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Han Juan
- Department of Biochemistry, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Gao Guo-Quan
- Department of Biochemistry, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
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Xu L, Zhu F, Zhu Z, Liu Z, Sun X, Qiao J, Mao S, Qiu Y. Comparison of 2 methods of incision closure in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion surgery. Spine (Phila Pa 1976) 2014; 39:E481-5. [PMID: 24480945 DOI: 10.1097/brs.0000000000000223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective, randomized, and controlled clinical trial. OBJECTIVE To compare surgical zipper with subcuticular Monocryl sutures in terms of incision closure time, cosmetic results, and the complication rate in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF) surgery. SUMMARY OF BACKGROUND DATA In previous literatures, the application of surgical zipper to incision closure has been reported to be associated with a favorable outcome. However, in the PSF surgery of patients with AIS, the use of surgical zipper has not been described. METHODS Ninety female patients with AIS undergoing PSF were assigned randomly to 2 incision closure groups either using surgical zipper or using the 4-0 absorbable subcuticular suture. The incision outcome was evaluated with the Hollander Incision Evaluation Score at 7 days, 2 weeks, 6 months, and 1 year after surgery, respectively. Besides, a visual analogue scale was allocated to each patient to rate the cosmetic result of the incision. The 2 groups were compared to determine the differences in terms of incision closure time, the complication rate, and cosmetic results. RESULTS The incision closure using surgical zipper consumed significantly less time than that using subcuticular suture (45.3 vs. 540.5 s, P < 0.001). As for the cosmetic results, no significant differences of Hollander Incision Evaluation Score scores between the 2 suturing groups were found. Besides, patients' satisfaction with cosmetic outcome on a linear visual analogue scale also revealed similar results between the 2 groups. As for postoperative complications, we found 1 case of mild blister due to allergy to the tape of the dressings and 2 cases of incisional pain in the Monocryl suture group. CONCLUSION The application of surgical zipper in PSF surgery is a safe and effective method. The ease and the speed of application make surgical zipper an attractive option for incision closure in patients with AIS undergoing PSF. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Leilei Xu
- From The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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Bowers CA, Burns G, Salzman KL, McGill LD, MacDonald JD. Comparison of tissue effects in rabbit muscle of surgical dissection devices. Int J Surg 2014; 12:219-23. [DOI: 10.1016/j.ijsu.2013.12.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 09/06/2013] [Accepted: 12/19/2013] [Indexed: 12/24/2022]
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Comparison of the effects of surgical dissection devices on the rabbit liver. Surg Today 2013; 44:1116-22. [DOI: 10.1007/s00595-013-0712-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 04/21/2013] [Indexed: 10/26/2022]
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Fine RE, Vose JG. Traditional electrosurgery and a low thermal injury dissection device yield different outcomes following bilateral skin-sparing mastectomy: a case report. J Med Case Rep 2011; 5:212. [PMID: 21619665 PMCID: PMC3118368 DOI: 10.1186/1752-1947-5-212] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 05/28/2011] [Indexed: 11/26/2022] Open
Abstract
Introduction Although a skin- and nipple-sparing mastectomy technique offers distinct cosmetic and reconstructive advantages over traditional methods, partial skin flap and nipple necrosis remain a significant source of post-operative morbidity. Prior work has suggested that collateral thermal damage resulting from electrocautery use during skin flap development is a potential source of this complication. This report describes the case of a smoker with recurrent ductal carcinoma in situ (DCIS) who experienced significant unilateral skin necrosis following bilateral skin-sparing mastectomy while participating in a clinical trial examining mastectomy outcomes with two different surgical devices. This unexpected complication has implications for the choice of dissection devices in procedures requiring skin flap preservation. Case presentation The patient was a 61-year-old Caucasian woman who was a smoker with recurrent DCIS of her right breast. As part of the clinical trial, each breast was randomized to either the standard of care treatment group (a scalpel and a traditional electrosurgical device) or treatment with a novel, low thermal injury dissection device, allowing for a direct, internally controlled comparison of surgical outcomes. Post-operative follow-up at six days was unremarkable for both operative sites. At 16 days post-surgery, the patient presented with a significant wound necrosis in the mastectomy site randomized to the control study group. Following debridement and closure, this site progressively healed over 10 weeks. The contralateral mastectomy, randomized to the alternative device, healed normally. Conclusion We hypothesize that thermal damage to the subcutaneous microvasculature during flap dissection may have contributed to this complication and that the use of a low thermal injury dissection device may be advantageous in select patients undergoing skin- and nipple-sparing mastectomy.
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Affiliation(s)
- Richard E Fine
- PEAK Surgical, Inc,, 2464 Embarcadero Way, Palo Alto, CA 94303, USA.
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