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Balgobin S, Balk EM, Porter AE, Misal M, Grisales T, Meriwether KV, Jeppson PC, Doyle PJ, Aschkenazi SO, Miranne JM, Hobson DT, Howard DL, Mama S, Gupta A, Antosh DD. Enabling Technologies for Gynecologic Vaginal Surgery: A Systematic Review. Obstet Gynecol 2024; 143:524-537. [PMID: 38301255 DOI: 10.1097/aog.0000000000005522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/07/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To systematically review the literature to evaluate clinical and surgical outcomes for technologies that facilitate vaginal surgical procedures. DATA SOURCES We systematically searched MEDLINE, EMBASE, and ClinicalTrials.gov from January 1990 to May 2022. METHODS OF STUDY SELECTION Comparative and single-arm studies with data on contemporary tools or technologies facilitating intraoperative performance of vaginal gynecologic surgical procedures for benign indications were included. Citations were independently double screened, and eligible full-text articles were extracted by two reviewers. Data collected included study characteristics, technology, patient demographics, and intraoperative and postoperative outcomes. Risk of bias for comparative studies was assessed using established methods, and restricted maximum likelihood model meta-analyses were conducted as indicated. TABULATION, INTEGRATION, AND RESULTS The search yielded 8,658 abstracts, with 116 eligible studies that evaluated pedicle sealing devices (n=32), nonrobotic and robotic vaginal natural orifice transluminal endoscopic surgery (n=64), suture capture devices (n=17), loop ligatures (n=2), and table-mounted telescopic cameras (n=1). Based on 19 comparative studies, pedicle sealing devices lowered vaginal hysterectomy operative time by 15.9 minutes (95% CI, -23.3 to -85), blood loss by 36.9 mL (95% CI, -56.9 to -17.0), hospital stay by 0.2 days (95% CI, -0.4 to -0.1), and visual analog scale pain scores by 1.4 points on a subjective 10-point scale (95% CI, -1.7 to -1.1). Three nonrandomized comparative studies and 53 single-arm studies supported the feasibility of nonrobotic vaginal natural orifice transluminal endoscopic surgery for hysterectomy, adnexal surgery, pelvic reconstruction, and myomectomy. Data were limited for robotic vaginal natural orifice transluminal endoscopic surgery, suture capture devices, loop ligatures, and table-mounted cameras due to few studies or study heterogeneity. CONCLUSION Pedicle sealing devices lower operative time and blood loss for vaginal hysterectomy, with modest reductions in hospital stay and pain scores. Although other technologies identified in the literature may have potential to facilitate vaginal surgical procedures and improve outcomes, additional comparative effectiveness research is needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022327490.
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Affiliation(s)
- Sunil Balgobin
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, the Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, and the Division of Urogynecology, Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; the Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio; the Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California; the Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico; the Woman's Center for Advanced Pelvic Surgery, Phoenix, Arizona; the Departments of Obstetrics and Gynecology and Urology, School of Medicine & Dentistry, University of Rochester, Rochester, New York; the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Waukesha, Wisconsin; the Division of Urogynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; the Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan; the Department of Obstetrics, Gynecology, and Reproductive Health, Rutgers New Jersey Medical School, Newark, and the Department of Obstetrics and Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey; and the Division of Female Pelvic Medicine & Reconstructive Surgery, University of Louisville Health, Louisville, Kentucky
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Miralles M, Falcón M, Requejo L, Plana E, Medina P, Sánchez-Nevárez I, Clará A. "In Vitro" Evaluation of Energy-Based Sealing of Graft Side Branches in Bypass Surgery. World J Surg 2023; 47:2888-2896. [PMID: 37432421 DOI: 10.1007/s00268-023-07107-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Our objective was to compare the in vitro efficacy of electrothermal bipolar [EB] vessel sealing and ultrasonic harmonic scalpel [HS] versus mechanical interruption, with conventional ties or surgical clips (SC), in sealing saphenous vein (SV) collaterals, during its eventual preparation for bypass surgery. METHODS Experimental in vitro study on 30 segments of SV. Each fragment included two collaterals at least 2 mm in diameter. One of them was sealed by ligation with 3/0 silk ties (control) and the other one with EB (n = 10), HS (n = 10) or medium-6 mm SC (n = 10). After incorporation in a closed circuit with pulsatile flow, the pressure was progressively increased until causing rupture. Collateral diameter, burst pressure, leak point, and histological study were recorded. RESULTS Burst pressure was higher for SC (1320.20 ± 373.847 mmHg) as compared with EB (942.2 ± 344.9 mmHg, p = 0.065), and especially with HS (637.00 ± 320.61 mmHg, p = 0.0001). No statistically significant difference between EB and HS was found, and bursting always happened at supraphysiological pressures. The leak point for HS was always detected in the sealing zone (10/10), while for EB and SC, it occurred in the sealing zone only in 6/10(60%) and 4/10(40%), respectively (p = 0.015). CONCLUSIONS Energy delivery devices showed similar efficacy and safety in sealing of SV side branches. Although bursting pressure was lower than with tie ligature or SC, non-inferiority efficacy was shown at the range of physiological pressures in both, EB and HS. Due to their speed and easy handling, they may be useful in the preparation of the venous graft during revascularization surgery. However, remaining questions about healing process, potential spread of tissue damage and sealing durability, will require further analysis.
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Affiliation(s)
- Manuel Miralles
- Department of Vascular Surgery, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Department of Surgery, Facultad de Medicina, Universidad de Valencia (UV), Valencia, Spain
- Hemostasia, Thrombosis, Arteriosclerosis and Vascular Biology, Instituto de Investigación Sanitaria IIS La Fe, Valencia, Spain
| | - Moisés Falcón
- Department of Vascular Surgery, Hospital de Manises, Valencia, Spain.
| | - Lucía Requejo
- Department of Vascular Surgery, Hospital Universitario de La Ribera, Alzira, Valencia, Spain
| | - Emma Plana
- Hemostasia, Thrombosis, Arteriosclerosis and Vascular Biology, Instituto de Investigación Sanitaria IIS La Fe, Valencia, Spain
| | - Pilar Medina
- Hemostasia, Thrombosis, Arteriosclerosis and Vascular Biology, Instituto de Investigación Sanitaria IIS La Fe, Valencia, Spain
| | | | - Albert Clará
- Department of Vascular Surgery, Hospital Universitari del Mar, Barcelona, Spain
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Comparison of the LigaSure™ bipolar vessel sealer to monopolar electrocoagulation for thoracoscopic lobectomy and lymphadenectomy: a prospective randomized controlled trial. Surg Endosc 2023:10.1007/s00464-023-09892-0. [PMID: 36792782 DOI: 10.1007/s00464-023-09892-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/15/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND High-energy devices allow better vessel sealing compared with monopolar electrocautery and could improve the outcomes of surgical operations. The objective of the study was to compare tissue dissection by the LigaSure™ device with that by monopolar electrocoagulation for thoracoscopic lobectomy and lymphadenectomy. METHODS This pragmatic, parallel group, prospective randomized controlled trial was funded by the Medtronic External Research Program (ISR-2016-10,756) and registered at www. CLINICALTRIALS gov (NCT03125798). The study included patients aged 18 years or older, who had undergone thoracoscopic lobectomy with lymphadenectomy at the Department of Thoracic Surgery of Poznan University of Medical Sciences between May 3, 2018, and November 4, 2021. Using simple randomization, the patients were assigned to undergo tissue dissection with either the LigaSure device (study group) or monopolar electrocautery (control group). Participants and care givers, except operating surgeons, were blinded to group assignment. The primary outcome was postoperative chest drainage volume. Secondary outcomes were change of the esophageal temperature during subcarinal lymphadenectomy and C-reactive protein level 72 h after surgery. RESULTS Study outcomes were analyzed in 107 patients in each group. We found no differences between the study and control groups in terms of chest drainage volume (550 vs. 600 mL, respectively; p = 0.315), changes in esophageal temperature (- 0.1 °C vs. - 0.1 °C, respectively; p = 0.784), and C-reactive protein levels (72.8 vs. 70.8 mg/L, respectively; p = 0.503). The mean numbers of lymph nodes removed were 12.9 (SD: 3.1; 95% CI, 12.4 to 13.5) in the study group and 11.6 (SD: 3.2; 95% CI, 11.0 to 12.2) in the control group (p < 0.001). CONCLUSIONS The use of the LigaSure device did not allow to decrease the chest drainage volume, local thermal spread, and systemic inflammatory response. The number of lymph nodes removed was higher in patients operated with the LigaSure device, which indicated better quality of lymphadenectomy.
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Sarvi JY, Gardhouse SM, Berke KA, Weber RL, Hiebert K, Whittaker JH, Kapaldo N. A three-portal laparoscopic hysterectomy in a chimpanzee (Pan troglodytes) with a uterine manipulator and vessel sealing device. Vet Surg 2022; 51:1167-1174. [PMID: 35899397 DOI: 10.1111/vsu.13856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/13/2022] [Accepted: 06/18/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the treatment and outcome of a a captive chimpanzee (Pan troglodytes) undergoing 3-portal laparoscopic hysterectomy. Additionally, the technique used for successful urinary catheterization is described. ANIMALS A 29-year-old female intact chimpanzee with uterine bleeding. STUDY DESIGN Clinical case report. METHODS Uterine changes consistent with adenomyosis and/or endometriosis were noted on abdominal ultrasonographic and computed tomographic examinations. A urinary catheter was placed before a 3-portal laparoscopic hysterectomy with a uterine manipulator (VCare) and a vessel sealer (Ligasure). The uterus was submitted for histopathology. RESULTS Preoperative urinary catheterization was achieved with several modifications and prevented bladder protrusion into the surgical field. Laparoscopy provided excellent visualization of the pelvic structures and VCare effectively maneuvered the uterus for a safe and efficient dissection. The use of the vessel sealer was effective, and bleeding was minimal. Anesthesia and surgery lasted 240 and 150 minutes, respectively. No complications were encountered. Histopathological changes of the uterus were consistent with adenomyosis and myometrial hyperplasia. The chimpanzee recovered uneventfully and returned to normal behavior with no recurrence of uterine bleeding 5 months after surgery. CONCLUSION The 3-portal laparoscopic technique reported here allowed hysterectomy without complication in this chimpanzee. Urinary catheterization was technically challenging but successful.
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Affiliation(s)
- Jasmine Y Sarvi
- Department of Clinical Sciences, Kansas State University College of Veterinary Medicine, Manhattan, Kansas, USA
| | - Sara M Gardhouse
- Department of Clinical Sciences, Kansas State University College of Veterinary Medicine, Manhattan, Kansas, USA
| | - Kara A Berke
- Department of Clinical Sciences, Kansas State University College of Veterinary Medicine, Manhattan, Kansas, USA
| | | | - Kara Hiebert
- Department of Clinical Sciences, Kansas State University College of Veterinary Medicine, Manhattan, Kansas, USA
| | - John H Whittaker
- Department of Clinical Sciences, Kansas State University College of Veterinary Medicine, Manhattan, Kansas, USA
| | - Nathaniel Kapaldo
- Department of Clinical Sciences, Kansas State University College of Veterinary Medicine, Manhattan, Kansas, USA
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Chen SWT, Hsin LJ, Lin WN, Tsai YT, Tsai MS, Lee YC. LigaSure versus Conventional Parotidectomy: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10040706. [PMID: 35455883 PMCID: PMC9027715 DOI: 10.3390/healthcare10040706] [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] [Received: 03/02/2022] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
Surgery with parotidectomy is the preferable treatment for most parotid tumors. Our meta-analysis compared the differences between the use of the LigaSure (LS) device and the conventional suture ligation technique (CT) in parotidectomies. A literature search in databases including EMBASE, MEDLINE, and the Cochrane Library was carried out. Studies including parotidectomy using LS and CT were included with the intraoperative and postoperative parameters collected. Continuous operative time data were measured by mean differences (MDs). Discrete data on postoperative complications, including facial palsy, postoperative bleeding, and salivary complications, were evaluated with risk differences (RDs). All values were reported with 95% confidence intervals (CIs). Five studies were included in our meta-analysis. The pooled analysis demonstrated a significant reduction in operative time in the LS group (MD: −21.92; 95% CI, −30.18 to −13.66). In addition, the analysis indicated that the incidence of postoperative complications, including permanent facial palsy (RD, −0.01; 95% CI, −0.06 to 0.05), temporary facial palsy (RD, 0.00; 95% CI, −0.03 to 0.04), salivary complications (RD, −0.01; 95% CI, −0.08 to 0.06), and postoperative bleeding (RD, −0.02; 95% CI, −0.07 to 0.04), were all similar between the LS group and the CT group. According to the results, the LS device appears to be a safe and useful tool and could shorten the operative time in patients needing parotidectomy.
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Affiliation(s)
- Sonia Wei-Ting Chen
- Department of Otolaryngology—Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (L.-J.H.); (W.-N.L.); (Y.-T.T.); (M.-S.T.)
| | - Li-Jen Hsin
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (L.-J.H.); (W.-N.L.); (Y.-T.T.); (M.-S.T.)
- Department of Otolaryngology—Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Wan-Ni Lin
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (L.-J.H.); (W.-N.L.); (Y.-T.T.); (M.-S.T.)
- Department of Otolaryngology—Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Yao-Te Tsai
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (L.-J.H.); (W.-N.L.); (Y.-T.T.); (M.-S.T.)
- Department of Otolaryngology—Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Ming-Shao Tsai
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (L.-J.H.); (W.-N.L.); (Y.-T.T.); (M.-S.T.)
- Department of Otolaryngology—Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Yi-Chan Lee
- Department of Otolaryngology—Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (L.-J.H.); (W.-N.L.); (Y.-T.T.); (M.-S.T.)
- Correspondence: ; Tel.: +886-2-2431-3131 (ext. 6255); Fax: +886-2-2431-1190
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Elnaim ALK, Musa S, Wong MPK, Sagap I. A Prospective Interventional Study on LigaSure TM Haemorrhoidectomy as a Daycare Procedure. Malays J Med Sci 2022; 28:102-107. [PMID: 35115892 PMCID: PMC8793980 DOI: 10.21315/mjms2021.28.5.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/26/2021] [Indexed: 11/02/2022] Open
Abstract
Objective This study was designed as a prospective and interventional study that evaluated LigaSure™ haemorrhoidectomies with regional anaesthesia as a daycare procedure. Methods Patients with third- and fourth-degree haemorrhoids were recruited from the clinic from January 2018 to December 2019. The procedure was performed as a day case under regional anaesthesia. Using a LigaSureTM device, excisional haemorrhoidectomies (Milligan-Morgan haemorrhoidectomy) were performed without sutures or an anal sponge. We evaluated wound bleeding, pain and urinary retention per daycare protocols. Results A total of 264 patients were enrolled. There were 153 males (57.9%) with a median age of 30 years old (range 16 years old-80 years old). A total of 142 patients (54%) had third-degree haemorrhoids, while the rest had fourth-degree haemorrhoids. The median operating time was 8 min (range 4 min-17 min) and minimal blood loss was observed. During follow-up, the complications were one case (0.3%) had anal stenosis, one case (0.3%) had minimal bleeding and one case (0.3%) had urine retention. Upon discharge, four patients (1.5%) required additional analgesia and another four (1.5%) developed post-spinal headaches. No incontinence was encountered. Conclusion LigaSure™ excisional haemorrhoidectomy is a safe and effective daycare procedure with acceptable re-admission and complication rates.
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Affiliation(s)
| | - Shareef Musa
- Department of Surgery, Kassala Police Hospital, Kassala, Sudan
| | - Michael Pak-Kai Wong
- Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Department of Surgery, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ismail Sagap
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Shady NW, Farouk HA, Sallam HF. Perioperative Outcomes of LigaSure Versus Standard Ligature Technique Among Overweight and Obese Women Undergoing Abdominal Hysterectomy: A Randomized Clinical Trial. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nahla W. Shady
- Obstetrics and Gynecology Department, Aswan Faculty of Medicine, Aswan University, Aswan Governorate, Egypt
| | - Hassan A. Farouk
- Obstetrics and Gynecology Department, Mansoura insurance hospital, Mansoura, Egypt
| | - Hany F. Sallam
- Obstetrics and Gynecology Department, Aswan Faculty of Medicine, Aswan University, Aswan Governorate, Egypt
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Giglio NC, Fried NM. Computational Simulations for Infrared Laser Sealing and Cutting of Blood Vessels. IEEE JOURNAL OF SELECTED TOPICS IN QUANTUM ELECTRONICS : A PUBLICATION OF THE IEEE LASERS AND ELECTRO-OPTICS SOCIETY 2021; 27:1-8. [PMID: 33746498 PMCID: PMC7978229 DOI: 10.1109/jstqe.2020.3045912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Blood vessel burst pressures were simulated and predicted for sealing and cutting of vessels in a two-step process, using low (<25 W), medium (~100 W), and high (200 W) power lasers at a wavelength of 1470 nm. Monte Carlo optical transport, heat transfer, Arrhenius integral tissue damage simulations, and vessel pressure equations were utilized. The purpose of these studies was to first validate the numerical model by comparison with experimental results (for low and medium power) and then to use the model to simulate parameters that could not be experimentally tested (for high power). The goal was to reduce the large range of parameters (power, irradiation time, and linear beam dimensions) to be tested in future experiments, for achieving short vessel sealing/cutting times, minimal bifurcated seal zones (BSZ), and high vessel burst pressures. Blood vessels were compressed to 400 μm thickness. A wide range of linear beam profiles (1-5 mm widths and 8-9.5 mm lengths), incident powers (20-200 W) and clinically relevant irradiation times (0.5-5.0 s) were simulated and peak seal and cut temperatures as well as thermal seal zones, ablation zones, and BSZ computed. A simplistic mathematical expression was used to estimate vessel burst pressures based on seal width. Optimal low-power parameters were: 24W/5s/8×2mm (sealing) and 24W/5s/8×1mm (cutting), yielding a BSZ of 0.4 mm, corresponding to experimental burst pressures of ~450 mmHg. Optimal medium-power parameters were: 90W/1s/9.5×3mm (sealing) and 90W/1s/9.5×1mm (cutting), yielding a BSZ of 0.9 mm for burst pressures of ~1300 mmHg. Simulated only optimal high-power parameters were: 200W/0.5s/9×3 mm (sealing) and 200W/0.5s/9×1mm (cutting), yielding a BSZ of 0.9 mm and extrapolated to predict a seal strength of ~1300 mmHg. All lasers produced seal zones between 0.4-1.5 mm, corresponding to high vessel burst pressures of 300-1300 mmHg (well above normal systolic blood pressure of 120 mmHg). Higher laser powers enable shorter sealing/cutting times and higher vessel strengths.
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Affiliation(s)
- Nicholas C Giglio
- Department of Physics and Optical Science, University of North Carolina at Charlotte, Charlotte, NC 28223 USA
| | - Nathaniel M Fried
- Department of Physics and Optical Science, University of North Carolina at Charlotte, Charlotte, NC 28223 USA
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Pierazzi DM, Pica Alfieri E, Cuomo R, Bocchiotti MA, Grimaldi L, Donniacuo A, Zerini I, Nisi G. Ligasure™ Impact and Ligasure™ Small Jaw in Body Contouring after Massive Weight Loss: A New Perspective. J INVEST SURG 2021; 35:659-666. [PMID: 33691572 DOI: 10.1080/08941939.2021.1897714] [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] [Indexed: 10/21/2022]
Abstract
BACKGROUND The most effective dissection technique for elevating flaps in body contouring is still controversial, particularly in high-risk massive weight loss (MWL) patients. LigaSure (Medtronic, Dublin, Ireland) is an energy device commonly used among different surgical specialties to reduce morbidity and improve outcomes. The aim of this study is to investigate the effectiveness of LigaSure Impact and LigaSure Small Jaw in body contouring after MWL compared with conventional technique. MATERIAL AND METHODS Patients who underwent abdominoplasty, mastopexy, brachioplasty and thigh lift after MWL at a single center from 1 December 2018 to 1 March 2020 were retrospectively reviewed. In each procedure patients were divided into two groups according to the dissection technique: LigaSure group and monopolar electrosurgery group. Patients characteristics, perioperative details and postoperative complications were evaluated. RESULTS Fourty-five patients underwent abdominoplasty, twenty-six mastopexy, twenty brachioplasty and sixteen medial thigh lift. Using LigaSure, operative time was longer in abdominoplasty and thigh lift, but shorter in mastopexy and brachioplasty. Although not statistically significant, the amount of blood and serum recorded from drains in the first 36 hours was reduced in LigaSure groups. Additional analgesic intake was reduced with LigaSure as well as postoperative subjective pain. In all body contouring procedures statistically significant difference was found in days of hospital stay favoring LigaSure groups. Complications occurred most frequently in control groups compared to LigaSure groups. CONCLUSION LigaSure Impact and LigaSure Small Jaw may be beneficial in improving outcomes because they might reduce fluids drainage, analgesics intake, hospital stay and postoperative complications.
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Affiliation(s)
- Diletta Maria Pierazzi
- Division of Plastic and Reconstructive Surgery; Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Italy
| | - Edoardo Pica Alfieri
- Division of Plastic and Reconstructive Surgery; Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Italy
| | - Roberto Cuomo
- Division of Plastic and Reconstructive Surgery; Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Italy
| | - Maria Alessandra Bocchiotti
- Division of Plastic and Reconstructive Surgery; Department of Surgery, Città della Salute e della Scienza Hospital, Molinette Ospital Unit, University of Turin, Italy
| | - Luca Grimaldi
- Division of Plastic and Reconstructive Surgery; Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Italy
| | | | - Irene Zerini
- Division of Plastic and Reconstructive Surgery; Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Italy
| | - Giuseppe Nisi
- Division of Plastic and Reconstructive Surgery; Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Italy
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Hutchens TC, Giglio NC, Cilip CM, Rosenbury SG, Hardy LA, Kerr DE, Nau WH, Fried NM. Novel Optical Linear Beam Shaping Designs for use in Laparoscopic Laser Sealing of Vascular Tissues . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5049-5052. [PMID: 33019121 PMCID: PMC8311731 DOI: 10.1109/embc44109.2020.9176571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Suture ligation of vascular tissues is slow and skill intensive. Ultrasonic (US) and radiofrequency (RF) devices enable more rapid vascular tissue ligation to maintain hemostasis, than sutures and mechanical clips, which leave foreign objects in the body and require exchange of instruments. However, US and RF devices are limited by excessive collateral thermal damage to adjacent tissues, and high jaw temperatures that require a long time to cool. A novel alternative method using infrared (IR) laser energy is being developed for more rapid and precise sealing of vessels. This study describes design, modeling, and initial testing of several optical beam shaping geometries for integration into the standard jaws of a laparoscopic device. The objective was to transform the circular laser beam into a linear beam, for uniform, cross-irradiation and sealing of blood vessels. Cylindrical mirrors organized in a staircase geometry provided the best spatial beam profile.Clinical Relevance-This study explored several optical designs for potential integration into the standard jaws of a laparoscopic vessel sealing device, transforming a circular laser beam into a linear beam for sealing of vascular structures.
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Lu Q, Chen S, Li Y, Zheng F, He B, Gu M. Exogenous abscisic acid (ABA) promotes cadmium (Cd) accumulation in Sedum alfredii Hance by regulating the expression of Cd stress response genes. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:8719-8731. [PMID: 31912395 DOI: 10.1007/s11356-019-07512-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 12/23/2019] [Indexed: 05/18/2023]
Abstract
Sedum alfredii Hance is a zinc (Zn) and cadmium (Cd) hyperaccumulator plant. However, the regulatory role of plant hormones in the Zn or Cd uptake and accumulation of S. alfredii remains unclear. In this work, the growth, Cd accumulation, abscisic acid (ABA) synthesis and catabolism, malonaldehyde (MDA) content, and transcriptional level of some Cd stress response genes under ABA and Cd co-treatment were investigated to reveal the impact of ABA on Cd resistance and Cd accumulation of S. alfredii. The results show that 0.2 mg/L ABA and 100 μmol/L Cd co-treatment enhanced Cd accumulation and growth in S. alfredii, whereas lower or higher ABA concentrations weaken or even reverse this effect, which was positively correlated with endogenous ABA content. The increase in endogenous ABA content might be the results of the increasing ABA synthetase activities and decreasing ABA lytic enzyme, which was induced by the application of 0.2 mg/L ABA under 100 μmol/L Cd treatment. Principal component analysis (PCA) indicated that ABA impacted the expression pattern of Cd stress response genes, which coincided with the Cd accumulation pattern in the shoots of S. alfredii. Cross-over analysis of partial least squares-discriminant analysis (PLS-DA) and correlation analysis indicated that HsfA4c, HMA4 expression in roots, and HMA2, HMA3, CAD, NAS expression in shoots were correlated with endogenous ABA, which suggests that endogenous ABA improves Cd resistance of seedlings, switches the root-to-shoot transporter from HMA2 to HMA4, and transports more Cd into apoplasts to promote Cd accumulation in the shoots of S. alfredii. Taken together, ABA plays an essential role not only in Cd resistance but also in Cd transport from root to shoot in S. alfredii under Cd stress.
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Affiliation(s)
- Qinyu Lu
- Guangxi Key Laboratory of Agri-environment and Agri-products Safety, Guangxi University, Nanning, 530004, China
- Agricultural College, Guangxi University, Nanning, 530004, China
| | - Shimiao Chen
- Guangxi Key Laboratory of Agri-environment and Agri-products Safety, Guangxi University, Nanning, 530004, China
- Agricultural College, Guangxi University, Nanning, 530004, China
| | - Yanyan Li
- Qinzhou Institute of Agricultural Sciences, Qinzhou, 535000, China
| | - Fuhai Zheng
- Guangzhou Institute of Forestry and Landscape Architecture, Guangzhou, 510405, China
| | - Bing He
- Guangxi Key Laboratory of Agri-environment and Agri-products Safety, Guangxi University, Nanning, 530004, China.
- Agricultural College, Guangxi University, Nanning, 530004, China.
| | - Minghua Gu
- Guangxi Key Laboratory of Agri-environment and Agri-products Safety, Guangxi University, Nanning, 530004, China.
- Agricultural College, Guangxi University, Nanning, 530004, China.
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12
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Moore BA, Robertson J, Tarbert DK, Good KL, Paul-Murphy JR. A novel surgical technique for enucleation in rabbits to reduce the risk of intra- and post-operative orbital hemorrhage. Vet Ophthalmol 2020; 23:409-413. [PMID: 31944539 DOI: 10.1111/vop.12737] [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: 10/06/2019] [Revised: 12/15/2019] [Accepted: 12/17/2019] [Indexed: 11/29/2022]
Abstract
A 10-year-old male castrated Holland Lop rabbit (Oryctolagus cuniculus) was presented for severe ulcerative stromal keratitis of the right eye and a luxated hypermature cataract and glaucoma of the left eye. Staged bilateral enucleation was elected. A LigaSure™ electrosurgical bipolar vessel-sealing device was used as a means to minimize intraoperative and post-operative hemorrhage, especially that associated with the orbital venous plexus. The LigaSure™ was used to ligate and transect all extraocular muscles, the optic nerve bundle, and the base of the third eyelid with no complications encountered. Overall, the LigaSure™ was easy to use, resulted in minimal hemorrhage, and reduced surgery time. This is the first report of the use of a LigaSure™ to aid in the enucleation of a rabbit. Although only positive results were achieved as an alternative to conventional methodologies, its use in clinical practice should be that of caution until a larger study evaluating the long-term results is performed.
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Affiliation(s)
- Bret A Moore
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - Jessica Robertson
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - Danielle K Tarbert
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - Kathryn L Good
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - Joanne R Paul-Murphy
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
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Giordano S, Kangas R, Veräjänkorva E, Koskivuo I. Ligasure impact™might reduce blood loss, complications, and re-operation occurrence after abdominoplasty in massive-weight-loss patients: A Comparative Study. Scand J Surg 2019; 109:151-158. [DOI: 10.1177/1457496919828237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Aims:The most effective dissection technique for raising the flap in abdominoplasty is still controversial, particularly in high-risk massive-weight-loss patients. LigaSure Impact™vessel-sealing system (Medtronic, Dublin, Ireland) is an energy device commonly used among different surgical specialties to reduce morbidity and implement outcomes. The aim of this study was to investigate the effectiveness of LigaSure Impact in abdominoplasty compared with the conventional techniques, diathermia.Material and Methods:Patients underwent primary abdominoplasty after massive weight loss at a single center from 1 January 2008 to 31 May 2015 and were retrospectively reviewed. A total of 94 patients eligible for the study were divided into two groups on basis of the dissection technique: LigaSure Impact group (29 patients) and the conventional technique group (65 patients). Total intraoperative blood loss was the primary endpoint. Duration of the operation, perioperative complications and re-operation were recorded as secondary endpoints.Results:Baseline characteristics were well balanced between the groups. Significant differences were found in intraoperative blood loss favoring LigaSure Impact group (259.6 ± 198.8 mL vs 377.9 ± 190.0 mL, p = 0.004) and blood transfusion rates (13.8% vs 35.4%, p = 0.047). In contrast, operative time was significantly longer in LigaSure Impact group (168.6 ± 121.2 vs 179.7 ± 57.6 min, p = 0.005), while a tendency to shorter hospital stay was found in LigaSure Impact group (3.6 ± 1.1 days vs 4.6 ± 3.2 days, p = 0.081). Overall complications occurrence, Clavien–Dindo grade II (24.1% vs 55.4%) and grade III (13.8% vs 30.8%) complications were significantly lower in LigaSure Impact group (respectively, p = 0.005, p = 0.007, p = 0.016). Late (>30 days) re-operation rate was significantly lower in the LigaSure Impact group (6.9% vs 27.70%, p = 0.0028). Specific wound complications showed no significant difference.Conclusion:LigaSure Impact vessel-sealing system may be beneficial in improving abdominoplasty outcomes in massive-weight-loss patients because it might reduce blood loss, need for transfusions, complications, and re-operations.
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Affiliation(s)
- S. Giordano
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
- Department of Surgery, Satakunta Central Hospital, Pori, Finland
- The University of Turku, Turku, Finland
| | - R. Kangas
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
- The University of Turku, Turku, Finland
| | - E. Veräjänkorva
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
- The University of Turku, Turku, Finland
| | - I. Koskivuo
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
- The University of Turku, Turku, Finland
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Lee CL, Wu KY, Huang CY, Yen CF. Comparison of LigaSure™ tissue fusion system and a conventional bipolar device in hysterectomy via natural orifice transluminal endoscopic surgery (NOTES): A randomized controlled trial. Taiwan J Obstet Gynecol 2019; 58:128-132. [DOI: 10.1016/j.tjog.2018.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2018] [Indexed: 10/27/2022] Open
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Hardy LA, Hutchens TC, Larson ER, Gonzalez DA, Chang CH, Nau WH, Fried NM. Rapid sealing of porcine renal blood vessels, ex vivo, using a high power, 1470-nm laser, and laparoscopic prototype. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:58002. [PMID: 28550708 DOI: 10.1117/1.jbo.22.5.058002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/28/2017] [Indexed: 06/07/2023]
Abstract
Energy-based, radiofrequency (RF) and ultrasonic (US) devices currently provide rapid sealing of blood vessels during laparoscopic procedures. We are exploring infrared lasers as an alternate energy modality for vessel sealing, capable of generating less collateral thermal damage. Previous studies demonstrated feasibility of sealing vessels in an in vivo porcine model using a 1470-nm laser. However, the initial prototype was designed for testing in open surgery and featured tissue clasping and light delivery mechanisms incompatible with laparoscopic surgery. In this study, a laparoscopic prototype similar to devices currently in surgical use was developed, and performance tests were conducted on porcine renal blood vessels, ex vivo. The 5-mm outer-diameter laparoscopic prototype featured a traditional Maryland jaw configuration that enables tissue manipulation and blunt dissection. Laser energy was delivered through a 550 - ? m -core-diameter optical fiber with side-delivery from the lower jaw and beam dimensions of 18 - mm ? length × 1.2 - mm ? width . The 1470-nm diode laser delivered 68 W with 3-s activation time, consistent with vessel seal times associated with RF and US-based devices. A total of 69 fresh porcine renal vessels with mean diameter of 3.3 ± 1.7 ?? mm were tested, ex vivo. Vessels smaller than 5-mm diameter were consistently sealed (48/51) with burst pressures greater than malignant hypertension blood pressure (180 mmHg), averaging 1038 ± 474 ?? mmHg . Vessels larger than 5 mm were not consistently sealed (6/18), yielding burst pressures of only 174 ± 221 ?? mmHg . Seal width, thermal damage zone, and thermal spread averaged 1.7 ± 0.8 , 3.4 ± 0.7 , and 1.0 ±
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Affiliation(s)
- Luke A Hardy
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
| | - Thomas C Hutchens
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
| | | | - David A Gonzalez
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
| | - Chun-Hung Chang
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
| | | | - Nathaniel M Fried
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
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16
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Comparison of Vaginal Hysterectomy Techniques and Interventions for Benign Indications. Obstet Gynecol 2017; 129:877-886. [DOI: 10.1097/aog.0000000000001995] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Bonino L, Mabrouk M, Del Piano E, Roviglione G, Deltetto F, Camanni M, Minelli L, Ceccaroni M. Hysterectomy for Large Sized Uteri with Benign Pathology: Total Laparoscopic or Vaginal Hysterectomy Using Blood Vessel Sealing Systems? Analysis of 514 Patients. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2015.0137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luca Bonino
- Department of Gynecology and Obstetrics, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Mohamed Mabrouk
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy
| | | | - Giovanni Roviglione
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy
| | | | | | - Luca Minelli
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy
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Guo T, Ren L, Wang Q, Li K. A network meta-analysis of updated haemostatic strategies for hysterectomy. Int J Surg 2016; 35:187-195. [PMID: 27725243 DOI: 10.1016/j.ijsu.2016.10.002] [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] [Received: 07/16/2016] [Revised: 09/15/2016] [Accepted: 10/06/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the best haemostatic strategy for hysterectomy through a network meta-analysis. METHODS We conducted a systematic literature search of the PubMed, Embase, and Cochrane Library databases and extracted data from randomized controlled trials comparing haemostatic strategies for hysterectomy. Direct comparisons and network meta-analyses were conducted in RevMan and ADDIS. Consistency models were established to identify the differences among different haemostatic strategies, and cumulative probability was used to rank the included strategies. Inconsistencies were also tested using node-splitting models. RESULTS Twenty studies from 16 articles (2 articles contained 3 studies each) comprising 1392 patients were included. Direct meta-analysis showed that the LigaSure (SMD = -1.42 [-2.39, -0.44], P = 0.004), bipolar vessel sealing systems (BVSS) (SMD = -0.35 [-0.66, -0.03], P = 0.03), and pituitrin (SMD = -2.13 [-4.14, -0.13], P = 0.04) applications were effective haemostatic strategies. Based on the network meta-analysis and related subgroup analysis of different surgical procedures, the results showed that the application of pituitrin seemed to be the best haemostatic method for hysterectomy (Rank P = 0.64), especially for vaginal hysterectomy (Rank P = 0.72). The application of LigaSure was the best strategy for abdominal hysterectomy (Rank P = 0.54) but was not effective for laparoscopic hysterectomy (direct comparison with BVSS, MD = -31.39 [-146.61, 83.83], P = 0.59). The node-splitting models test revealed that no significant inconsistencies existed in this research. CONCLUSIONS Pituitrin application seemed to be the most effective haemostatic strategy for hysterectomy and was especially suitable for vaginal hysterectomy. The best method for reducing blood loss in abdominal hysterectomy was the application of LigaSure.
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Affiliation(s)
- Tao Guo
- Department of General Surgery, Zhongnan Hospital, Wuhan University, Wuhan 430071, PR China
| | - Liang Ren
- Department of Gynaecology and Obstetrics, Zhongnan Hospital, Wuhan University, Wuhan 430071, PR China
| | - Quanxiong Wang
- Department of General Surgery, Zhongnan Hospital, Wuhan University, Wuhan 430071, PR China
| | - Kun Li
- Department of General Surgery, Zhongnan Hospital, Wuhan University, Wuhan 430071, PR China.
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A comparison of electrothermal bipolar vessel sealing system and electrocautery in selective neck dissection. Eur Arch Otorhinolaryngol 2016; 273:3835-3838. [PMID: 27007131 DOI: 10.1007/s00405-016-3999-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
Abstract
The use of LigaSure™ vessel sealing system in head and neck surgery was reported to be reliable and safe, providing sufficient hemostasis and reducing operating time. The aim of this study was to evaluate efficacy of this technique in patients undergoing selective neck dissections. This study was carried out as a prospective controlled study at an otolaryngology department of a tertiary medical center between July 2013 and July 2015. Twenty-five patients older than 18 years who underwent unilateral selective neck dissection for head and neck cancer were included in the study. In the control group (group 2, 10 patients) only monopolar and bipolar diathermy was used; in the Ligasure group (group 1, 15 patients) Ligasure was used for hemostasis and dissection in addition to the conventional techniques. Cervical lymphadenectomy time, operation time, preoperative hemoglobin levels, preoperative hematocrit levels, postoperative hemoglobin levels, postoperative hematocrit levels, total neck drainage and drain removal time were analyzed and compared between the groups. Median operation time in group 1 and 2 were 95 min (IQR = 35) and 142.5 min (IQR = 63), respectively. Median cervical lymphadenectomy time in group 1 and 2 were 55 min (IQR = 23) and 102.5 min (IQR = 49), respectively. Median operation time and cervical operation time were significantly lower in group 1 (p < 0.05). In conclusion, LigaSure™ vessel sealing system is a safe, efficacious technique and significantly lowers cervical lymphadenectomy and operation time in selective neck dissections compared to controls. Given the superb hemostatic properties, this technique should be in the surgeon's armamentarium when possible.
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Affiliation(s)
- Adam Biedrzycki
- Department of Surgical Sciences; School of Veterinary Medicine; University of Wisconsin-Madison; Madison WI
| | - Sabrina H. Brounts
- Department of Surgical Sciences; School of Veterinary Medicine; University of Wisconsin-Madison; Madison WI
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21
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LigaSure™ 5-mm Blunt Tip Laparoscopic Instrument. J Obstet Gynaecol India 2015; 65:350-2. [PMID: 26405409 DOI: 10.1007/s13224-015-0745-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022] Open
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22
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Miyagi K, Rossi S, Malata C, Forouhi P. Novel use of LigaSure Impact™ electrosurgical bipolar vessel sealing system in skin-sparing mastectomy. J Plast Reconstr Aesthet Surg 2015; 68:e126-8. [DOI: 10.1016/j.bjps.2015.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 01/11/2015] [Accepted: 01/18/2015] [Indexed: 11/30/2022]
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23
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Gouaillier-Vulcain F, Marchand E, Martinez R, Picquet J, Enon B. Utility of Electrofusion for the Femoral Approach in Vascular Surgery: A Randomized Prospective Study. Ann Vasc Surg 2015; 29:801-9. [DOI: 10.1016/j.avsg.2014.09.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/12/2014] [Accepted: 09/09/2014] [Indexed: 12/30/2022]
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Giglio NC, Hutchens TC, Perkins WC, Latimer C, Ward A, Nau WH, Fried NM. Rapid sealing and cutting of porcine blood vessels, ex vivo, using a high-power, 1470-nm diode laser. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:38002. [PMID: 24658792 DOI: 10.1117/1.jbo.19.3.038002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 03/03/2014] [Indexed: 06/03/2023]
Abstract
Suture ligation with subsequent cutting of blood vessels to maintain hemostasis during surgery is time consuming and skill intensive. Energy-based electrosurgical and ultrasonic devices are often used to replace sutures and mechanical clips to provide rapid hemostasis and decrease surgery time. Some of these devices may create undesirably large collateral zones of thermal damage and tissue necrosis, or require separate mechanical blades for cutting. Infrared lasers are currently being explored as alternative energy sources for vessel sealing applications. In a previous study, a 1470-nm laser was used to seal vessels 1 to 6 mm in diameter in 5 s, yielding burst pressures of ∼500 mmHg. The purpose of this study was to provide vessel sealing times comparable with current energy-based devices, incorporate transection of sealed vessels, and demonstrate high vessel burst pressures to provide a safety margin for future clinical use. A 110-W, 1470-nm laser beam was transmitted through a fiber and beam shaping optics, producing a 90-W linear beam 3.0 by 9.5 mm for sealing (400 W/cm2), and 1.1 by 9.6 mm for cutting (1080 W/cm2). A two-step process sealed and then transected ex vivo porcine renal vessels (1.5 to 8.5 mm diameter) in a bench top setup. Seal and cut times were 1.0 s each. A burst pressure system measured seal strength, and histologic measurements of lateral thermal spread were also recorded. All blood vessels tested (n=55 seal samples) were sealed and cut, with total irradiation times of 2.0 s and mean burst pressures of 1305±783 mmHg. Additional unburst vessels were processed for histological analysis, showing a lateral thermal spread of 0.94±0.48 mm (n=14 seal samples). This study demonstrated that an optical-based system is capable of precisely sealing and cutting a wide range of porcine renal vessel sizes and, with further development, may provide an alternative to radiofrequency- and ultrasonic-based vessel sealing devices.
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Affiliation(s)
- Nicholas C Giglio
- University of North Carolina at Charlotte, Department of Physics and Optical Science, 9201 University City Boulevard, Charlotte, North Carolina 28223
| | - Thomas C Hutchens
- University of North Carolina at Charlotte, Department of Physics and Optical Science, 9201 University City Boulevard, Charlotte, North Carolina 28223
| | - William C Perkins
- University of North Carolina at Charlotte, Department of Physics and Optical Science, 9201 University City Boulevard, Charlotte, North Carolina 28223
| | | | - Arlen Ward
- Covidien, 5920 Longbow Drive, Boulder, Colorado 80301
| | - William H Nau
- Covidien, 5920 Longbow Drive, Boulder, Colorado 80301
| | - Nathaniel M Fried
- University of North Carolina at Charlotte, Department of Physics and Optical Science, 9201 University City Boulevard, Charlotte, North Carolina 28223
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Lopez J, Vilallonga R, Targarona EM, Balague C, Enriquez L, Rivera R, Balibrea JM, Perez-Ochoa F, Rodriguez K, Baeza M, Reyes A. Can LigaSure™ be used to perform sleeve gastrectomy? – Tensile strength and histological changes. MINIM INVASIV THER 2013; 23:144-51. [DOI: 10.3109/13645706.2013.875924] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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LigaSure vessel sealing system in vaginal hysterectomy: safety, efficacy and limitations. Arch Gynecol Obstet 2013; 288:1067-74. [PMID: 23625333 DOI: 10.1007/s00404-013-2857-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/13/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study is to compare vaginal hysterectomy performed with standard technique versus the one performed with LigaSure. METHODS Observational-longitudinal-cohort study on 42 women candidates to vaginal hysterectomy because of benign uterine pathology. Outcome variables, methods of analysis, inclusion and exclusion criteria were determined prospectively. Eligible patients were subdivided in Group-A (LigaSure-21 patients), or in Group-B (classical-21 patients). Group-A was divided into Subgroup-A1 (10 patients) and Subgroup-A2 (11 patients), depending on the point where the stump of the uterosacral-ligament was transfixed: Subgroup-A1 at cervical portion, Subgroup-A2 at intermediate portion. For all patients were reported: pre-post surgery haemoglobin and hematocrit, number of sutures, duration of intervention and blood loss, NRS-score on first/third post-operative days. All patients underwent gynaecological examination 30 and 180 days after surgery. RESULTS General characteristics did not show significant differences between the two groups. Statistically significant differences emerged from the comparison between Group-A versus Group-B in terms of: intraoperative bleeding, post-operative value of haemoglobin, Δ-Hb, number of sutures, surgical time, pain at first and third post-operative day. The 180 days follow-up demonstrated four cases of vaginal vault prolapse, only in the Subgroup-A1 related to thermal damage of the uterosacral ligament. CONCLUSION LigaSure vessel sealing system is a safe alternative for securing pedicles in vaginal hysterectomy with significant improvement in patients outcome. Following vaginal vault prolapse, we determined the optimal fixation-site to perform the colposuspension in the intermediate portion of the uterosacral-ligament, especially if the cervical portion received a thermal damage, as occurs during the LigaSure use.
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Ghirardini G, Mohamed M, Bartolamasi A, Malmusi S, Dalla Vecchia E, Algeri I, Zanni A, Renzi A, Cavicchioni O, Braconi A, Pazzoni F, Alboni C. Minimally invasive vaginal hysterectomy using bipolar vessel sealing: Preliminary experience with 500 cases. J OBSTET GYNAECOL 2012; 33:79-81. [DOI: 10.3109/01443615.2012.721027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lakeman MME, The S, Schellart RP, Dietz V, ter Haar JF, Thurkow A, Scholten PC, Dijkgraaf MGW, Roovers JPWR. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial. BJOG 2012; 119:1473-82. [DOI: 10.1111/j.1471-0528.2012.03484.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Aydin C, Yildiz A, Kasap B, Yetimalar H, Kucuk I, Soylu F. Efficacy of Electrosurgical Bipolar Vessel Sealing for Abdominal Hysterectomy with Uterine Myomas More than 14 Weeks in Size: A Randomized Controlled Trial. Gynecol Obstet Invest 2012; 73:326-9. [DOI: 10.1159/000336400] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 01/11/2012] [Indexed: 12/29/2022]
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30
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Surgit O, Gumus II, Derbent A, Simavli S. Laparoscopic type 7 total hysterectomy and adnexectomy with or without Burch colposuspension: operative technique with the LigaSure device and results. Arch Gynecol Obstet 2011; 285:1287-94. [DOI: 10.1007/s00404-011-2123-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 10/17/2011] [Indexed: 11/24/2022]
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Yao HS, Wang WJ, Wang Q, Gao WC, Xiang HG, Hu ZQ, Gao JD, Chen XY, Wang WM. Randomized clinical trial of vessel sealing system (LigaSure) in esophagogastric devascularization and splenectomy in patients with portal hypertension. Am J Surg 2011; 202:82-90. [PMID: 21741519 DOI: 10.1016/j.amjsurg.2010.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 10/11/2010] [Accepted: 10/11/2010] [Indexed: 01/02/2023]
Abstract
BACKGROUND The LigaSure vessel sealing system (Valleylab, Boulder, CO) has been tested, with excellent results, in different fields of surgery. However, no study has evaluated the efficiency of the LigaSure in open esophagogastric decongestion and splenectomy in a randomized trial to date. METHODS Patients scheduled to undergo esophagogastric decongestion and splenectomy were assigned to the use of either the LigaSure or a conventional clamp-and-tie technique. Primary outcome measures were operating time and intraoperative blood loss. Secondary outcome measures were postoperative drainage volume, complications such as spleen fever, bleeding, portal vein thrombosis, length of incision, pain, and time to discharge. RESULTS Sixty patients were randomized to the LigaSure (n = 30) and clamp-and-tie (n = 30) groups. The groups were well matched with respect to liver function, associated illnesses, and grading of esophageal varices. Postoperative outcomes in drainage and major complications did not differ between the groups, while operative time and the volume of blood loss were significantly decreased in the LigaSure group compared with the clamp-and-tie group (P < .001). CONCLUSIONS The use of the LigaSure is safe and effective in vessel division and homeostasis in the esophagogastric decongestion and splenectomy, with statistically significant decreases in operative time and intraoperative blood loss and without significantly modifying postoperative results.
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Affiliation(s)
- Hou Shan Yao
- Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, China
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Elhao M, Abdallah K, Serag I, El-Laithy M, Agur W. Efficacy of using electrosurgical bipolar vessel sealing during vaginal hysterectomy in patients with different degrees of operative difficulty: a randomised controlled trial. Eur J Obstet Gynecol Reprod Biol 2009; 147:86-90. [PMID: 19729238 DOI: 10.1016/j.ejogrb.2009.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 06/17/2009] [Accepted: 07/22/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the efficacy of electrosurgical bipolar vessel sealing using the LigaSure system during vaginal hysterectomy in comparison with conventional suture ligation method. STUDY DESIGN 103 patients undergoing vaginal hysterectomy for benign conditions were randomised to either LigaSure or Suture groups. Each group was divided into two subgroups according to the degree of surgical difficulty. RESULTS Participants in the LigaSure had shorter procedure time (52.5 min vs. 90 min; p<0.001) and less blood loss (230 ml vs. 360 ml; p<0.001). Complication rates were not statistically different between the two groups. The advantage of the LigaSure system in reducing the operative blood loss was more pronounced in the more difficult procedures. CONCLUSION The LigaSure system reduces the operating time (by reducing pedicle-securing time) and blood loss without increasing the post-operative complication rates of vaginal hysterectomy. This beneficial effect was found to be more pronounced in difficult procedures.
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Affiliation(s)
- Mounir Elhao
- Obstetrics & Gynaecology Department, Ain Shams University, Abbassia Square, Cairo, Egypt
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Kriplani A, Garg P, Sharma M, Lal S, Agarwal N. A review of total laparoscopic hysterectomy using LigaSure uterine artery-sealing device: AIIMS experience. J Laparoendosc Adv Surg Tech A 2009; 18:825-9. [PMID: 18999973 DOI: 10.1089/lap.2008.0034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVE The aim of this study was to evaluate the efficacy and safety of total laparoscopic hysterectomy (TLH) by using the Ligasure system for the sealing of uterine arteries. DESIGN We conducted a retrospective review of cases who underwent TLH over 1.5 years. SETTINGS This study was conducted in a tertiary care hospital setting, at the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (New Delhi, India). PATIENTS A total of 110 patients of TLH done for uterine pathology [leiomyoma in 67 (60.9%), dysfunctional uterine bleeding in 34 (30.9%), and others in 9 (8.1%)]. INTERVENTIONS Total laparoscopic hysterectomy, using the LigaSure system (Valleylab Inc., Boulder, CO), was done by the sealing of uterine arteries and Prashant Mangeshikar uterine manipulator for elevation of the uterus. RESULTS The mean age of the patients was 43.1 +/- 0.602 years and mean body mass index was 25.19 +/- 0.39 kg/m(2). The mean operating time was 116.91 +/- 3.4 minutes, mean intraoperative blood loss was 173.09 +/- 11.64 mL, and the mean weight of the removed uterus was 224.14 +/- 17.62 g. Six patients were converted from a laparoscopic to an open procedure (large myoma in 4 and dense adhesion in 2) and 1 was converted to laparoscopically assisted vaginal hysterectomy (tear in vaginal cuff). One patient (0.9%) developed lung emphysema during the intraoperative period. Postoperative complications included paralytic ileus in 3 (2.7%), retention of urine in 2 (1.8%), and febrile morbidity in 12 (10.9%) patients. There were no bladder or bowel injuries. CONCLUSION Laparoscopic hysterectomy by uterine artery sealing with LigaSure is a safe, efficient procedure with a low complication rate.
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Affiliation(s)
- Alka Kriplani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
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Bipolar coagulation with the BiClamp® forceps versus conventional suture ligation: a multicenter randomized controlled trial in 175 vaginal hysterectomy patients. Arch Gynecol Obstet 2009; 280:753-60. [DOI: 10.1007/s00404-009-1010-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 02/10/2009] [Indexed: 11/26/2022]
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Electrosurgical Bipolar Vessel Sealing Versus Conventional Clamping and Suturing for Total Abdominal Hysterectomy: A Randomized Trial. J Minim Invasive Gynecol 2008; 15:547-53. [DOI: 10.1016/j.jmig.2008.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 05/25/2008] [Accepted: 05/31/2008] [Indexed: 11/23/2022]
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Moreno-Sanz C, Picazo-Yeste J, Seoane-Gonzáles J, Manzanera-Díaz M, Tadeo-Ruiz G. Division of the small bowel with the LigaSure Atlas device during the right laparoscopic colectomy. J Laparoendosc Adv Surg Tech A 2008; 18:99-101. [PMID: 18266584 DOI: 10.1089/lap.2007.0014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Bowel division and anastomosis were facilitated greatly with the advent of stapling techniques. Since then, there have not been any new evolving technologies to facilitate these maneuvers. For this reason, we recently applied the LigaSure Atlas device (Valleylab, Boulder, CO) to the division of the small bowel during this procedure to obtain a reliable and low-cost division of the ileum. METHODS After vessel ligation and ileocolic mobilization, the terminal ileum is sealed and divided with the LigaSure Atlas. This device is applied sequentially along the small bowel twice to ensure an adequate seal before the cut. A terminolateral ileotransversostomy is performed extracorporeally with a mechanical circular stapling device, installing the anvil of the circular stapler into the ileal stump. RESULTS We have not encountered any problems with this technique since its introduction in our institution, and no leakage or bursting of the ileal stumps. CONCLUSIONS This technique enables an easy, reliable, and inexpensive technical option to optimize the right laparoscopic colectomy procedure.
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Affiliation(s)
- Carlos Moreno-Sanz
- Department of Surgery, La Mancha-Centro General Hospital, Alcazar de San Juan, Spain.
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Dubuisson J, Golfier F, Massoud M, Benchaib M, Bryssine B, Raudrant D. [Vaginal hysterectomy using electrofusion: a study of 96 cases]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2007; 37:82-7. [PMID: 18068907 DOI: 10.1016/j.jgyn.2007.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 10/11/2007] [Accepted: 10/17/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare ligature by electrofusion versus sutures in the practice of vaginal hysterectomy. STUDY DESIGN This is a retrospective study on 96 patients completed over a period of 47 months. Patients were allocated into two groups: the electrofusion "suture-free" group (n=54) and the "suture" control group (n=42). Designed-end points were operating time, postoperative pain, duration of postoperative hospitalization and perioperative complications. RESULTS In the electrofusion group, the operating time was significantly reduced (51.3+/-22.6 min versus 67.6+/-20.1 min) as well as the reported postoperative pain (based on the visual analog scale - VAS) (1.9+/-2.0 versus 3.5+/-2.3). The average morphine consumption rate and the timing of postoperative morphine administration were lower in the electrofusion group (22.4+/-31.0mg versus 45.4+/-51.3 mg and 22.4+/-13.4 h versus 29.4+/-18.8 h, respectively). Moreover, in the electrofusion group there was less need for additional analgesics (1.9+/-2.0 versus 3.5+/-2.3) and the hospital-stay was shorter (4.2+/-1.3 days versus 5.0+/-1.0 days). There was no significant difference between the two groups in regard to perioperative complications. CONCLUSION The use of electrofusion in vaginal hysterectomy appears to be a reliable ligation technique which reduces significantly the operating time, the postoperative pain and the length of postoperative hospitalization.
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Affiliation(s)
- J Dubuisson
- Service de gynécologie obstétrique, hôpital Hôtel-Dieu, 61 quai Jules-Courmont, Lyon cedex, France.
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Demirturk F, Aytan H, Caliskan AC. Comparison of the use of electrothermal bipolar vessel sealer with harmonic scalpel in total laparoscopic hysterectomy. J Obstet Gynaecol Res 2007; 33:341-5. [PMID: 17578364 DOI: 10.1111/j.1447-0756.2007.00533.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of the present study was to compare the use of electrothermal bipolar vessel sealer (EBVS) with harmonic scalpel (HS) during total laparoscopic hysterectomy with respect to operation time, estimated blood loss and related complications. METHODS A retrospective study was conducted in the university hospital. Forty patients who underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy were enrolled. Nineteen hysterectomies were performed with HS and in 21 patients the same surgeons used EBVS. Data about the characteristics of the patients, operation time, estimated blood loss, uterine weights, related complications and length of hospital stay were registered and compared. RESULTS Mean procedure time and estimated blood loss were significantly less in the EBVS arm (59.57 +/- 3.71 vs 90.95 +/- 5.73 min, P < 0.001; 87.76 +/- 25.48 vs 152.63 +/- 60.90 mL; P < 0.001, respectively). The change in hemoglobin and hematocrit values was found to be more significant in the HS group. CONCLUSION EBVS was found to be less time-consuming and caused less bleeding when compared with HS.
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Affiliation(s)
- Fazli Demirturk
- Gaziosmanpasa University, Faculty of Medicine, Department of Obstetrics and Gynecology, Tokat, Turkey
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Douay N, Belot F, Bader G, Guyot B, Heitz D, Fauconnier A. Douleur postopératoire après hystérectomie par voie vaginale selon la méthode d'hémostase utilisée: thermofusion ou suture aux fils. ACTA ACUST UNITED AC 2007; 35:632-6. [PMID: 17587630 DOI: 10.1016/j.gyobfe.2007.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Accepted: 05/23/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purpose of the study was to compare the postoperative pain of patients who had a hysterectomy through vaginal route according to the process of binding: wire or electrosurgical bipolar vessel sealing. PATIENTS AND METHODS Retrospective study carried out in the 60 last patients who underwent a hysterectomy by vaginal route for a benign pathology in the gynaecological service of surgery of the CHI Poissy-Saint-Germain-en-Laye until March 2006. Among these patients, 32 had profited from a binding by wire and 28 of the electrosurgical bipolar vessel sealing. The studied criteria were the post-operative pain, total morphine consumption and the durations of the analgesic treatment, the hospitalisation and intervention time. RESULTS The postoperative pain in the first 24 hours was twice lower using thermofusion; it was valid in immediate post-operative period and after 24 hours. In addition, total morphine consumption was also significantly lower using thermofusion. DISCUSSION AND CONCLUSION This pilot study shows that the electrosurgical bipolar vessel sealing allows a reduction in the pain into the immediate postoperative period. Other prospective and randomised studies would allow it and conclude on the duration of hospitalisation, the quality of life from the patients and the cost in terms of public health.
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Affiliation(s)
- N Douay
- Service de gynécologie-obstétrique, CHI de Poissy-Saint-Germain-en-Laye, 10 rue du Champ-Gaillard, 78300 Poissy, France
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Soon PSH, Yeh MW, Sywak MS, Sidhu SB. USE OF THE LIGASURE VESSEL SEALING SYSTEM IN LAPAROSCOPIC ADRENALECTOMY. ANZ J Surg 2006; 76:850-2. [PMID: 16922910 DOI: 10.1111/j.1445-2197.2006.03881.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Laparoscopic adrenalectomy is the operation of choice for benign adrenal lesions. During laparoscopic surgery, vessels are usually ligated with diathermy, ligaclips, staplers or ultrasonic coagulators. Use of the electrothermal bipolar vessel sealer (LigaSure; Valleylab, Boulder, CO, USA) has recently been described in a variety of procedures, not including adrenalectomy. This article is a retrospective study of 28 patients undergoing laparoscopic adrenalectomy within the University of Sydney Endocrine Surgical Unit at the Royal North Shore Hospital using the LigaSure vessel sealing system. Between July 2004 and August 2005, 28 consecutive patients underwent laparoscopic adrenalectomy using the LigaSure vessel sealing system to divide feeding adrenal vessels as well as the adrenal vein. There were no bleeding complications. The LigaSure vessel sealing system can be safely used to secure haemostasis, including division of the adrenal vein, in laparoscopic adrenalectomy.
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Affiliation(s)
- Patsy S H Soon
- Endocrine Surgical Unit, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
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