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Kaku K, Kubo S, Sato Y, Mei T, Noguchi H, Okabe Y, Nakamura M. Efficacy and Safety Evaluation of Energy Devices in Bench Surgery for Pancreas Transplantation. J Surg Res 2024; 298:149-159. [PMID: 38608426 DOI: 10.1016/j.jss.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION Bench surgery for the preparation of deceased donor pancreatic grafts is labor-intensive and time-consuming. We hypothesized that energy devices could be used during bench surgery to decrease the bench surgery time. However, because bench surgery has two unique characteristics, wet conditions and no blood flow in the vessels, it is necessary to verify the safety and efficacy under such conditions. METHODS In an animal tissue model, we validated both ultrasonic and bipolar energy devices: Harmonic Shears and the LigaSure (LS) vessel-sealing device by evaluating heat spread and pressure resistance under bench surgery conditions. In a clinical evaluation of the LS, we compared the outcomes of 22 patients in two different bench surgery groups: with and without the use of the LS. RESULTS Clinically, the bench surgery time was significantly shorter in the LS group than that in the conventional group (P < 0.001). In the animal tissue experiments, the highest temperature in bench surgery conditions was 60.4°C after 1 s at a 5-mm distance in the LS group. Pressure resistance of ≥ 750 mmHg was achieved in almost all trials in both veins and arteries, with no difference between Harmonic Shears and LS. There was more surgical smoke visually in bench conditions versus in dry conditions and under half bite versus full bite conditions. CONCLUSIONS The encouraging results of our exploratory clinical and animal studies of the energy devices suggest that they may be useful in the setting of bench surgery.
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Affiliation(s)
- Keizo Kaku
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinsuke Kubo
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yu Sato
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanori Mei
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Noguchi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Okabe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Park JH, Kong SH, Berlth F, Choi JH, Kim S, Kim SH, Kang SH, Lee S, Yoo J, Goo E, Jeong K, Kim HM, Park YS, Ahn SH, Suh YS, Park DJ, Lee HJ, Kim HH, Yang HK. Comparison of perioperative outcomes between bipolar sealing, ultrasonic shears and a hybrid device during laparoscopic gastrectomy for early gastric cancer: a prospective, multicenter, randomized study. Gastric Cancer 2023; 26:438-450. [PMID: 36735157 DOI: 10.1007/s10120-023-01365-6] [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] [Received: 10/20/2022] [Accepted: 01/14/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although EBDs are essential for minimally invasive surgery, well-established prospective randomized studies comparing EBDs are scarce. This study aimed to compare the intraoperative inflammatory response and short-term surgical outcomes among different energy-based devices (EBDs) in laparoscopic distal gastrectomy (LDG). METHODS Patients with clinical stage I gastric cancer scheduled for LDG at two different medical centers were prospectively randomized into three groups: ultrasonic shears (US), advanced bipolar (BP) and ultrasonic-bipolar hybrid (HB). The C-reactive protein (CRP) level, operation time, intraoperative blood loss (IBL), laboratory tests, cytokines (interleukin (IL)-6 and IL-10), hospital stay, and complication rate were analyzed. A novel semiquantitative measurement method using indocyanine green (ICG) and a near-infrared camera measured the amount of lymphatic leakage. RESULTS The primary endpoint, the CRP level, was significantly lower in the BP (n = 60) group than in the US (n = 57) or HB (n = 57) group [9.03 ± 5.55 vs. 11.12 ± 5.02 vs. 12.67 ± 6.14, p = 0.001, on postoperative day (POD) 2 and 7.48 vs. 9.62 vs. 9.48, p = 0.026, on POD 4]. IBL was significantly lower in BP than in US or HB (26.3 ± 25.3 vs. 43.7 ± 42.0 vs. 34.9 ± 37.0, p = 0.032). Jackson-Pratt drainage triglycerides were significantly lower in BP than in US (53.6 ± 33.7 vs. 84.2 ± 59.0, p = 0.11; HB: 71.3 ± 51.4). ICG fluorescence intensity, operation time, laboratory results, cytokines, hospital stay, and complication rate were not significantly different among the 3 groups. CONCLUSION BP showed a lower postoperative CRP level and less IBL than US and HB, suggesting less collateral thermal damage and better sealing function. Surgeons may consider this when selecting EBDs for laparoscopic surgery.
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Affiliation(s)
- Ji-Hyeon Park
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of Surgery, Gachon University Gil Medical Center, Incheon, South Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea. .,Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea. .,Cancer Research Institute, Seoul National University, Seoul, South Korea. .,VITCAL Co., Ltd., Seoul, South Korea.
| | - Felix Berlth
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jong-Ho Choi
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of Surgery, Eulji University, Seoul, South Korea
| | - Sara Kim
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Sa-Hong Kim
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | - So Hyun Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sangjun Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jaeun Yoo
- Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Eunhee Goo
- Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Kyoungyun Jeong
- Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Hyun Myong Kim
- Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Cancer Research Institute, Seoul National University, Seoul, South Korea
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3
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Thiel C, Frericks LT, Schenk M, Königsrainer A, Brucker SY, Kraemer B, Steger V, Biber U, Linzenbold W, Enderle MD, Thiel K. A new bipolar device for sealing and cutting: ex and in vivo studies for performance evaluation. MINIM INVASIV THER 2022; 31:1131-1139. [PMID: 36260701 DOI: 10.1080/13645706.2022.2124523] [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: 01/03/2023]
Abstract
INTRODUCTION A novel multipurpose bipolar radiofrequency instrument, the Erbe Dissector (EDS), which simultaneously seals and cuts tissue, was developed. Ex vivo sealing rate and time, burst pressure, jaw temperature and thermal spread were studied in porcine renal arteries. MATERIAL AND METHODS In vivo, 13 surgical tasks were performed in two pigs: beside sealing rate and time, overall performance in sharp and blunt dissection, tissue sticking, hemostasis, precision, etc., were evaluated by four surgeons compared with ENSEAL G2 (EG2) using surveys on a Likert scale (1 = very poor; 5 = very good). RESULTS Ex vivo, the EDS sealing rate was 91.7% (33/36 arteries) at an average sealing time of 2.1 s (range 1.7-2.8) and a burst pressure of 1040 ± 350 mmHg. The maximum jaw temperature was 87 ± 4 °C and the mean lateral thermal spread was 0.8 ± 0.2 mm. In vivo, the sealing rate for arteries and veins was 92.6% (50/54) and the median seal and cut time was 1.6 s (range: 1.3-2.9). The average EDS performance score across all tasks was 4.4 ± 0.6 Likert points. For five shared tasks, EDS was better than EG2 (4.4 ± 0.5 versus 3.4 ± 0.6 Likert points; p = 0.016). CONCLUSIONS EDS seals and cuts arteries and veins rapidly with good safety and user-friendliness.
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Affiliation(s)
- Christian Thiel
- Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Luca T Frericks
- Department of Research and Basic Technologies, Erbe Elektromedizin GmbH, Tuebingen, Germany
| | - Martin Schenk
- Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Sara Y Brucker
- Department of Gynaecology and Obstetrics, Tuebingen University Hospital, Tuebingen, Germany
| | - Bernhard Kraemer
- Department of Gynaecology and Obstetrics, Tuebingen University Hospital, Tuebingen, Germany
| | - Volker Steger
- Department of Thoracic, Cardiac and Vascular Surgery, Tuebingen University Hospital, Tuebingen,Germany
| | - Ulrich Biber
- Department of Research and Basic Technologies, Erbe Elektromedizin GmbH, Tuebingen, Germany
| | - Walter Linzenbold
- Department of Research and Basic Technologies, Erbe Elektromedizin GmbH, Tuebingen, Germany
| | - Markus D Enderle
- Department of Research and Basic Technologies, Erbe Elektromedizin GmbH, Tuebingen, Germany
| | - Karolin Thiel
- Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Tuebingen, Germany
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Lacitignola L, Crovace A, Passantino G, Staffieri F. Ex-Vivo Evaluation of "First Tip Closing" Radiofrequency Vessel Sealing Devices for Swine Small Intestinal Transection. Vet Sci 2022; 9:vetsci9080445. [PMID: 36006360 PMCID: PMC9415842 DOI: 10.3390/vetsci9080445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 12/02/2022] Open
Abstract
This study compared burst pressure (BP), number of activations, and histological assessment of ex vivo swine small intestine loops transected by stapler, a single fulcrum radiofrequency vessel sealing (RFVS) device, and the newly-developed jaws RFVS. Fifty (n = 50) 20 cm long jejunal loops were randomly assigned to be transected with RFVS devices and linear stapler (Caiman5, Caiman Maryland, Caiman12, Ligasure Atlas, and Stapler group as control respectively). Caiman5, Caiman12 and stapler required only one activation to complete the sealing. The mean BP in Caiman5 and Caiman Maryland groups were significantly lower (p < 0.05) than the S group as control and the other RFVS devices studied. RFVS Caiman12 and Ligasure Atlas produced mean BP values that were close to the Control and did not differ between them. The lumen was totally closed in the Caiman12 and Ligasure Atlas groups. The findings of this investigation were promising; we discovered that Caiman12 and Ligasure Atlas produce comparable mechanical capabilities as well as stapled intestinal closure, however Caiman12 need a single activation to complete the transection.
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Affiliation(s)
- Luca Lacitignola
- Department of Emergencies and Organ Transplantation, Section of Veterinary Clinics and Animal Production, University of Bari, Valenzano, 70010 Bari, Italy
- Correspondence:
| | - Alberto Crovace
- Department of Emergencies and Organ Transplantation, Section of Veterinary Clinics and Animal Production, University of Bari, Valenzano, 70010 Bari, Italy
| | - Giuseppe Passantino
- Department of Veterinary, Medicine University of Bari, Valenzano, 70010 Bari, Italy
| | - Francesco Staffieri
- Department of Emergencies and Organ Transplantation, Section of Veterinary Clinics and Animal Production, University of Bari, Valenzano, 70010 Bari, Italy
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Carlo I, Antonia DD, Federico D, Marco E, Fabio C, Claudia B, Andrea B. Feasibility and safety of renal artery closure with advanced bipolar energy device during nephrectomy. Urologia 2022:3915603221116973. [DOI: 10.1177/03915603221116973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Many devices are available to control the renal pedicle during nephrectomy but the gold standard is still a matter of debate. Nanotechnology has evolved to include vessel-sealing systems; companies guarantee an efficacy for vessels until 7 mm. The aim of our study is to evaluate feasibility and safety of closure of the renal artery with radiofrequency energy during nephrectomy. Methods: We retrospectively evaluated consecutive patients undergoing nephrectomy between November 2016 and July 2020. Inclusion criteria were: renal artery diameter <7 mm and no significant arterial wall calcification. The EnSeal device was used in all cases for dissection, hemostasis and to secure the renal artery when feasible. Results: Overall 101 patients underwent nephrectomy, in 68 cases the radiofrequency alone was used to close the renal artery; in 45 patients during a laparoscopic procedure and in 23 during an open surgery. Conversion to open surgery was never necessary. No patients had major hemorrhagic complications. Mean operative time was 75 min, mean intraoperative blood loss was 85 ml. Overall 11 patients had postoperative complications, according to Clavien-Dindo: five grade I, three grade II, three grade III. Discussion: In our experience the closure of the renal artery with a radiofrequency energy device is a feasible and safe procedure. It allows a safe manipulation of the renal hilum, free from clips, which could limit surgeons’ maneuvers and be dislocated. We believe that a deep knowledge of the available technologies is fundamental for the surgeon and guarantees the best achievable results.
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Affiliation(s)
- Introini Carlo
- Department of Urology, E.O. Ospedali Galliera, Genoa, Italy
| | | | - Dotta Federico
- Department of Urology, E.O. Ospedali Galliera, Genoa, Italy
| | - Ennas Marco
- Department of Urology, E.O. Ospedali Galliera, Genoa, Italy
| | | | | | - Benelli Andrea
- Department of Urology, E.O. Ospedali Galliera, Genoa, Italy
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6
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Homma T. Advances and safe use of energy devices in lung cancer surgery. Gan To Kagaku Ryoho 2022; 70:207-218. [PMID: 35107778 PMCID: PMC8881425 DOI: 10.1007/s11748-022-01775-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/13/2022] [Indexed: 12/12/2022]
Abstract
Objectives A clear understanding of energy devices would help achieve high effectiveness and safety and guide the selection of devices. The present review aimed to elucidate the efficacy and adverse events of energy devices in lung cancer to guide the selection of appropriate devices depending on the situation. Methods Four major databases were searched electronically for relevant articles published until 16 April 2021. The reference lists of the identified papers were examined. We excluded (1) irrelevant studies, (2) manuscripts published in languages other than English and Japanese, (3) duplicates, and (4) studies for which the full text was not available in the databases. The results and key information obtained were summarized by means of a narrative approach. Results A total of 78 papers were included in the review and these were categorized according to the main topic of investigation as follows: (1) electrosurgery-related injuries, (2) fundamentals of electrosurgery, (3) monopolar devices, (4) bipolar electrosurgical devices, (5) ultrasonic energy devices, (6) energy devices in lung cancer surgery, (7) operating room fire risks, and (8) basic principles of surgery. Conclusions Understanding energy devices could help us use them in a more effective and safer manner. Knowledge of their selection criteria (suitability), merits, risks, and safety precautions relevant to each process of lung cancer surgery could guide appropriate selection. Supplementary Information The online version contains supplementary material available at 10.1007/s11748-022-01775-w.
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Affiliation(s)
- Takahiro Homma
- Department of General Thoracic and Cardiovascular Surgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan.
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7
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Comparing Two Approaches for Thyroidectomy: A Health Technology Assessment through DMAIC Cycle. Healthcare (Basel) 2022; 10:healthcare10010124. [PMID: 35052288 PMCID: PMC8776080 DOI: 10.3390/healthcare10010124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 01/09/2023] Open
Abstract
Total thyroidectomy is very common in endocrine surgery and the haemostasis can be obtained in different ways across surgery; recently, some devices have been developed to support this surgical phase. In this paper, a health technology assessment is conducted through the define, measure, analyse, improve, and control cycle of the Six Sigma methodology to compare traditional total thyroidectomy with the surgical operation performed through a new device in an overall population of 104 patients. Length of hospital stay, drain output, and time for surgery were considered the critical to qualities in order to compare the surgical approaches which can be considered equal regarding the organizational, ethical, and security impact. Statistical tests (Kolmogorov–Smirnov, t test, ANOVA, Mann–Whitney, and Kruskal–Wallis tests) and visual management diagrams were employed to compare the approaches, but no statistically significant difference was found between them. Considering these results, this study shows that the introduction of the device to perform total thyroidectomy does not guarantee appreciable clinical advantages. A cost analysis to quantify the economic impact of the device into the practice could be a future development. Healthy policy leaders and clinicians who are requested to make decisions regarding the supply of biomedical technologies could benefit from this research.
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8
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Zobe A, Rohwedder T, Böttcher P. Partial lung lobectomy with the Caiman ® Seal & Cut device in a dog with spontaneous pneumothorax: Case report. Open Vet J 2022; 12:910-918. [PMID: 36650868 PMCID: PMC9805754 DOI: 10.5455/ovj.2022.v12.i6.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/01/2022] [Indexed: 12/26/2022] Open
Abstract
Background Spontaneous pneumothorax in dogs is characterized by an accumulation of air in the interpleural space without underlying trauma and consecutive acute onset of respiratory distress. Underlying causes for spontaneous pneumothorax vary with ruptured bullae being one of the main causes. Treatment after initial stabilization often requires partial or complete surgical resection of affected lung lobes. Partial lung lobectomy can be performed with stapling devices or sealing devices for example, by different surgical approaches including video-assisted thoracoscopic surgery. However, inter-thoracic surgery in small-sized dogs using either of the techniques is challenging. Case Description A 12-year-old Shih Tzu was presented with spontaneous pneumothorax. Further diagnostics with computed tomography and intercostal thoracoscopy revealed a bulla in the right middle lung lobe. Partial lung lobectomy (2.5 × 2.5 × 2 cm) of the respective lung lobe was performed by an intercostal approach using the Caiman® 5 Seal & Cut sealing device. The Caiman® 5 Seal & Cut device allowed quick and safe partial lung lobectomy in the treatment of spontaneous pneumothorax without intra- or post-operative complications. The dog was discharged 2 days after surgery in good clinical condition. This report demonstrates the in-vivo efficacy and safety of the Caiman® 5 Seal & Cut sealing device for partial lung lobectomy in a small breed dog. Conclusion Using the Caiman® 5 Seal & Cut device lung tissue could be resected without intra- or post-operative complications in a small breed dog. This case may emphasize the use of the device in fully video-assisted thoracoscopic surgery also in small-sized patients.
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Affiliation(s)
- Anne Zobe
- Corresponding Author: Anne Zobel. Small Animal Clinic, Freie Universität Berlin, Berlin, Germany.
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9
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Hurcombe SD, Roessner HA, Klein CE, Engiles JB, Hopster K. Use of Polyamide (Nylon) Cable Ties for Vascular Ligation of Healthy Equine Jejunal Mesentery. Front Vet Sci 2021; 8:639424. [PMID: 34458347 PMCID: PMC8387623 DOI: 10.3389/fvets.2021.639424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/20/2021] [Indexed: 11/24/2022] Open
Abstract
Jejunal vascular ligation is an essential step in performing jejunojejunostomy. Hand sewn ligation is typically used and can increase operative time with long sections of bowel to be removed. Nylon cable ties (NCT) have been used for vascular ligation in horses but are yet to be investigated for application on the mesenteric vasculature of the gastrointestinal tract. Our objective was to evaluate the efficacy and short-term safety of NCT jejunal mesenteric vessel ligation in healthy horses. Eight healthy adult horses underwent midline celiotomy. A segment of jejunal mesentery was identified (≥4 arcades). Briefly, three fenestrations (proximal, middle, distal) were made 5–10 mm apart adjacent to the first and last vascular arcade to be ligated. Two sterilized NCT were passed to encircle the mesentery through the proximal and middle fenestrations, separated by intact mesentery. NCT were closed tightly and the vascular pedicle transected with Mayo scissors through the distal fenestration. Jejunojejunostomy was then performed and the mesentery sutured closed. The number of vascular arcades and time to ligate using NCT were recorded. At 2 weeks, horses underwent repeat celiotomy to assess the healing of the NCT ligation site and an equal number of vascular arcades were hand sewn double ligated using 2-0 Polyglactin 910 as a timed comparison. NCT mesenteric ligation was significantly faster than hand sewn methods (P < 0.01). Effective hemostasis was achieved in all cases. There was no evidence of local infection or adhesions at 14 days post-operatively. Further investigation in the long-term effects in horses as well as horses with strangulating jejunal lesions are needed for clinical application.
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Affiliation(s)
- Samuel D Hurcombe
- Department of Clinical Sciences, School of Veterinary Medicine, New Bolton Center, University of Pennsylvania, Kennett Square, PA, United States
| | - Holly A Roessner
- Department of Clinical Sciences, School of Veterinary Medicine, New Bolton Center, University of Pennsylvania, Kennett Square, PA, United States
| | - Chelsea E Klein
- Department of Clinical Sciences, School of Veterinary Medicine, New Bolton Center, University of Pennsylvania, Kennett Square, PA, United States
| | - Julie B Engiles
- Department of Clinical Sciences, School of Veterinary Medicine, New Bolton Center, University of Pennsylvania, Kennett Square, PA, United States.,Department of Pathobiology, School of Veterinary Medicine, New Bolton Center, University of Pennsylvania, Kennett Square, PA, United States
| | - Klaus Hopster
- Department of Clinical Sciences, School of Veterinary Medicine, New Bolton Center, University of Pennsylvania, Kennett Square, PA, United States
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10
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Lacitignola L, Imperante A, Trisciuzzi R, Zizzo N, Crovace AM, Staffieri F. Swine Small Intestine Sealing Performed by Different Vessel Sealing Devices: Ex-Vivo Test. Vet Sci 2021; 8:vetsci8020034. [PMID: 33671834 PMCID: PMC7926574 DOI: 10.3390/vetsci8020034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/19/2021] [Indexed: 02/01/2023] Open
Abstract
This study aimed to evaluate the sealing quality of swine small intestine using different laparoscopic radiofrequency vessel sealing devices (two 5 mm: RFVS-1 and -2; one 10 mm: RFVS-3) and a harmonic scalpel (HS) compared to golden standard closure technique. The study was divided into two arms. In study arm 1: n = 50 swine intestinal loops (10 per group) were transected with each instrument and the loops in which the devices provided complete sealing, at the gross inspection, were tested for maximum burst pressure (BP) and histological evaluation and compared to an automatic linear stapler. After the BP tests, the devices that achieved significantly lower BP values were excluded from the second arm. The RFVS-1 and -3 provided statistically significant results and were used in study arm 2, to obtain full-thickness biopsies along the antimesenteric border of the loop and were compared with hand-sewn intestinal closure (n = 30; 10 per group). The biopsies were histologically evaluated for thermal injury and diagnostic features, and intestinal loops tested for BP. RFVS-3 achieved comparable results (69.78 ± 4.23 mmHg, interquartile range (IQR) 5.8) to stapler closing technique (71.09 ± 4.22 mmHg, IQR 4.38; p > 0.05), while the RFVS-1 resulted in significantly (p < 0.05) lower BP (45.28 ± 15.23 mmHg, IQR 24.95) but over the physiological range, conversely to RFVS-2 (20.16 ± 7.19 mmHg, IQR 12.02) and HS (not measurable). RFVS-3 resulted not significantly different (p > 0.05) (45.09 ± 8.75 mmHg, IQR 10.48) than Suture (35.71 ± 17.51 mmHg, IQR 23.77); RFVS-1 resulted significantly lower values (23.96 ± 10.63 mmHg, IQR 9.62; p < 0.05). All biopsies were judged diagnostic. Data confirmed that RFVS-1 and -3 devices provided suitable intestinal sealing, with BP pressures over the physiological range. Conversely, the HS and RFVS-2 should not be considered for intestinal sealing. RFVS devices could be employed to obtain small intestine stump closure or full-thickness biopsies. However, further studies should be performed in live animals to assess the role of the healing process.
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Affiliation(s)
- Luca Lacitignola
- Dipartimento dell’Emergenze e Trapianti di Organi (D.E.T.O.), Sezione di Cliniche Veterinarie e Produzioni Animali, Università degli Studi di Bari “Aldo Moro”, 70124 Bari, Italy;
- Correspondence:
| | - Annarita Imperante
- Dottorato di Ricerca in “Trapianti di Tessuti ed Organi e Terapie Cellulari”, Dipartimento dell’Emergenza e Trapianti di Organi (D.E.T.O.), Università degli Studi di Bari “Aldo Moro”, 70124 Bari, Italy; (A.I.); (R.T.)
| | - Rodrigo Trisciuzzi
- Dottorato di Ricerca in “Trapianti di Tessuti ed Organi e Terapie Cellulari”, Dipartimento dell’Emergenza e Trapianti di Organi (D.E.T.O.), Università degli Studi di Bari “Aldo Moro”, 70124 Bari, Italy; (A.I.); (R.T.)
| | - Nicola Zizzo
- Dipartimento di Medicina Veterinaria, Sez. di Anatomia Patologica, Università degli Studi di Bari “Aldo Moro”, 70010 Bari, Italy;
| | - Alberto Maria Crovace
- Dipartimento di Scienze Mediche di Base, Neuroscienze e Organi di Senso, Università degli Studi di Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Francesco Staffieri
- Dipartimento dell’Emergenze e Trapianti di Organi (D.E.T.O.), Sezione di Cliniche Veterinarie e Produzioni Animali, Università degli Studi di Bari “Aldo Moro”, 70124 Bari, Italy;
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Kajiwara S, Noshiro H, Kitagawa H, Tanaka T, Kai K. Modification of the Thermal Spread by the Blade Shape of an Ultrasonically Activated Device. World J Surg 2021; 45:1698-1705. [PMID: 33598724 DOI: 10.1007/s00268-021-05971-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Few studies have focused on the spread of thermal damage from different blade shapes of ultrasonically activated devices (USADs) used during minimally invasive surgery. METHODS In vivo experiments using pig arteries, nerves, and mesentery were used to compare the thermal spread of two different blade types of USADs, non-tapered and tapered, under the same conditions. The tissue temperatures were monitored using a high-resolution infrared thermographic camera and calculated using an image analysis program. The spread of heat denaturation was measured histologically. RESULTS The temperature was greater at the sides with greater curvature when non-tapered USADs were activated (artery, 1 s, 2 mm: - 0.92 ± 0.5 °C vs. - 0.44 ± 0.5 °C, P = 0.022). This effect was more prominent in the tapered type (artery, 1 s, 0/1/2 mm: 9.14 ± 3.7 °C vs. 28.3 ± 16.2 °C/0.5 ± 1.4 °C vs. 9.76 ± 6.2 °C/ - 0.12 ± 0.9 °C vs. 1.44 ± 1.9 °C, P = 0.044/0.016/0.038, respectively). The temperatures in the tapered USAD were significantly higher at some time- and distance-points than those in a non-tapered USAD (artery, 1 s, 0 mm, Less/1 s, 1 mm, Gre: 4.2 ± 2.9 °C vs. 9.14 ± 3.7 °C /0.36 ± 0.5 °C vs. 9.76 ± 6.2 °C, P = 0.047/0.027; nerve, 2 s, 0 mm, Gre: 6.54 ± 3.9 °C vs. 17.66 ± 6.2 °C, P = 0.012). A three-directional study revealed the thermal spread of the mesentery was greatest at the tip side of the non-tapered type USAD (4.55 ± 2.53 °C vs. 12.43 ± 4.03 °C/12.43 ± 4.03 °C vs. 5.04 ± 1.91 °C, P = 0.003/0.005). CONCLUSIONS The thermal spread changed according to the blade shape of the USAD. This knowledge can be applied to more meticulous and complicated procedures, reducing surgical morbidity.
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Affiliation(s)
- Shuhei Kajiwara
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Hirokazu Noshiro
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Hiroshi Kitagawa
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Tomokazu Tanaka
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Keita Kai
- Department of Pathology, Saga University Hospital, Saga, Japan
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12
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LigaSure for the Creation of Bloodless Breast Pockets in Patients Undergoing Transaxillary Breast Augmentation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3295. [PMID: 33425607 PMCID: PMC7787310 DOI: 10.1097/gox.0000000000003295] [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: 08/28/2020] [Accepted: 10/14/2020] [Indexed: 11/26/2022]
Abstract
Background: The energy-based LigaSure device is widely utilized to facilitate dissection and hemostasis during various open and endoscopic procedures. Previous studies have demonstrated that this device can reduce intraoperative blood loss in various surgical settings. The present study aimed to report our experience with LigaSure and the advantages of using this device during transaxillary submuscular pocket dissection over those of a monopolar electrocautery dissector in patients undergoing breast augmentation. Methods: A total of 156 patients who underwent transaxillary breast augmentation between November 2019 and May 2020 were retrospectively reviewed. Submuscular pocket dissection using LigaSure was performed in 92 patients and a conventional technique using a monopolar electrocautery dissector was performed in the remaining 64 patients. A bloodless breast pocket was defined as a clear operating field with little or no blood staining at any stage of the procedure. All endoscopic procedures were recorded to determine whether bloodless pockets had been established. The amount of postoperative drainage at 1 day after surgery was also assessed to compare between the LigaSure and conventional groups. Results: Bloodless breast pockets were successfully established in 83 patients (90.2%) in the LigaSure group and in 38 patients (59.4%) in the conventional group (P < 0.001). Postoperative drainage amount at 1 day following surgery was significantly lower in the LigaSure group than in the conventional group (P < 0.001). Conclusion: Our findings indicate that the LigaSure system is a safe and effective alternative in breast augmentation requiring transaxillary submuscular dissection.
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13
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Dunay MP, Lipcsey Z, Arany-Tóth A, Németh T, Solymosi N, Venczel L, Nagy E, Pap-Szekeres J. Experimental assessment of three electrosurgical tissue-sealing devices in a porcine model. Acta Vet Hung 2020; 68:318-322. [PMID: 33136067 DOI: 10.1556/004.2020.00051] [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: 05/17/2020] [Accepted: 10/17/2020] [Indexed: 12/31/2022]
Abstract
Three electrosurgical tissue-sealing devices (EnSeal ETSDRC-01, LigaSure LS1500 and Thunderbeat TB-0535PC) were compared regarding sealing time (ST), maximum working temperature (WTmax) and the total (MTZtotal) as well as the collateral microscopic thermal injury zone (MTZcollat) using laparoscopic handpieces 5 mm in diameter on four types of tissue (liver, mesentery, cross striated muscle and spleen) in an in vivo porcine model. LigaSure had the lowest mean ST in spleen, mesentery, muscle and liver, followed by Thunderbeat and EnSeal with significant differences between all types of tissues and devices. The significantly lowest mean WTmax was obtained for EnSeal in mesentery, muscle and liver. LigaSure and EnSeal operated at the lowest temperature in spleen without a significant difference between them. Thunderbeat produced significantly higher temperature peaks in all cases. The lowest mean MTZtotal was caused by LigaSure and EnSeal in spleen, mesentery and muscle without significant differences between them, followed by the significantly higher values of Thunderbeat. Nevertheless, Thunderbeat produced the significantly lowest mean MTZtotal in the liver. EnSeal produced the lowest mean MTZcollat in the liver, followed by LigaSure and Thunderbeat showing significant differences. EnSeal and LigaSure produced the lowest mean MTZcollat in the spleen, mesentery and muscle without significant differences between them, followed by the significantly higher values of Thunderbeat. Based on the results of this study, Thunderbeat seems to be more invasive to tissue integrity (even without the activation of the ultrasonic scissor function) than EnSeal or LigaSure, that operate at lower temperatures and were found to cause negligible collateral thermal damage.
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Affiliation(s)
- Miklós Pál Dunay
- 1Department and Clinic of Surgery and Ophthalmology, University of Veterinary Medicine, István u. 2, H-1078, Budapest, Hungary
| | - Zsuzsanna Lipcsey
- 1Department and Clinic of Surgery and Ophthalmology, University of Veterinary Medicine, István u. 2, H-1078, Budapest, Hungary
| | - Attila Arany-Tóth
- 1Department and Clinic of Surgery and Ophthalmology, University of Veterinary Medicine, István u. 2, H-1078, Budapest, Hungary
| | - Tibor Németh
- 1Department and Clinic of Surgery and Ophthalmology, University of Veterinary Medicine, István u. 2, H-1078, Budapest, Hungary
| | - Norbert Solymosi
- 2Centre of Bioinformatics, University of Veterinary Medicine, Budapest, Hungary
| | - László Venczel
- 3Department of General Surgery, County Teaching Hospital, Kecskemét, Hungary
| | - Enikő Nagy
- 3Department of General Surgery, County Teaching Hospital, Kecskemét, Hungary
| | - József Pap-Szekeres
- 3Department of General Surgery, County Teaching Hospital, Kecskemét, Hungary
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14
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Koo K, Aro T, Becker RE, Lim S, Winoker JS, Petrisor D, Stoianovici D, Matlaga BR. Integrated Real-Time Digital Measurement During Ureteroscopic Procedures for Nephrolithiasis: A Workflow Feasibility Study. J Endourol 2020; 34:900-904. [DOI: 10.1089/end.2020.0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Kevin Koo
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tareq Aro
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Robotics Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Russell E.N. Becker
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sunghwan Lim
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Robotics Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jared S. Winoker
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Doru Petrisor
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Robotics Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dan Stoianovici
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Robotics Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian R. Matlaga
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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15
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Molotkovets VY, Medvediev VV, Korsak AV, Chaikovsky YB, Marynsky GS, Tsymbaliuk VI. Restoration of the Integrity of a Transected Peripheral Nerve with the Use of an Electric Welding Technology. NEUROPHYSIOLOGY+ 2020. [DOI: 10.1007/s11062-020-09848-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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16
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Blanc P, Pradat C, Breton C, Kassir R. Comparison Between Caïman® and Ligasure® in Laparoscopic Sleeve Gastrectomy: a Retrospective Study of 200 Patients. Obes Surg 2020; 30:2804-2806. [PMID: 32297080 DOI: 10.1007/s11695-020-04588-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Pierre Blanc
- Department of Bariatric Surgery, Clinique chirurgicale mutualiste, Saint Etienne, France
| | - Camille Pradat
- Department of Bariatric Surgery, Clinique chirurgicale mutualiste, Saint Etienne, France
| | - Christophe Breton
- Department of Bariatric Surgery, Clinique chirurgicale mutualiste, Saint Etienne, France
| | - Radwan Kassir
- Department of General Surgery, CHU Felix-Guyon, St-Denis, La Réunion, France.
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17
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Quitzan JG, Singh A, Beaufrere H, Valverde A, Lillie B, Salahshoor M, Bardelcik A, Saleh TM. Evaluation of the performance of an endoscopic 3-mm electrothermal bipolar vessel sealing device intended for single use after multiple use-and-resterilization cycles. Vet Surg 2020; 49 Suppl 1:O120-O130. [PMID: 32053219 DOI: 10.1111/vsu.13396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/22/2019] [Accepted: 01/18/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the performance of an endoscopic 3-mm electrothermal bipolar vessel sealing device (EBVS) intended for single use after multiple use-and-resterilization cycles. STUDY DESIGN Ex vivo study. SAMPLE POPULATION Eight 3-mm EBVS handpieces. METHODS Handpieces were subjected to a maximum of 15 cycles of testing, including simulated surgery, sealing and burst pressure testing of porcine carotid arteries, reprocessing, and hydrogen peroxide plasma resterilization. Failure was defined as two sequential vascular seal leakage events occurring at <250 mm Hg. Histological evaluation, maximum external temperature of the jaws, sealing time, tissue adherence, jaw surface characterization, and mechanical deterioration were studied. Failure rate was analyzed by using a Kaplan-Meier curve. Linear and ordinal logistic mixed models were used to analyze sealing time, handpiece jaw temperature, and adherence score. RESULTS Mean ± SD diameter of arteries was 3.22 ± 0.35 mm. Failure was observed starting at cycle 10 and going up to cycle 13 in 37.5% (3/8) of the handpieces. Tissue adherence increased after each cycle (P < .001). Maximum external temperature (79.8°C ± 13.9°C) and sealing time (1.8 ± 0.5 seconds) were not significantly different throughout cycles up to failure. A flatter surface and large scratches were observed microscopically throughout the jaw surface after repeated use and resterilization. CONCLUSION The 3-mm EBVS handpiece evaluated in this study can be considered safe to use for up to nine reuse-and-resterilization cycles. CLINICAL SIGNIFICANCE These data provide the basis for establishing preliminary guidelines for the reuse and hydrogen peroxide plasma resterilization of an endoscopic 3-mm EBVS handpiece.
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Affiliation(s)
- Juliany Gomes Quitzan
- School of Veterinary Medicine and Animal Science, Sao Paulo State University, Botucatu, Sao Paulo, Brazil.,Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Ontario, Canada
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Ontario, Canada
| | - Hugues Beaufrere
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Ontario, Canada
| | - Alexander Valverde
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Ontario, Canada
| | - Brandon Lillie
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Ontario, Canada
| | - Masoomeh Salahshoor
- School of Engineering, College of Engineering and Physical Sciences, University of Guelph, Ontario, Canada
| | - Alexander Bardelcik
- School of Engineering, College of Engineering and Physical Sciences, University of Guelph, Ontario, Canada
| | - Tarek M Saleh
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Ontario, Canada
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18
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El‐Sayed M, Mohamed S, Saridogan E. Safe use of electrosurgery in gynaecological laparoscopic surgery. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/tog.12620] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mohsen El‐Sayed
- Consultant Obstetrician and Gynaecologist Darent Valley Hospital Dartford DA2 8DA UK
- Honorary Senior Clinical Lecturer King's College London GKT School of Medical EducationLondon WC2R 2LS UK
| | - Sahar Mohamed
- Consultant Obstetrician and Gynaecologist Southend University Hospital Southend‐on‐Sea SS0 0RY UK
| | - Ertan Saridogan
- Consultant Gynaecologist University College London Hospitals London WC1E 6DB UK
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19
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Velotti N, Manigrasso M, Di Lauro K, Vitiello A, Berardi G, Manzolillo D, Anoldo P, Bocchetti A, Milone F, Milone M, De Palma GD, Musella M. Comparison between LigaSure™ and Harmonic® in Laparoscopic Sleeve Gastrectomy: A Single-Center Experience on 422 Patients. J Obes 2019; 2019:3402137. [PMID: 30719344 PMCID: PMC6335858 DOI: 10.1155/2019/3402137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/26/2018] [Accepted: 12/09/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND New laparoscopic devices, such as electrothermal bipolar-activated devices (LigaSure™ (LS)) or ultrasonic systems (Harmonic® scalpel (HS)), have been applied recently to bariatric surgery allowing to reduce blood loss and surgical risks. The aim of this study was to retrospectively compare intraoperative performance of HS and LS, postoperative results, and clinical outcomes in a large cohort of patients undergoing LSG. METHODS Data from 422 morbidly obese patients undergoing LSG in our Bariatric Unit at the Advanced Biomedical Sciences Department of the "Federico II" University of Naples (Italy) between January 2009 and December 2017 were retrospectively analyzed. Subjects were divided into two groups (HS and LS), and operative time, intraoperative complications, and postoperative (within 30 days from surgery) complications were compared. Bleeding from the omentum or from the staple line, use of hemostatic clips, and absorbable hemostat were recorded as intraoperative complications; hemorrhages, abscess formation, gastric leaks, fever, and mortality were considered as postoperative complications. RESULTS Statistical analysis showed no difference in terms of baseline demographics between the two cohorts. Operative time (48 ± 9 vs 49 ± 6 min, p=0.646) and the rates of intraoperative and postoperative complications did not significantly differ between groups. CONCLUSION Harmonic® and LigaSure™ are both useful tools in bariatric surgery, and these two advanced power devices are user-friendly and can facilitate surgeon work; from this point of view, the choice of the energy device should be based on the preference of the surgeon and on the hospital costs policy and availability.
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Affiliation(s)
- N. Velotti
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - M. Manigrasso
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - K. Di Lauro
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - A. Vitiello
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - G. Berardi
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - D. Manzolillo
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - P. Anoldo
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - A. Bocchetti
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - F. Milone
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - M. Milone
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - G. D. De Palma
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - M. Musella
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
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