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Wienerroither V, Hammer R, Kornprat P, Schrem H, Wagner D, Mischinger HJ, El-Shabrawi A. Use of LigaSure vessel sealing system versus conventional axillary dissection in breast cancer patients: a retrospective comparative study. BMC Surg 2022; 22:436. [PMID: 36544128 PMCID: PMC9773442 DOI: 10.1186/s12893-022-01888-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In locally advanced breast cancer, axillary lymph node dissection remains a pivotal component of surgical therapy. Apart from this, it has been mostly replaced by sentinel node biopsy. Complications after axillary dissection include wound infection, neuropathy, lymphedema and-most frequently-seroma. In this retrospective multi-centre study, we compared the use of LigaSureTM with monopolar electrocautery regarding perioperative outcome. METHODS A retrospective data analysis from female breast cancer patients who underwent axillary dissection at two breast centres in Austria that are using two different surgical techniques was performed for this study. We compared the rate of complications and re-operations, length of hospital stay, time to drain removal, total drain fluid, seroma formation after drain removal, number of seroma aspirations and total seroma fluid. RESULTS Seventy one female patients with a median age of 63 (30-83) were included in this study. In 35 patients LigaSureTM and in 36 monopolar cautery was used for axillary dissection. There was no significant difference regarding intraoperative complications and rate of re-operations between the two groups (2.9 vs. 5.6%; p = 1 and 2.9 vs. 13.9%; p = 0.199). The time to drain removal and the length of hospital stay was similar in both groups. A significant difference in the occurence of postoperative wound infection could also not be shown. However, we found a significantly smaller total drain fluid in the LigaSureTM-group compared to the cautery-group (364.6 ml vs. 643.4 ml; p = 0.004). Seroma formation after drain removal was more frequent in the LigaSureTM-group (68.6 vs. 41.7%; p = 0.032) with a higher number of outpatient seroma aspirations (2.0 vs. 0.9; p = 0.005). CONCLUSION LigaSureTM and monopolar cautery provide equivalent techniques in axillary lymph node dissection with comparable postoperative outcomes.
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Affiliation(s)
- V. Wienerroither
- grid.11598.340000 0000 8988 2476Department of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - R. Hammer
- Department of Surgery, LKH Graz II, Graz, Austria
| | - P. Kornprat
- grid.11598.340000 0000 8988 2476Department of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - H. Schrem
- grid.11598.340000 0000 8988 2476Department of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - D. Wagner
- grid.11598.340000 0000 8988 2476Department of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - H. J. Mischinger
- grid.11598.340000 0000 8988 2476Department of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - A. El-Shabrawi
- grid.11598.340000 0000 8988 2476Department of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
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PAVLIDIS ET, MICCOLI P. Hemostasis during thyroidectomy in the era of energy-based devices: an update. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.22.05398-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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3
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Gupta V, Chauhan SPS, Gupta M, Verma R, Singh SP, Panday A. Efficacy and Safety of LigaSure in Laparoscopic Sutureless Appendectomy. Cureus 2022; 14:e24764. [PMID: 35755548 PMCID: PMC9216166 DOI: 10.7759/cureus.24764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/05/2022] Open
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Olasehinde O, Owojuyigbe A, Adeyemo A, Mosanya A, Aaron O, Wuraola F, Owoniya T, Owojuyigbe T, Alatise O, Adisa A. Use of energy device in general surgical operations: impact on peri-operative outcomes. BMC Surg 2022; 22:90. [PMID: 35264141 PMCID: PMC8908598 DOI: 10.1186/s12893-022-01540-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 02/07/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The introduction of energy devices has significantly expanded the scope of surgical expedition. The LigaSure™ vessel sealing system is a bipolar electrosurgical device, recently introduced to our practice. Its impact on peri-operative outcomes in a variety of major operations was evaluated in this study. METHODS A retrospective review of operations performed following the adoption of the LigaSure™ vessel sealing device was carried out. Five categories of operations were evaluated (Thyroidectomies, Gastrectomies, Colectomies, Pancreaticoduodenectomies, and Anterior/Abdomino-perineal resection [A/APR of the rectum). Peri-operative outcomes (duration of operation, intra-operative blood loss, blood transfusion rates) were compared with a cohort of similar operations performed using conventional techniques. Data analysis and comparisons were done on a subgroup basis. RESULTS A total of 117 operations were performed using the LigaSure™ device with thyroidectomies being the most common (66/117-56.4%). Compared to cases done using conventional techniques of suture and knot with electrocautery (120 cases), the use of LigaSure™ was associated with a significant reduction in operation time in all categories of operations. Intraoperative blood loss was also lower in all categories of cases, but this was only statistically significant following A/APR and Thyroidectomies. Generally, there was a trend towards a reduction in blood transfusion rates. CONCLUSIONS The use of energy devices for surgical operations is feasible in a resource-limited setting. It has the potential of improving outcomes.
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Affiliation(s)
- Olalekan Olasehinde
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria.
| | - Afolabi Owojuyigbe
- Department of Anaesthesia, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Adekunle Adeyemo
- Department of Otorhinolaryngology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Arinzechukwu Mosanya
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - Olurotimi Aaron
- Department of Anaesthesia, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Funmilola Wuraola
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - Temitope Owoniya
- Department of Anaesthesia, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Temilola Owojuyigbe
- Department of Haematology, Obafemi Awolowo University Teaching Hospitals Complex, Ile- Ife, Nigeria
| | - Olusegun Alatise
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - Adewale Adisa
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
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Yu P, Zhong W. Hemostatic materials in wound care. BURNS & TRAUMA 2021; 9:tkab019. [PMID: 34541007 PMCID: PMC8445204 DOI: 10.1093/burnst/tkab019] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/08/2021] [Indexed: 12/22/2022]
Abstract
Blood plays an essential role in the human body. Hemorrhage is a critical cause of both military and civilian casualties. The human body has its own hemostatic mechanism that involves complex processes and has limited capacity. However, in emergency situations such as battlefields and hospitals, when the hemostatic mechanism of the human body itself cannot stop bleeding effectively, hemostatic materials are needed for saving lives. In this review, the hemostatic mechanisms and performance of the most commonly used hemostatic materials, (including fibrin, collagen, zeolite, gelatin, alginate, chitosan, cellulose and cyanoacrylate) and the commercial wound dressings based on these materials, will be discussed. These materials may have limitations, such as poor tissue adhesion, risk of infection and exothermic reactions, that may lessen their hemostatic efficacy and cause secondary injuries. High-performance hemostatic materials, therefore, have been designed and developed to improve hemostatic efficiency in clinical use. In this review, hemostatic materials with advanced performances, such as antibacterial capacity, superhydrophobicity/superhydrophilicity, superelasticity, high porosity and/or biomimicry, will be introduced. Future prospects of hemostatic materials will also be discussed in this review.
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Affiliation(s)
- Peiyu Yu
- Department of Biosystems Engineering, University of Manitoba, 75A Chancellor's Circle, Winnipeg, MB, R3T 2N2 Canada
| | - Wen Zhong
- Department of Biosystems Engineering, University of Manitoba, 75A Chancellor's Circle, Winnipeg, MB, R3T 2N2 Canada
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Radunz S, Salem H, Houben P, Pascher A, Büsing M, Utech M. LigaSure Impact™ reduces complications after abdominoplasty in weight loss patients. Langenbecks Arch Surg 2021; 407:321-326. [PMID: 34463791 PMCID: PMC8847208 DOI: 10.1007/s00423-021-02299-2] [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: 02/19/2021] [Accepted: 08/06/2021] [Indexed: 10/30/2022]
Abstract
PURPOSE Bariatric surgery is on the rise worldwide. With the desired weight loss after bariatric surgery, patients frequently develop massive skin flaps resulting in the need of abdominoplasty. In these patients, this surgical technique is frequently associated with perioperative complications. Strategies to minimize complications are sought after. The objective of our study was to compare two different dissection techniques and their impact on postoperative outcome. METHODS We included 66 patients in our study who underwent abdominoplasty after massive weight loss following bariatric surgery. In group 1, abdominoplasty was performed using the conventional technique of diathermia (n = 20). In group 2, abdominoplasty was performed using LigaSure Impact™ (n = 46). The duration of the surgical procedure and perioperative complications were recorded as primary endpoints. Secondary endpoints were length of hospital stay and assessment of additional risk factors. RESULTS Baseline characteristics were comparable between groups. The duration of surgery was significantly shorter in group 2. Postoperative complications were significantly less frequent in group 2 (p = 0.0035). Additional risk factors, e.g., smoking and diabetes mellitus, were not associated with increased rates of perioperative complications. CONCLUSIONS The choice of technical device for dissection in abdominoplasty alone will not guarantee minimized complication rates. Yet, the utilization of LigaSure Impact™ in refined surgical techniques may facilitate reduced rates of complications, especially wound infections, and a shortened duration of surgery.
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Affiliation(s)
- Sonia Radunz
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Haider Salem
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Philipp Houben
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Martin Büsing
- Department of General, Visceral and Bariatric Surgery, Plastic Surgery, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
| | - Markus Utech
- Department of General and Visceral Surgery, Knappschaftskrankenhaus Bergmannsheil-Buer, Gelsenkirchen, Germany
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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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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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Wong C, Goh A, Merkur H. Comparison of surgical outcomes using Gyrus PKS™ vs LigaSure™ in total laparoscopic hysterectomy: A randomised controlled trial. Aust N Z J Obstet Gynaecol 2020; 60:790-796. [PMID: 32729141 DOI: 10.1111/ajo.13217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Advanced vessel sealing devices are widely used in laparoscopic surgery. However, there remains a lack of adequately powered trials comparing laparoscopic advanced vessel sealing devices in the clinical setting, especially in gynaecology. AIMS This single-blinded randomised controlled trial aims to compare the surgical outcomes of total laparoscopic hysterectomy (TLH) using either the Gyrus PKS™ LYONS dissecting forceps or the LigaSure™ Maryland jaw vessel sealer/divider. MATERIALS AND METHODS Women who required TLHs for benign indications were randomised to having their surgeries performed using either Gyrus PKS™ or LigaSure™. Time to haemostasis (from initial skin incision to detachment of the uterus with secured haemostasis) was the primary outcome; a 20% difference in time was considered clinically significant. Secondary outcomes measured were intra-operative blood loss, complications, conversions, post-operative analgesia use, and length of stay. This study was registered with the Australia New Zealand Clinical Trials Registry ACTRN12615000639516. RESULTS Sixty-four women were included in the study - 33 and 31 in the Gyrus PKS™ and LigaSure™ arms, respectively. TLHs performed by LigaSure™ had statistically significantly shorter time to haemostasis compared to Gyrus PKS™ by 10.6 min (95% CI 1.3-2.0, P = 0.03). There were no differences in any of the other secondary outcomes measured. CONCLUSIONS This trial suggests there is no difference between using either device. TLHs performed using LigaSure™ have statistically significantly shorter time to haemostasis than those using Gyrus PKS™; however, the difference is not considered clinically significant as it was only 14.2%. No other differences in surgical outcomes were detected.
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Affiliation(s)
- Clare Wong
- Sydney West Advanced Pelvic Surgery Unit, Sydney, New South Wales, Australia.,Department of Obstetrics and Gynaecology, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Amy Goh
- Sydney West Advanced Pelvic Surgery Unit, Sydney, New South Wales, Australia.,Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Harry Merkur
- Sydney West Advanced Pelvic Surgery Unit, Sydney, New South Wales, Australia.,Department of Obstetrics and Gynaecology, Blacktown Hospital, Sydney, New South Wales, Australia.,Department of Obstetrics and Gynaecology, Western Sydney University School of Medicine, Blacktown/Mt Druitt Clinical School, Blacktown Hospital, Sydney, New South Wales, Australia
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Sirochman AL, Milovancev M, Townsend K, Grimes JA. Influence of use of a bipolar vessel sealing device on short-term postoperative mortality after splenectomy: 203 dogs (2005-2018). Vet Surg 2019; 49:291-303. [PMID: 31837169 DOI: 10.1111/vsu.13367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 09/26/2019] [Accepted: 11/15/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare short-term postoperative mortality in dogs after splenectomy performed with or without a bipolar vessel sealing device (BVSD) and to identify variables associated with mortality. STUDY DESIGN Retrospective study. SAMPLE POPULATION Client-owned dogs (n = 203). METHODS Medical records of dogs that underwent splenectomy from 2005-2018 were reviewed. Mortality rates were compared between dogs that underwent splenectomy with or without BVSD. Causes of death and variables associated with short-term mortality were assessed. RESULTS Fifteen of 203 (7.4%) dogs died prior to discharge, and seven (3.4%) dogs died prior to suture removal for a total short-term mortality rate of 22 of 203 (10.8%). The estimated difference in proportion of deaths prior to discharge between the BVSD and non-BVSD groups was -0.01 (95% confidence interval = -0.08 to 0.06). Duration of anesthesia was longer when splenectomy was performed without BVSD (median 168 vs 152 minutes; P = .03). Multivariate analysis identified intraoperative (odds ratio [OR] 5.7) or postoperative (OR 13.6) administration of blood products, increasing duration of anesthesia (OR 1.15 per additional 16 minutes), and intraoperative ventricular arrhythmias (OR 6.8) as significantly associated with death prior to discharge. Intraoperative (OR 3.2) or postoperative (OR 7.7) administration of blood products was associated with death prior to suture removal. CONCLUSION Use of a BVSD did not appear to increase short-term mortality after splenectomy. CLINICAL SIGNIFICANCE Dogs undergoing splenectomy that require intraoperative or postoperative transfusions, experience intraoperative ventricular arrhythmias, or have prolonged anesthesia may be at risk for death in the short-term postoperative period.
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Affiliation(s)
- Anna L Sirochman
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon
| | - Milan Milovancev
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon
| | - Katy Townsend
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon
| | - Janet A Grimes
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
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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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Tagkalos E, Heimann A, Gaiser T, Hirsch D, Gockel I, Lang H, Jansen-Winkeln B. Cecal Resection with Bipolar Sealing Devices in a Rat Model. J INVEST SURG 2018; 33:59-66. [PMID: 29775392 DOI: 10.1080/08941939.2018.1469698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Background: Bipolar sealing devices are routinely used to seal blood vessels. The aim of the study is to evaluate the feasibility and safety of colonic sealing with the use of the bipolar energy devices in rats as model for experimental appendectomy. Methods: Seventy-five male Wistar rats underwent a cecal resection with four different bipolar sealing devices or a linear stapler. The harvesting procedure was performed immediately or at postoperative day (POD) 7. The sealing front bursting pressure (BP) was measured in both groups. At POD7, the resection line was clinically examined and the hydroxyproline (HDP) levels were determined. Hematoxylin and Eosin (H&E) staining was used for histopathological evaluation of the sealing front as well. Results: There was no mortality and no insufficiency. The BPs between the bipolar sealing devices showed no statistical differences. The early phase of the seal (POD 0) provides a low BP with an 30.8% increase until POD 7. The BPs in the stapler group showed significant better values. The hydroxyproline levels did not differ statistically between the groups. Histopathologically, there were more signs of ischemic necrosis in the stapler group than in the sealing devices groups. Conclusion: The resection and sealing of the cecum as an experimental appendectomy model with the use of bipolar energy devices proved feasible and safe in rats. The different energy devices in this study produce comparable results. To justify clinical practice in humans, several studies on the underlying mechanisms of early stage wound healing are needed.
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Affiliation(s)
- E Tagkalos
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - A Heimann
- Institute for Neurosurgical Pathophysiology, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - T Gaiser
- Department of Pathology, University Hospital Mannheim, Mannheim, Germany
| | - D Hirsch
- Department of Pathology, University Hospital Mannheim, Mannheim, Germany
| | - I Gockel
- Department of Visceral, Transplant-, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - H Lang
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - B Jansen-Winkeln
- Department of Visceral, Transplant-, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
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Roy KK, GC N, Singhal S, Bharti J, Kumar S, Mitra DK, Ray R, Meena J, Vanamail P. Impact of energy devices on the post-operative systemic immune response in women undergoing total laparoscopic hysterectomy for benign disease of the uterus. J Turk Ger Gynecol Assoc 2018; 19:1-6. [PMID: 29503255 PMCID: PMC5838771 DOI: 10.4274/jtgga.2017.0076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/24/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Laparoscopic surgery is associated with reduced surgical stress response, lesser post- operative immune function, and consequent early recovery compared with conventional open surgery. There is a lack of evidence regarding the inflammatory stress response with the use of different energy devices. The present study was conducted to evaluate and compare the inflammatory response in total laparoscopic hysterectomy (TLH) using three different energy devices. MATERIAL AND METHODS A prospective randomized controlled study was conducted in 60 women with abnormal uterine bleeding undergoing TLH. They were divided into three groups based on the energy devices used, namely integrated bipolar and ultrasonic energy (Thunderbeat), ultrasonic (Harmonic) and electrothermal bipolar vessel sealing system (Ligasure). Cytokines and chemokines were measured in all three groups at different time points. RESULTS Serum levels of interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-α) increased postsurgery in all three groups and gradually declined by 72 hours. The geometric mean serum (IL)-6 levels was highest with Ligasure at 24 hours as compared with the other groups. Levels of TNF-α, macrophage inflammatory protein (MIP-1) α, MIP-1 β were also higher at 3 hours in the Ligasure group. When the differences between the groups were measured at different time points, there was a significantly greater increase in serum IL-6 levels in the Ligasure group at 24 hours (p=0.010). No significant difference was found in the post-operative course between the groups. CONCLUSION A greater inflammatory response was seen after the use of Ligasure indicating greater tissue damage. However, this response was not correlated with any difference in postoperative recovery.
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Affiliation(s)
- Kallol Kumar Roy
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Netra GC
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Juhi Bharti
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipendra K. Mitra
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | - Ruma Ray
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Meena
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Perumal Vanamail
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Panovski MJ, Fildishevski IV, Ognjenovic LL, Dejanova-Ilijevska VI. New Surgical Technologies Could Facilitate Surgical Hemostasis in Hemophilic Patients. Open Access Maced J Med Sci 2017; 5:295-298. [PMID: 28698745 PMCID: PMC5503725 DOI: 10.3889/oamjms.2017.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/02/2017] [Accepted: 04/05/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND It's assumed that surgery in haemophilia can be accomplished these days safely. AIM The aim of this study was to investigate the influence of new surgical technologies in the perioperative management and outcome of surgical procedures in haemophiliacs. METHODS Two patients with mild haemophilia A underwent surgery (laparoscopic appendectomy and inguinal hernia repair). In both patients, the replacement therapy, with factor VIII, started 30 min before surgery. We used the available surgical technologies and techniques with a proven value in the best clinical practice, to achieve proper and permanent hemostasis. Postoperatively, the replacement therapy and thromboembolic prophylaxis was continued according to the international guidelines for the management of haemophilia. RESULTS The operative and post-operative periods were uneventful. No significant differences were found in the operation time in our hemophilic patients versus non-hemophilic patients. Significant differences related to the hospital stay duration were found in both patients compared with controls, due to the necessary replacement therapy. CONCLUSION With new surgical technologies, proper and permanent hemostasis can be achieved, without prolonging the operation time.
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Affiliation(s)
- Milcho J. Panovski
- University Clinic for Digestive Surgery, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Igor V. Fildishevski
- University Clinic for Digestive Surgery, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Ljubomir Lj. Ognjenovic
- University Clinic for Digestive Surgery, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Violeta I. Dejanova-Ilijevska
- National Center for Hemophilia, Republic Institute for Transfusiology, Vodnjanska 17, Skopje 1109, Republic of Macedonia
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LAPAROSCOPIC OVARIECTOMY IN THE ASIATIC BLACK BEAR (URSUS THIBETANUS) WITH THE USE OF THE SONICISION™ DEVICE. J Zoo Wildl Med 2017; 48:213-216. [PMID: 28363060 DOI: 10.1638/2015-0082.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Laparoscopic ovariectomy was performed in two Asiatic black bears ( Ursus thibetanus ). Bears were placed in a 20° Trendelenburg position on a surgical table. A three-portal technique was used. A camera port was established 10 cm caudal to the umbilicus with a 5-mm cannula. Two instrument ports were made 1 cm caudal to the umbilicus with a 5-mm cannula and 8 cm caudal to the camera port with a 12-mm cannula, respectively. The suspensory ligament, ovarian vasculature, and uterine horn tip were progressively dissected following coagulation with the Sonicision™ cordless ultrasonic dissection device. The resected ovary was exteriorized through the 12-mm instrument portal site but enlarged to a 2-cm incision length. The abdominal musculature, subcutaneous tissue, and skin of the portal sites were closed separately. Total surgical time was 113 min (Bear A) and 49 min (Bear B), and no postoperative complications were encountered. This is the first report of laparoscopic ovariectomy in the Asiatic black bear.
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Chavez KV, Barajas EM, Ramírez J, Pantoja JP, Sierra M, Velázquez-Fernandez D, Herrera MF. Comparative analysis between a bipolar vessel sealing and cutting device and the tie and suture technique in thyroidectomy: A randomized clinical trial. Surgery 2016; 161:477-484. [PMID: 27614416 DOI: 10.1016/j.surg.2016.07.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/16/2016] [Accepted: 07/27/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Advanced bipolar and ultrasonic devices have shown significant reduction in the surgical time of thyroid operations. This randomized, controlled trial assessed if operative time and other relevant outcomes are different for thyroidectomies performed either with a second-generation advanced bipolar device or traditional tie and suture technique. METHODS Forty-one patients were randomized into 2 groups (advanced bipolar device and traditional tie and suture). Secondary end points included estimated blood loss, postoperative hemorrhage or hematoma requiring operative reintervention, recurrent laryngeal nerve injury, hypoparathyroidism, pain intensity, number of ligatures, analgesia usage, and loss of signal during recurrent laryngeal nerve monitoring. RESULTS Preoperative characteristics were similar between both groups. Mean operative time in the advanced bipolar device group was reduced by 32.5 minutes compared with the traditional tie and suture group (P = .006). Intraoperative blood loss was similar in both groups. Four patients presented postoperative vocal cord dysmotility, 3 in the traditional tie and suture group and 1 in the advanced bipolar device group (P = ns). Two of these 4 patients also had a >50% amplitude decrease during continuous intraoperative neuromonitoring, 1 in each group. Pain intensity, 12 hours after operation, was significantly greater in the traditional tie and suture group (P = .015), even though pain medication requirements during the initial 24 hours after operation were similar between groups (P = .97). There were no cases of postoperative hemorrhage or hematoma requiring reintervention. Postoperative, symptomatic hypocalcemia occurred in 6 patients, 4 in the traditional tie and suture, and 2 in the advanced bipolar device group. One of them developed permanent hypocalcemia. CONCLUSION The use of an advanced bipolar device in thyroid operation reduces operative time by >30 minutes, with a similar postoperative outcome profile when compared with the traditional tie and suture technique.
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Affiliation(s)
- K Verónica Chavez
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - E Manuel Barajas
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Jaqueline Ramírez
- Otolaryngology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Juan Pablo Pantoja
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Mauricio Sierra
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - David Velázquez-Fernandez
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Miguel F Herrera
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México.
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Vidal O, Saavedra-Perez D, Valentini M, Astudillo E, Fernández-Cruz L, García-Valdecasas JC. Surgical outcomes of total thyroidectomy using the LigaSure™ Small Jaw versus LigaSure Precise™: A retrospective study of 2000 consecutive patients. Int J Surg 2016; 37:8-12. [PMID: 27565244 DOI: 10.1016/j.ijsu.2016.08.241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND We compared surgical outcomes of LigaSure™ Small Jaw, which is a multifunctional thermal device that incorporates a tissue divider versus LigaSure Precise™ in thyroid surgery. METHODS A retrospective, single-center study was carried out in an acute-care teaching hospital in Barcelona, Spain. Between January 2008 and June 2015, consecutive patients scheduled for total thyroidectomy were included in the study. Surgical outcomes were operative time, length of skin incision, use of a suction drain, intraoperative bleeding, postoperative complications and length of hospital stay. RESULTS A total of 2000 patients were included (LigaSure™ Small Jaw, n = 1000; LigaSure Precise™, n = 1000). Demographics and indication for surgery were similar in both groups. A significant and independent shorter operative time (median 40 vs. 65 min, P = 0.002), smaller length of the skin incision (mean [SD] 4 [2] vs. 7 [3] cm, P = 0.031), lower percentages of patients with suction drain (15% vs. 66%, P = 0.012) and intraoperative bleeding (4% vs. 9%, P = 0.045) and reduced length of stay (median 1 vs. 3 days, P = 0.039) were found in the LigaSure™ Small Jaw than in the LigaSure Precise™. Postoperative complications including haematoma, hypoparathyroidism and recurrent laryngeal nerve injury were similar. CONCLUSIONS The LigaSure™ Small Jaw in thyroid surgery results in significant less blood loss and operative time as well as shorter hospital stay compared to LigaSure Precise™. These findings could have direct application in daily practice.
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Affiliation(s)
- Oscar Vidal
- Department of Endocrine Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
| | - David Saavedra-Perez
- Department of Endocrine Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Mauro Valentini
- Department of Endocrine Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Emiliano Astudillo
- Department of Endocrine Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Laureano Fernández-Cruz
- Department of Endocrine Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Juan C García-Valdecasas
- Department of Endocrine Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
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Ghisi D, Fanelli A, Vianello F, Gardini M, Mensi G, La Colla L, Danelli G. Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Total Laparoscopic Hysterectomy. Anesth Analg 2016; 123:488-92. [DOI: 10.1213/ane.0000000000001267] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Upadhyaya A, Hu T, Meng Z, Li X, He X, Tian W, Jia Q, Tan J. Harmonic versus LigaSure hemostasis technique in thyroid surgery: A meta-analysis. Biomed Rep 2016; 5:221-227. [PMID: 27446546 DOI: 10.3892/br.2016.691] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/18/2016] [Indexed: 01/21/2023] Open
Abstract
Harmonic scalpel and LigaSure vessel sealing systems have been suggested as options for saving surgical time and reducing postoperative complications. The aim of the present meta-analysis was to compare surgical time, postoperative complications and other parameters between them in for the open thyroidectomy procedure. Studies were retrieved from MEDLINE, Cochrane Library, EMBASE and ISI Web of Science until December 2015. All the randomized controlled trials (RCTs) comparing Harmonic scalpel and LigaSure during open thyroidectomy were selected. Following data extraction, statistical analyses were performed. Among the 24 studies that were evaluated for eligibility, 7 RCTs with 981 patients were included. The Harmonic scalpel significantly reduced surgical time compared with LigaSure techniques (8.79 min; 95% confidence interval, -15.91 to -1.67; P=0.02). However, no significant difference was observed for the intraoperative blood loss, postoperative blood loss, duration of hospital stay, thyroid weight and serum calcium level postoperatively in either group. The present meta-analysis indicated superiority of Harmonic Scalpel only in terms of surgical time compared with LigaSure hemostasis techniques in open thyroid surgery.
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Affiliation(s)
- Arun Upadhyaya
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Tianpeng Hu
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Xue Li
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Xianghui He
- Department of General Surgery, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Weijun Tian
- Department of General Surgery, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Qiang Jia
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Jian Tan
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
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Evaluation of the LigaSure(™) Vessel Sealing System for bowel transection and intestinal anastomosis-an experimental study in a porcine model. Langenbecks Arch Surg 2016; 401:381-7. [PMID: 27007724 DOI: 10.1007/s00423-016-1406-3] [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: 01/04/2016] [Accepted: 03/11/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of the present study is to assess the value of the LigaSure™ Vessel Sealing System (LVSS) as a means for bowel transection and intestinal anastomosis. METHODS We compared the LVSS for (1) transecting bowel and (2) creation of an intestinal anastomosis with standard methods such as stapler (S) and hand-sewn (HS) in a porcine model. For each study arm, i.e., bowel transection and anastomosis creation, both the small bowel and colon were examined. In total, ten transections and ten anastomoses were performed for each. Burst and anastomotic leak pressures were compared. RESULTS In the study arm 1, LVSS achieved lowest burst pressures in both small bowel (LVSS 39.8 ± 3.6 mmHg, S 81.9 ± 3.9, HS 111.9 ± 14.7 mmHg, p < 0.0001) and colon transections (LVSS 21.5 ± 2.6 mmHg, S 79.5 ± 4.9, HS 91.0 ± 5.2 mmHg, p < 0.0001). There was no difference in burst pressures between S and HS in both small bowel and colon transections. In the study arm 2, LVSS showed the lowest anastomotic leak pressures for small bowel (LVSS 26.4 ± 2.6 mmHg, S 52.1 ± 6.2, HS 87.4 ± 7.0 mmHg, p < 0.0001) and colonic anastomoses (LVSS 16.9 ± 1.3 mmHg, S 55.9 ± 4.3, HS 74.4 ± 4.4 mmHg, p < 0.0001). Furthermore, small bowel and colonic anastomoses using S demonstrated significantly lower leak pressures than HS anastomosis p < 0.001 and p = 0.004, respectively. CONCLUSIONS The LVSS achieves significantly lower burst pressures and anastomotic leak pressures for bowel transection and intestinal anastomosis than S and HS techniques. However, due to the achieved pressure levels of 39.8 ± 3.6 mmHg, LVSS appears to be a sufficient stand-alone method for bowel transection. Whether it can be used to perform intestinal anastomosis warrants further research in a survival model.
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Das A, Chattopadhyay S, Mandal D, Chhaule S, Mitra T, Mukherjee A, Mandal SK, Chattopadhyay S. Does the preoperative administration of tranexamic acid reduce perioperative blood loss and transfusion requirements after head neck cancer surgery? A randomized, controlled trial. Anesth Essays Res 2015; 9:384-90. [PMID: 26712979 PMCID: PMC4683496 DOI: 10.4103/0259-1162.161806] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Head and neck cancer (HNC) surgery is associated with high intraoperative blood loss which may require urgent blood transfusion. Many strategies have been recommended to decrease the need for allogenic transfusion. Use of perioperative tranexamic acid (TA) has a promising role. Aims: This study was to evaluate the effectiveness of single preoperative bolus dose of TA on blood loss prevention and red blood cell transfusion in patients undergoing HNC surgery. Study Design: A prospective, double-blind, and randomized controlled study. Materials and Methods: From 2007 July to 2010 January; 80 patients, aged (35–55), of American Society of Anesthesiologists II-III scheduled for unilateral HNC surgeries were randomly received either TA (Group T) in a dose of 20 mg/kg diluted to 25 cc with normal saline or an equivalent volume of normal saline (Group C) in a tertiary care hospital. Hemoglobin (Hb) concentration, platelet count, packed cell volume, fibrinogen level, D-dimer level were measured pre- and post-operatively. Results: Saline (C) Group required more blood, colloid, crystalloid for blood loss. In Group T, 32 patients did not require transfusion of any blood products compared to five patients in Group C (P < 0.0001) and only eight units of blood was transfused in Group T, whereas a total of 42 units of blood was transfused in Group C. Even after numerous transfusions, Hb% after 6 h and 24 h in Group C were significantly low in comparison with Group T (P < 0.05). Conclusion: Thus, TA significantly reduces blood loss and chances of colloid, blood, and crystalloid transfusion caused by HNC surgery.
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Affiliation(s)
- Anjan Das
- Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Berhampore, West Bengal, India
| | - Surajit Chattopadhyay
- Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Berhampore, West Bengal, India
| | - Debabrata Mandal
- Department of Oral and Maxillofacial Surgery, Dr. R. Ahmed Dental College, Berhampore, West Bengal, India
| | - Subinay Chhaule
- Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Berhampore, West Bengal, India
| | - Tapobrata Mitra
- Department of Anaesthesiology, Murshidabad Medical College, Berhampore, West Bengal, India
| | - Anindya Mukherjee
- Department of Anaesthesiology, N.R.S. Medical College, Kolkata, West Bengal, India
| | - Subrata Kumar Mandal
- Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Berhampore, West Bengal, India
| | - Sandip Chattopadhyay
- Department of Gynecology and Obstetrics, College of Medicine and Sagore Dutta Hospital, Berhampore, West Bengal, India
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Electrocautery device does not provide adequate pulmonary vessel sealing in transumbilical anatomic pulmonary lobectomy. Surg Endosc 2015; 30:1911-9. [PMID: 26275535 DOI: 10.1007/s00464-015-4412-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Safe pulmonary vessel sealing device plays a crucial role in anatomic lung resection. In 2014, we reported high rates of massive bleeding complications during transumbilical lobectomy in a canine model due to difficulty in managing the pulmonary vessel with an endostapler. In this animal survival series, we aimed to evaluate the outcome of pulmonary vessel sealing with an electrocautery device to simplify the transumbilical thoracic surgery. METHODS Under general anesthesia, a 3-cm longitudinal incision was made over the umbilicus. Under video guidance, a bronchoscope was inserted through the incision for exploration. The diaphragmatic wound was created with an electrocautery knife and used as the entrance into the thoracic cavity. Using the transumbilical technique, anatomic lobectomy was performed with electrosurgical devices and endoscopic vascular staplers in 15 canines. RESULTS Transumbilical endoscopic anatomic lobectomy was successfully completed in 12 of the 15 animals. Intraoperative bleeding developed in three animals during pulmonary hilum dissection, where one animal was killed due to hemodynamic instability and the other two animals required thoracotomy to complete the operation. There were five delayed bleeding and surgical mortality cases caused by inadequate vessel sealing by electrosurgical devices. Postmortem examination confirmed correct transumbilical lobectomy in the twelve animals that survived the operations. CONCLUSION Transumbilical anatomic lobectomy is technically feasible in a canine model; however, the electrosurgical devices were not effective in sealing the pulmonary vessel in the current canine model.
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Abstract
Since its invention nearly 20 years ago, the Covidien LigaSure device along with its ForceTriad generator has dominated the Electrothermal Bipolar Vessel Sealing market. The LigaSure was used for surgical procedures, both open and laparoscopic. The purpose of this review is to provide evidence of the safety and utility of the LigaSure device compared to more traditional means of hemostasis and its ultrasonic competitor, particularly in laparoscopic applications. We will provide evidence related to electrothermal bipolar vessel sealing in general and look specifically at Covidien's newest product, the LigaSure Maryland Jaw Device.
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Affiliation(s)
- Nisar Zaidi
- Endocrine Surgical Unit, Royal North Shore Hospital, University of Sydney, St. Leonards, New South Wales 2065, Australia
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Non-vascular experimental and clinical applications of advanced bipolar radiofrequency thermofusion technology in the thorax and abdomen: a systematic review. Surg Endosc 2014; 29:1659-78. [DOI: 10.1007/s00464-014-3893-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 09/08/2014] [Indexed: 11/26/2022]
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Wyld L, Audisio RA, Poston GJ. The evolution of cancer surgery and future perspectives. Nat Rev Clin Oncol 2014; 12:115-24. [PMID: 25384943 DOI: 10.1038/nrclinonc.2014.191] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Surgery is the oldest oncological discipline, dating back thousands of years. Prior to the advent of anaesthesia and antisepsis 150 years ago, only the brave, desperate, or ill-advised patient underwent surgery because cure rates were low, and morbidity and mortality high. However, since then, cancer surgery has flourished, driven by relentless technical innovation and research. Historically, the mantra of the cancer surgeon was that increasingly radical surgery would enhance cure rates. The past 50 years have seen a paradigm shift, with the realization that multimodal therapy, technological advances, and minimally invasive techniques can reduce the need for, or the detrimental effects of, radical surgery. Preservation of form, function, and quality of life, without compromising survival, is the new mantra. Today's surgeons, no longer the uneducated technicians of history, are highly trained medical professionals and together with oncologists, radiologists, scientists, anaesthetists and nurses, have made cancer surgeries routine, safe, and highly effective. This article will review the major advances that have underpinned this evolution.
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Affiliation(s)
- Lynda Wyld
- Department of Oncology, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield S10 2RX, UK
| | - Riccardo A Audisio
- Department of Surgery, St Helens Teaching Hospital, University of Liverpool, St Helens, Merseyside WA9 3DA, UK
| | - Graeme J Poston
- Department of Surgery, Aintree University Hospital, Longmoor Lane, Liverpool, Merseyside L9 7AL, UK
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Bipolar sealing of lung parenchyma: tests in an ex vivo model. Surg Endosc 2014; 29:127-32. [PMID: 25027470 DOI: 10.1007/s00464-014-3664-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Almost every pulmonary lobe resection requires cutting the lung parenchyma in the area of a lung fissure. A monopolar cutter or stapler is often used for this purpose. The seal should be absolutely airtight to prevent post-operative pulmonary fistulas. In the present study, the bipolar sealing technique was evaluated regarding air tightness of the seals during normal ventilation and its burst pressure in an ex vivo animal model. MATERIALS AND METHODS The investigations were carried out on paracardial lung lobes obtained from heart-lung preparations taken from freshly killed pigs at a slaughter house. In the laboratory, each individual lobe was perfused with Ringer's solution at body temperature and protectively ventilated through a tube (frequency: 20 1/min, p insp = 20 mbar, PEEP +5 mbar). Non-anatomic resection was carried out in the periphery of the lung lobe. The two control groups (12 lobes per group; Group 1-stapler, Group 2-parenchyma suture) were compared to three groups in which different bipolar sealing instruments were used. They were Group 3-MARSEAL(®) 10 mm (KLS Martin, Tuttlingen); Group 4-MARSEAL(®) 5 mm; and Group 5-MARCLAMP(®) (KLS Martin, Tuttlingen). The SealSafe(®) G3 electric current was used in all cases. Ventilation was continued for 20 min following parenchymal resection. Parenchymal sealing was then judged visually in a water bath and given a score (0-3). Burst pressure (mbar) was measured by increasing the inspiration pressure stepwise. Group mean values were compared (nonparametric Mann-Whitney U test, p < 0.005). RESULTS Parenchymal seals were airtight under ventilation throughout the observation period in all groups. Mean burst pressures were as follows: Group 1: 47.1 ± 6.2 mbar; Group 2: 32.9 ± 3.9 mbar; Group 3: 38.8 ± 2.2 mbar; Group 4: 25.0 ± 6.4 mbar; and Group 5: 32.9 ± 5.8 mbar. Group 1, the stapler group, thus exhibited the highest burst pressures. Burst pressures for Group 3 were significantly greater than those for Group 2 (p < 0.006). Burst pressures for groups 2 and 5 were similar (p = 0.97). However, the burst pressures for Group 4 were significantly lower than those for Group 2 (p < 0.001). CONCLUSION MARSEAL(®) 10 mm and MARCLAMP(®) achieved adequate burst pressures compared to the two control groups and thus might be suitable for clinical use.
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Butskiy O, Wiseman SM. Electrothermal bipolar vessel sealing system (LigaSure™) for hemostasis during thyroid surgery: a comprehensive review. Expert Rev Med Devices 2014; 10:389-410. [DOI: 10.1586/erd.13.6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Contin P, Gooßen K, Grummich K, Jensen K, Schmitz-Winnenthal H, Büchler MW, Diener MK. ENERgized vessel sealing systems versus CONventional hemostasis techniques in thyroid surgery--the ENERCON systematic review and network meta-analysis. Langenbecks Arch Surg 2013; 398:1039-56. [PMID: 24240627 DOI: 10.1007/s00423-013-1137-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/25/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Energized vessel-sealing systems have been proposed to save operation time and reduce post-operative complications. The aim of the present systematic review was to compare operation time and postoperative morbidity for ultrasonic and electrothermal bipolar-activated devices with conventional hemostasis techniques and with each other in open thyroidectomy. METHODS A systematic literature search (MEDLINE, Cochrane Library, EMBASE and ISI Web of Science) was performed to identify randomised controlled trials (RCTs) comparing conventional hemostasis techniques, ultrasonic devices (Harmonic® scalpel) and/or electrothermal bipolar-activated vessel sealing systems (Ligasure®) during open thyroidectomy. For the primary endpoint (operation time), a network meta-analysis with Bayesian random effects model was performed. Pairwise meta-analyses with random effects were calculated for primary and secondary endpoints. RESULTS One hundred sixteen publications were evaluated for eligibility; 35 RCTs (4,061 patients) were included. There was considerable methodological and clinical heterogeneity of included trials. The Harmonic scalpel significantly reduced operation time compared with conventional techniques (22.26 min, 22.7 min in the inconsistency model). The use of Ligasure significantly reduced operation time in total thyroidectomy (13.84 min in the consistency model, 12.18 min in the inconsistency model). In direct comparison, operations with the Harmonic scalpel were faster than with Ligasure (8.42 min in the consistency model, 2.45 min in the inconsistency model). The rates of recurrent nerve palsy and postoperative hypocalcaemia did not significantly differ in the intervention groups. CONCLUSIONS This meta-analysis shows superiority of ultrasonic devices in terms of operation time compared with conventional hemostasis techniques in thyroid surgery, with no detriment to safety outcomes.
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Affiliation(s)
- Pietro Contin
- Department of General-, Visceral- and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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Law KSK, Lyons SD. Comparative studies of energy sources in gynecologic laparoscopy. J Minim Invasive Gynecol 2013; 20:308-18. [PMID: 23659751 DOI: 10.1016/j.jmig.2013.01.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 01/23/2013] [Indexed: 10/26/2022]
Abstract
Energy sources incorporating "vessel sealing" capabilities are being increasingly used in gynecologic laparoscopic surgery although conventional monopolar and bipolar electrosurgery remain popular. The preference for one device over another is based on a combination of factors, including the surgeon's subjective experience, availability, and cost. Although comparative clinical studies and meta-analyses of laparoscopic energy sources have reported small but statistically significant differences in volumes of blood loss, the clinical significance of such small volumes is questionable. The overall usefulness of the various energy sources available will depend on a number of factors including vessel burst pressure and seal time, lateral thermal spread, and smoke production. Animal studies and laboratory-based trials are useful in providing a controlled environment to investigate such parameters. At present, there is insufficient evidence to support the use of one energy source over another.
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Affiliation(s)
- Kenneth S K Law
- Department of Endo-Gynaecology, Royal Hospital for Women, Sydney, Australia.
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Bertolaccini L, Viti A, Cavallo A, Terzi A. Results of Li-Tho trial: a prospective randomized study on effectiveness of LigaSure(R) in lung resections. Eur J Cardiothorac Surg 2013; 45:693-8; discussion 698. [DOI: 10.1093/ejcts/ezt445] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Total thyroidectomy: Ligasure versus Clamp & Knot technique for intraoperative hemostasis. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.ejenta.2013.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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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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Arya S, Hadjievangelou N, Lei S, Kudo H, Goldin RD, Darzi AW, Elson DS, Hanna GB. Radiofrequency-induced small bowel thermofusion: an ex vivo study of intestinal seal adequacy using mechanical and imaging modalities. Surg Endosc 2013; 27:3485-96. [PMID: 23572219 DOI: 10.1007/s00464-013-2935-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 03/12/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bipolar radiofrequency (RF) induced tissue fusion is believed to have the potential to seal and anastomose intestinal tissue thereby providing an alternative to current techniques which are associated with technical and functional complications. This study examines the mechanical and cellular effects of RF energy and varying compressive pressures when applied to create ex vivo intestinal seals. METHODS A total of 299 mucosa-to-mucosa fusions were formed on ex vivo porcine small bowel segments using a prototype bipolar RF device powered by a closed-loop, feedback-controlled RF generator. Compressive pressures were increased at 0.05 MPa intervals from 0.00 to 0.49 MPa and RF energy was applied for a set time period to achieve bowel tissue fusion. Seal strength was subsequently assessed using burst pressure and tensile strength testing, whilst morphological changes were determined through light microscopy. To further identify the subcellular tissue changes that occur as a result of RF energy application, the collagen matrix in the fused area of a single bowel segment sealed at an optimal pressure was examined using transmission electron microscopy (TEM). RESULTS An optimal applied compressive pressure range was observed between 0.10 and 0.25 MPa. Light microscopy demonstrated a step change between fused and unfused tissues but was ineffective in distinguishing between pressure levels once tissues were sealed. Non uniform collagen damage was observed in the sealed tissue area using TEM, with some areas showing complete collagen denaturation and others showing none, despite the seal being complete. This finding has not been described previously in RF-fused tissue and may have implications for in vivo healing. CONCLUSIONS This study shows that both bipolar RF energy and optimal compressive pressures are needed to create strong intestinal seals. This finding suggests that RF fusion technology can be effectively applied for bowel sealing and may lead to the development of novel anastomosis tools.
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Affiliation(s)
- Shobhit Arya
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, 10th Floor, QEQM Building, South Wharf Road, London W2 1NY, UK.
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Use of a vessel sealing system versus conventional electrocautery for lung parenchymal resection: a comparison of the clinicopathological outcomes in porcine lungs. Surg Today 2013; 44:540-5. [PMID: 23494066 DOI: 10.1007/s00595-013-0545-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 12/25/2012] [Indexed: 01/16/2023]
Abstract
PURPOSE LigaSure, a vessel sealing system, has been shown to have excellent hemostatic properties; however, its use for lung parenchymal resection has been limited. We herein examined the hemostatic properties and potential for inducing histological lung injury of the LigaSure system in non-anatomic pulmonary resection to estimate the feasibility of its clinical application. METHODS Non-anatomic pulmonary wedge resections of the right cranial, middle, and caudal lobes were performed in four pigs using the LigaSure system (Group A) or electrocautery (Group B). In each resection, the resection time, blood loss, and weight of the resected lung were measured. The thermal effect on the lung tissue was examined by means of intraoperative thermography and histology. RESULTS A total of 12 lung wedge resections were performed in each group. For an equivalent length of operation and weight of the resected lung parenchyma, Group A showed significantly lower blood loss and lower maximum and minimum temperatures of the lung tissue, as assessed by thermography, than Group B. The degree of thermal injury as estimated by a histological examination was lower in Group A than in Group B. CONCLUSION Our study suggests that the LigaSure system may be superior to conventional electrocautery, indicating its clinical usefulness for non-anatomic pulmonary resection.
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Tsirline VB, Lau KN, Swan RZ, Montero PN, Sindram D, Martinie JB, Iannitti DA. Evaluation of an innovative, cordless ultrasonic dissector. Surg Innov 2013; 20:524-9. [PMID: 23302577 DOI: 10.1177/1553350612471206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Ultrasonic thermal energy is commonly used for dissection and vessel ligation. This study compared HARMONIC ACE and Sonicision Cordless Ultrasonic Dissector (SCUD). The devices were used in an in vivo porcine model to coagulate 189 arteries up to 5 mm. Seal times were similar: SCUD, 5.2 ± 1.7 s; ACE, 4.9 ± 1.5 s (P = .20). Burst pressures for SCUD and AVE were 578 ± 284 and 605 ± 288 mm Hg, respectively (P = .48). Stratification by vessel diameter yielded similar results. In all, 17 applications resulted in seal failure on either the proximal or distal side, with no difference between SCUD (4.4%) and ACE (6.6%; P = .37). Histological examination of 48 specimens showed similar thermal spreads: 1.06 ± 0.05 versus 1.08 ± 0.05 mm for SCUD and ACE, respectively (P = .82). In 41 timed mesenteric transections, SCUD required 24.8 ± 4.9 s, which was significantly less than the 33.8 ± 5.4 s for ACE (P < .0001), with no bleeding in either group. SCUD and ACE showed similar vessel seal times, burst pressures, thermal spreads, and seal failure rates. SCUD was more efficient than ACE in mesenteric transection.
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A multicenter, randomized, controlled clinical trial of LigaSure small jaw vessel sealing system versus conventional technique in thyroidectomy. Eur Arch Otorhinolaryngol 2012; 270:2109-14. [PMID: 23241823 DOI: 10.1007/s00405-012-2289-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 11/13/2012] [Indexed: 10/27/2022]
Abstract
The objective of this work was to compare efficacy and adverse effects between vessel sealing system thyroid lobectomy (VSSL) with the new LigaSure™ Small Jaw Instrument and conventional thyroid lobectomy (CTL). This is a multicenter, randomized and controlled study, conducted in the Department of Otolaryngology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok and Division of Otolaryngology, Sukhothai General Hospital, Sukhothai, Thailand. Forty subjects with solitary thyroid nodule planned for thyroid lobectomy were enrolled consecutively in both centers. Intervention was randomized by block randomization into two groups (VSSL, CTL). Primary outcomes were operative time and intraoperative blood loss. Secondary outcomes were postoperative blood loss and recurrent laryngeal nerve paralysis. There was clinically significant less operative time (VSSL/CTL = 62.4 ± 15.9/83.3 ± 16.1 min, p < 0.001) and less intraoperative blood loss (VSSL/CTL = 40.5 ± 19.1/63.3 ± 22.4 mL, p = 0.001) in VSSL group compared with CTL group. There was no significant difference of postoperative blood loss (VSSL/CTL = 58.8 ± 30.6/76.0 ± 36.9 mL, p = 0.116) between both the groups. There was one case of permanent recurrent laryngeal nerve injury found in both groups. VSSL with the new LigaSure™ Small Jaw Instrument was better than conventional technique in terms of shortening operative time. It was also better in reducing intraoperative hemorrhage, but this effect did not exceed clinically significant levels. Postoperative blood loss and recurrent laryngeal nerve injury were not significantly different between both the groups.
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Gracia-Calvo L, Martín-Cuervo M, Jiménez J, Vieítez V, Durán ME, Argüelles D, Ezquerra LJ. Intra and postoperative assessment of re-sterilised Ligasure Atlas for orchidectomies in horses: clinical study. Vet Rec 2012; 171:98. [DOI: 10.1136/vr.100601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- L.A. Gracia-Calvo
- Veterinary Teaching Hospital; School of Veterinary Medicine; University of Extremadura; Avenida Universidad s/n 10004 Cáceres Spain
| | - M. Martín-Cuervo
- Veterinary Teaching Hospital; School of Veterinary Medicine; University of Extremadura; Avenida Universidad s/n 10004 Cáceres Spain
| | - J. Jiménez
- Veterinary Teaching Hospital; School of Veterinary Medicine; University of Extremadura; Avenida Universidad s/n 10004 Cáceres Spain
| | - V. Vieítez
- Veterinary Teaching Hospital; School of Veterinary Medicine; University of Extremadura; Avenida Universidad s/n 10004 Cáceres Spain
| | - M. E. Durán
- Veterinary Teaching Hospital; School of Veterinary Medicine; University of Extremadura; Avenida Universidad s/n 10004 Cáceres Spain
| | - D. Argüelles
- Veterinary Teaching Hospital; School of Veterinary Medicine; University of Extremadura; Avenida Universidad s/n 10004 Cáceres Spain
| | - L. J. Ezquerra
- Veterinary Teaching Hospital; School of Veterinary Medicine; University of Extremadura; Avenida Universidad s/n 10004 Cáceres Spain
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Olmez A, Karabulut K, Aydin C, Kayaalp C, Yilmaz S. Comparison of Harmonic Scalpel Versus Conventional Knot Tying for Transection of Short Hepatic Veins at Liver Transplantation: Prospective Randomized Study. Transplant Proc 2012; 44:1717-9. [DOI: 10.1016/j.transproceed.2012.05.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Helpman L, Covens A. Laparoscopic Appendectomy Using the LigaSure®Vessel Sealing Device at the Time of Gynecologic Surgery. J Gynecol Surg 2012. [DOI: 10.1089/gyn.2010.0101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Limor Helpman
- Division of Gynecologic Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Allan Covens
- Division of Gynecologic Oncology, University of Toronto, Toronto, Ontario, Canada
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Radiofrequency versus ultrasonic energy in laparoscopic colorectal surgery: a metaanalysis of operative time and blood loss. Surg Endosc 2012; 26:2917-24. [PMID: 22580873 DOI: 10.1007/s00464-012-2285-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Various energy sources are available for tissue dissection and vessel sealing in laparoscopic colorectal surgery. The electrothermal bipolar vessel sealing system (EBVS) and ultrasonic energy (UE) devices are widely used to provide hemostatic dissection in laparoscopic procedures. Nevertheless, available evidenced-based data comparing their operative results still are scarce. This study conducted a metaanalysis of controlled clinical trials comparing EBVS and UE in terms of operative time and intraoperative blood losses in laparoscopic colorectal surgery. METHODS The MEDLINE and Embase databases were searched using medical subject headings and free text words. All randomized controlled trials (RCTs) and controlled clinical trials using EBVS and UE in laparoscopic colorectal surgery were considered for inclusion in the study. Random effects models were used in case of heterogeneity to obtain summary statistics for the overall difference in operating time and blood loss between instruments. RESULTS Four studies comparing EBVS with UE for 397 patients (200 EBVS vs. 197 UE patients) were included in the study. The findings showed that EBVS was associated with a significantly shorter operative time and less intraoperative blood loss than UE (p < 0.05). CONCLUSIONS The metaanalysis indicated that EBVS is associated with a shorter operative time and less blood loss than UE in laparoscopic colorectal surgery. However, these results should be interpreted with caution due to the high heterogeneity of the included trials and the limited number of studies with a high level of evidence. More adequately designed RCTs with a larger number of patients are required to confirm the results of this metaanalysis.
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Effectiveness of electrothermal bipolar vessel-sealing devices versus other electrothermal and ultrasonic devices for abdominal surgical hemostasis: a systematic review. Surg Endosc 2012; 26:2892-901. [PMID: 22538684 DOI: 10.1007/s00464-012-2276-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 03/23/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adequate hemostatic techniques are essential for optimal intra- and postoperative results. A number of different hemostatic techniques and devices have been developed over the past few years, but which device should be preferred during laparoscopic and open abdominal procedures? METHODS We conducted a systematic search for randomized controlled trials (RCTs) that compared the effectiveness and costs of vessel-sealing devices with those of other electrothermal or ultrasonic devices in abdominal surgical procedures. RESULTS Seven RCTs that included 554 patients met the inclusion criteria. Various procedures that used a vessel-sealing device (LigaSure™) (n = 264) were compared to ultrasonic devices (n = 139) and mono- (n = 20) or bipolar devices (n = 130). LigaSure was favored in two studies with respect to less blood loss, shorter operating time, and lower costs. However, no differences were observed in the other studies. Considering the relatively low number of complications, all hemostatic devices used may be considered relatively safe. None of the studies reported on quality of life or cost effectiveness. CONCLUSIONS Vessel-sealing devices may be considered safe and their use may reduce costs due to reduced blood loss and shorter operating time in some abdominal surgical procedures compared to mono- or bipolar electrothermal devices. Wider-ranging RCTs of sufficient quality that assess (cost) effectiveness are required to make firm conclusions.
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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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Gezen C, Kement M, Altuntas YE, Aksakal N, Okkabaz N, Civil O, Vural S, Oncel M. Safety and effectiveness of 5-mm and 10-mm electrothermal bipolar vessel sealers (LigaSure) in laparoscopic resections for sigmoid colon and rectal cancers. J Laparoendosc Adv Surg Tech A 2012; 22:572-7. [PMID: 22458835 DOI: 10.1089/lap.2012.0083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND LigaSure™ (Covidien, Mansfield, MA) has been used in cases undergoing laparoscopic colon and rectal resections. This study aims to analyze the efficacy and safety of the 5-mm and 10-mm devices. SUBJECTS AND METHODS Patients who received a laparoscopic or hand-assisted laparoscopic operation for a tumor located in the sigmoid colon or rectum since 2006 were abstracted from a prospectively designed database, and findings were analyzed in two groups based on size of the device used during the procedure. The videotapes of the procedures were watched, and operation reports were read to obtain further information on specific intra- and postoperative complications. Demographics, tumor and operation-related information, and postoperative data were compared. RESULTS Among 215 (128 [59.5%] males; median age, 59.5±13.8 years) patients, data obtained from the 5-mm (n=32) and 10-mm (n=183) groups were identical regarding demographics and data related to tumor (localization and stage) and operation (number of harvested lymph nodes, conversion rates, operation time, intraoperative bleeding, transfusion requirement, reoperation rates, complications, 30-day mortality, and length of hospital stay). However, more patients underwent an anterior resection in the 10-mm group than in the 5-mm group (31.7% versus 15.6%, P<.05). Further analyses found device-related bleeding in 8 (3.7%) cases (2 [6.3%] versus 6 [3.3%] in the 5-mm versus 10-mm group, respectively, P>.05), requiring further attempts for hemorrhage control (n=6), conversion to open surgery (n=1), or relaparotomy (n=1). CONCLUSIONS The 5-mm and 10-mm LigaSure devices are similarly effective and safe during laparoscopic sigmoid colon and rectal resections. Severe bleeding from larger vessels may be observed, requiring conversion to open surgery or relaparotomy.
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Affiliation(s)
- Cem Gezen
- General Surgery Department, Kartal Education and Research Hospital, Istanbul, Turkey.
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Schiphorst AHW, Twigt BA, Elias SG, van Dalen T. Randomized clinical trial of LigaSure versus conventional suture ligation in thyroid surgery. HEAD & NECK ONCOLOGY 2012; 4:2. [PMID: 22257756 PMCID: PMC3277470 DOI: 10.1186/1758-3284-4-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 01/18/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND In thyroid surgery vessel division and haemostasis make up an important and time consuming part of the operation. While the presence of the recurrent laryngeal nerve limits the liberal use of diathermia, the many arterial and venous branches to and from the thyroid gland necessitates the use of numerous conventional suture ligatures.This study evaluates the effect of using a vessel sealing system on operation time during thyroid surgery. METHODS A randomized clinical trial was performed between September 2005 and October 2008 in a teaching hospital. Forty patients undergoing total hemithyroidectomy participated in the trial. Twenty were randomized to the intraoperative use of the LigaSure Precise™ vessel sealing system, and twenty to the use of conventional suture ligatures. RESULTS The total median operation time was 10 minutes shorter in the LigaSure group (56 versus 66 minutes, P = 0.001). No significant differences in complications were noticed. CONCLUSION Using an electrothermal vessel sealing system during thyroid surgery is time saving. TRIAL REGISTRATION This trial was registered in the international standard randomized controlled trials number register (ISRCTNR) under number ISRCTNR82389535.
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Evaluation of modified Estimation of Physiologic Ability and Surgical Stress in gastric carcinoma surgery. Gastric Cancer 2012; 15:7-14. [PMID: 21538017 DOI: 10.1007/s10120-011-0052-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 03/17/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND We recently modified our prediction scoring system "Estimation of Physiologic Ability and Surgical Stress" and have designated the current version mE-PASS. This scoring system has been designed to obtain predicted postoperative mortality rates before surgery and this study was performed to assess its usefulness in elective surgery for gastric carcinoma. METHODS We investigated seven variables for mE-PASS and evaluated the postoperative course in 3,449 patients who underwent elective surgery for gastric carcinoma in Japan between August 20, 1987 and April 9, 2007, in order to quantify the predicted in-hospital mortality rates (R). The calibration and discrimination power of R were assessed using the Hosmer-Lemeshow test and the area under the receiver operating characteristic curve (AUC), respectively. The ratios of observed-to-estimated mortality rates (OE ratios) were quantified as a measure of quality. RESULTS The overall postoperative morbidity and mortality rates were 19.0 and 2.0%, respectively. R demonstrated good power in calibration (χ(2) value, 12.5; df 8; P = 0.89) as well as discrimination (AUC, 95% confidence intervals: 0.80, 0.75-0.85). The OE ratios between hospitals ranged from 0.44 to 1.8. Overall, the OE ratios seemed to improve with time (OE ratio, 95% confidence intervals: 1.3, 0.73-2.4 for the early period between 1987 and 2000; 1.0, 0.59-1.7 for the middle period between 2001 and 2004; and 0.65, 0.36-1.2 for the late period between 2005 and 2007). CONCLUSION Based on these findings, mE-PASS might be useful for medical decision-making and for assessing the quality of care in elective surgery for gastric carcinoma.
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Siracuse JJ, Saillant NN, Hauser CJ. Technological advancements in the care of the trauma patient. Eur J Trauma Emerg Surg 2011; 38:241-51. [DOI: 10.1007/s00068-011-0160-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 10/15/2011] [Indexed: 12/11/2022]
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Bipolar electrothermal vessel sealing system and 5-mm 2 expandable trocar approach in pediatric laparoscopic varicocelectomy: a successful time-effective technical refinement. Surg Laparosc Endosc Percutan Tech 2011; 21:e256-9. [PMID: 22002289 DOI: 10.1097/sle.0b013e31823118d3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To present our initial experience with electrothermal bipolar vessel device and only 2 expandable ports for laparoscopic Palomo varicocele procedure in pediatric and adolescent population. METHODS In a 3-year period between 2006 and 2009, sixty-three boys and adolescents diagnosed in our institution as having varicocele underwent Palomo laparoscopic surgery with a two 5-mm expandable-trocar laparoscopic approach using the LigaSure technology (Valleylab Inc., Covidien, Boulder, CO) for spermatic vessels sealing. The outcome variables recorded for analysis were age at presentation, symptoms, varicocele grade based on Dubin and Amelar Classification, testicular atrophy, operative time, complications, recurrence, and reactive hydrocele formation. Mean follow-up was 1.8 years (range, 6 mo to 3 y). RESULTS Children's age at diagnosis ranged between 9 and 19 years. Mean age at operation was 14.8 ± 1.2 years. All cases were left side varicoceles and 70% had grade III varicocele. Testicular atrophy was noticed in 39.8% of cases. All boys underwent Palomo laparoscopic sealing of the spermatic vessels using bipolar vascular electrothermal device Ligasure with a 2-trocar approach. Mean operative surgery time was 21 minutes. Median hospital stay was 21 ± 8 hours. No conversion cases were registered. Nine patients developed hydrocele after laparoscopic procedure (14.2%). Three patients of these cases underwent Winkelman-Lord's hydrocelectomy (4.7% of total). CONCLUSIONS Laparoscopic Palomo varicocele surgery for pediatric patients using Ligasure as spermatic vessels sealant and only 2 radially expandable 5-mm trocars is a safe, feasible, and time-effective technical improvement.
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