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Mongardini FM, Paolicelli M, Catauro A, Conzo A, Flagiello L, Nesta G, Esposito R, Ronchi A, Romano A, Patrone R, Docimo L, Conzo G. Outcomes and Follow-Up Trends in Adrenal Leiomyosarcoma: A Comprehensive Literature Review and Case Report. J Clin Med 2024; 13:3499. [PMID: 38930027 PMCID: PMC11204854 DOI: 10.3390/jcm13123499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/08/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Leiomyosarcoma (LMS) originating from the adrenal gland is exceedingly rare, constituting a minute fraction of soft tissue sarcomas. Due to its rarity, with less than 50 documented cases in English medical literature, the diagnosis and management of adrenal LMS remain challenging. The aim of this study was to perform a review of the literature, in order to evaluate the prognosis of these rare cancers and report our specific case. Methods: A systematic review of the literature was conducted using PubMed, Web of Science, Google Scholar, and Scopus databases, up to December 2020. The search utilized MeSH terms such as "Adrenal Gland Neoplasms," "Leiomyosarcoma," "Adrenalectomy," and "Smooth Muscle Tumor." The inclusion criteria focused on studies reporting patients with a histopathological diagnosis of adrenal leiomyosarcoma. The PRISMA guidelines were followed to ensure a comprehensive analysis. Results: Out of 63 identified studies, 43 met the inclusion criteria and were reviewed. These studies highlighted the rarity and aggressive behavior of adrenal leiomyosarcoma. Surgical excision remains the cornerstone of treatment, often complemented by adjuvant therapies. The reviewed case involved a 52-year-old woman who underwent a right laparoscopic adrenalectomy for a 9 × 7 × 6 cm grade 3 leiomyosarcoma. Despite subsequent adjuvant chemotherapy, hepatic metastases were detected, illustrating the aggressive nature of the disease. The literature underscores the importance of histopathological analysis and long-term surveillance for managing disease progression. Conclusions: Optimal management of adrenal leiomyosarcoma requires a multidisciplinary approach and meticulous follow-up. The rarity of the disease poses challenges for standardizing treatment, but surgical excision and tailored adjuvant therapies show promise. Further research is essential to refine treatment strategies and improve prognosis for this rare malignancy.
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Affiliation(s)
- Federico Maria Mongardini
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
| | - Maddalena Paolicelli
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
| | - Antonio Catauro
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
| | - Alessandra Conzo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
| | - Luigi Flagiello
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
| | - Giusiana Nesta
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
| | - Rosetta Esposito
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
| | - Andrea Ronchi
- Division of Pathology, Department of Mental Health and Preventive Medicine, Luigi Vanvitelli University of Campania, 80138 Naples, Italy;
| | - Alessandro Romano
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
| | - Renato Patrone
- Division of Epatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy;
| | - Ludovico Docimo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
| | - Giovanni Conzo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
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LyBarger KS. Review of Evidence Supporting the Arista™ Absorbable Powder Hemostat. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2024; 17:173-188. [PMID: 38800552 PMCID: PMC11127658 DOI: 10.2147/mder.s442944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/21/2024] [Indexed: 05/29/2024] Open
Abstract
Background Uncontrolled and diffuse bleeding is a dreaded event during open and laparoscopic surgery that may lead to postoperative complications, obstruction of the surgical field that reduces visualization, and prolonged operating times. Powder hemostats can be used to control bleeding and are easy to use, have a safe profile, and can achieve broad coverage area at a low cost. Methods A strategic literature search of peer-reviewed, English language studies was conducted to capture evidence on the clinical efficacy and safety of a Microporous Polysaccharide Hemosphere (MPH) based Hemostat (Arista™ Absorbable Hemostat (Arista™ AH)). Results Six preclinical studies were found which supported the use of MPH in various animal models of laparoscopic and open surgery, all of which demonstrated its safety and efficacy. Five single-arm and 11 comparative clinical studies similarly supported the efficacy and safety of MPH in various surgery types, including cardiac, renal, and dermatologic surgery. Conclusion Published evidence supports the safe and effective use of MPH across a variety of surgical settings.
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Zorzato PC, Ferrari FA, Garzon S, Franchi M, Cianci S, Laganà AS, Chiantera V, Casarin J, Ghezzi F, Uccella S. Advanced bipolar vessel sealing devices vs conventional bipolar energy in minimally invasive hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309:1165-1174. [PMID: 37955717 PMCID: PMC10894136 DOI: 10.1007/s00404-023-07270-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE To compare conventional bipolar electrosurgery with advanced bipolar vessel sealing (ABVS) devices for total laparoscopic hysterectomy (TLH). METHODS A systematic review was conducted by searching Scopus, PubMed/MEDLINE, ScienceDirect, and Cochrane Library from January 1989 to November 2021. We identified all studies comparing ABVS devices with conventional bipolar electrosurgery in TLH and reporting at least one of the following outcomes: total blood loss, total operative time, hospital stay, perioperative complications, or costs. Meta-analysis was conducted with a random effect model reporting pooled mean differences and odds ratios (ORs) with related 95% confidence intervals (CIs). RESULTS Two randomized controlled trials and two retrospective studies encompassing 314 patients were included out of 615 manuscripts. The pooled estimated total blood loss in the ABVS devices group was lower than conventional bipolar electrosurgery of 39 mL (95% CI - 65.8 to - 12.6 mL; p = .004). The use of ABVS devices significantly reduced the total operative time by 8 min (95% CI - 16.7 to - 0.8 min; p = .033). Hospital stay length did not differ between the two groups, and a comparable overall surgical complication rate was observed [OR of 0.9 (95% CI 0.256 - 3.200; p = .878]. CONCLUSIONS High-quality evidence comparing ABVS devices with conventional bipolar electrosurgery for TLH is lacking. ABVS devices were associated with reduced total blood loss and operative time; however, observed differences seem clinically irrelevant. Further research is required to clarify the advantages of ABVS devices over conventional bipolar electrosurgery and to identify cases that may benefit more from their use.
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Affiliation(s)
- Pier Carlo Zorzato
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, AOUI Verona, Verona, Italy
| | - Filippo Alberto Ferrari
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, AOUI Verona, Verona, Italy
| | - Simone Garzon
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, AOUI Verona, Verona, Italy.
| | - Massimo Franchi
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, AOUI Verona, Verona, Italy
| | - Stefano Cianci
- Department of Obstetrics and Gynecology, University of Messina, Messina, Italy
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Obstetrics and Gynecology, Paolo Giaccone Hospital, Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Stefano Uccella
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, AOUI Verona, Verona, Italy
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Kang B, Keum H, Park HY, Jung JH, Kim WW, Lee J. Usefulness of cordless ultrasonic cutting energy devices in endoscopic nipple-sparing mastectomy: a retrospective study. Ann Surg Treat Res 2024; 106:147-154. [PMID: 38435493 PMCID: PMC10902625 DOI: 10.4174/astr.2024.106.3.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/15/2023] [Accepted: 12/02/2023] [Indexed: 03/05/2024] Open
Abstract
Purpose Endoscopic nipple-sparing mastectomy (E-NSM) is a minimally invasive surgical technique that shows good results in patients with breast cancer. The authors compared 3 different types of commercial energy devices to examine their efficacy and safety in E-NSM performed with breast reconstruction. Methods A total of 36 cases of E-NSM were conducted with either Sonicision (S group, n = 11), Harmonic (H group, n = 6), or Thunderbeat (T group, n = 19). The clinicopathologic factors and postoperative complications, including nipple or skin necrosis and surgical site seroma volume, were evaluated for 3 months after surgery. Results The surgical duration of E-NSM was significantly shorter in the S group than in the H group (P = 0.043) and T group (P = 0.037). However, the total surgical duration including E-NSM and breast reconstruction, and the total and daily drainage volume of postoperative seroma did not differ significantly among the 3 groups. Even when the energy devices were compared according to their working principle, i.e., ultrasonic (S and H) vs. hybrid (T), the total breast surgery duration and total and daily drainage volume of seroma showed no difference between the 2 groups. Although surgeon satisfaction did not significantly differ when using 3 devices for E-NSM (P = 0.428), surgeon's fatigue was found to be lowest in the S group, though it was not significant (P = 0.064). Conclusion Any energy device can be safely used for E-NSM with breast reconstruction without causing any major complications. However, cordless ultrasonic energy devices allow greater mobility for the surgeon and, therefore, may shorten surgical time in breast surgery.
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Affiliation(s)
- Byeongju Kang
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Heejung Keum
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Ho Yong Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Jin Hyang Jung
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Wan Wook Kim
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Jeeyeon Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
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Saeed WM, Fried NM. A Real-Time Fluorescence Feedback System for Infrared Laser Sealing of Blood Vessels. IEEE JOURNAL OF SELECTED TOPICS IN QUANTUM ELECTRONICS : A PUBLICATION OF THE IEEE LASERS AND ELECTRO-OPTICS SOCIETY 2023; 29:7200407. [PMID: 36466144 PMCID: PMC9718054 DOI: 10.1109/jstqe.2022.3221338] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
This study explores UV light induced fluorescence from blood vessels for indicating successful infrared laser sealing of vascular tissues. A light emitting diode (LED) with center wavelength of 340 nm and 0.1 mW power was used with a Y-shaped fiber bundle of seven 200-μm-core fibers. The central excitation fiber was connected to the LED, while the detection ring of six fibers was connected to a spectrometer. The fiber bundle was aligned with porcine renal arteries compressed between optical windows. Fluorescence was acquired before and after vessel sealing, with a 1470 nm laser for 5 s at 30 W (sealing, n = 10) or 5 W (control, n = 10). Signal increase in the 470-520 nm spectrum was correlated with vessel burst pressures (BP). Integrated fluorescence increased 71 ± 25% at 30 W vs. 19 ± 14% at 5 W (p < 0.05), corresponding to a successful BP of 639 ± 189 mmHg vs. failed seal BP of 39 ± 41 mmHg (p < 0.05). Real-time measurements showed a gradual increase in fluorescence with the signal reaching a plateau at 3-4 s, indicating that shorter seal times are possible. The increase in fluorescence signal during laser vessel sealing may provide a non-destructive, real-time, optical method for indicating hemostatic seals.
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Affiliation(s)
- Woheeb M Saeed
- Optical Science and Engineering Program, University of North Carolina at Charlotte, Charlotte, NC 28223
| | - Nathaniel M Fried
- Department of Physics and Optical Science, University of North Carolina at Charlotte, Charlotte, NC 28223
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Conzo G, Patrone R, Flagiello L, Catauro A, Conzo A, Cacciatore C, Mongardini FM, Cozzolino G, Esposito R, Pasquali D, Bellastella G, Esposito K, Docimo L. Impact of Current Technology in Laparoscopic Adrenalectomy: 20 Years of Experience in the Treatment of 254 Consecutive Clinical Cases. J Clin Med 2023; 12:4384. [PMID: 37445419 DOI: 10.3390/jcm12134384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Laparoscopic adrenalectomy (LA), which avoids large abdomen incisions, is considered the gold standard technique for the treatment of benign small- and medium-size adrenal masses (<6 cm) and weighing < 100 g. A trascurable mortality and morbidity rate, short hospitalization and patient rapid recovery are the main advantages compared to traditional surgery. During the past decade, a new surgical technology has been developed that expedites a "clipless" adrenalectomy. Here, the authors analyze a clinical series of 254 consecutive patients who were affected by adrenal gland neoplasms and underwent LA by the transabdominal lateral approach over the two last decades. A literature review is also presented. METHODS Preoperative, intraoperative and postoperative data from 254 patients who underwent LA between January 2003 and December 2022 were retrospectively collected and reviewed. Diagnosis was obtained on the basis of clinical examination, laboratory values and imaging techniques. Doxazosin was preoperatively administered in the case of pheochromocytoma (PCC) while spironolactone and potassium were employed to treat Conn's disease. The same surgeon (CG) performed all the LA and utilized the same laparoscopic transabdominal lateral approach. Different dissection tools-ultrasonic, bipolar or mixed scissors-and hemostatic agents were used during this period. The following results were obtained: 254 patients were included in the study; functioning tumors were diagnosed in 155 patients, 52 patients were affected by PCCs, 55 by Conn's disease, 48 by Cushing's disease. Surgery mean operative time was 137.33 min (range 100-180 min) during the learning curve adrenalectomies and 98.5 min (range 70-180) in subsequent procedures. Mean blood loss was respectively 160.2 mL (range 60-280) and 96.98 mL (range 50-280) in the first 30 procedures and the subsequent ones. Only three conversions (1.18%) to open surgery occurred. No mortality or postoperative major complications were observed, while minor complications occurred in 19 patients (3.54%). In 153 out of 155 functioning neoplasms, LA was effective in the normalization of the endocrine profile. According to our experience, a learning curve consisting of 30 cases was identified. In fact, a lower operative time and a lower complication rate was reported following 30 LA. CONCLUSIONS LA is a safe procedure, even for masses larger than 6 cm and PCCs. Undoubtedly, the development of surgical technology has made it possible reducing operative times, performing a "clipless" adrenalectomy and extending the indications in the treatment of more complex patients. A multidisciplinary team, in referral high-volume centers, is recommended in the management of adrenal pathology. A 30-procedure learning curve is necessary to improve surgical outcomes.
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Affiliation(s)
- Giovanni Conzo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Renato Patrone
- Dieti Department, University of Naples Federico II, 80100 Naples, Italy
- Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy
| | - Luigi Flagiello
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Antonio Catauro
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Alessandra Conzo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Chiara Cacciatore
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Federico Maria Mongardini
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Giovanni Cozzolino
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Rosetta Esposito
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Daniela Pasquali
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80100 Naples, Italy
| | - Giuseppe Bellastella
- Division of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Second University of Naples, 80138 Naples, Italy
| | - Katherine Esposito
- Diabetes Unit, Department of Clinical and Experimental Medicine, Second University of Naples, 80138 Naples, Italy
| | - Ludovico Docimo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
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Piemontese A, Cohen L, Wright GWJ, Robledinos-Antón N, Jamous N, Tommaselli GA, Galvain T. Adopting a portfolio of ultrasonic and advanced bipolar electrosurgery devices from a single manufacturer compared to currently used ultrasonic and advanced bipolar devices: a probabilistic budget impact analysis from a Spanish hospital perspective. J Med Econ 2023; 26:179-188. [PMID: 36646702 DOI: 10.1080/13696998.2023.2169496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AIMS Advanced energy devices are commonly used in electrosurgery, including ultrasonic and advanced bipolar (ABP) devices. Smoke evacuation and reusable dispersive electrodes are also utilized during electrosurgery to improve staff and patient safety. This study assessed the budget impact of adopting a portfolio of Ethicon energy devices compared to devices from other manufacturers from a Spanish hospital perspective. METHODS The main analysis compared the Ethicon advanced energy device portfolio (ultrasonic and ABP devices) to Non-Ethicon advanced energy devices. It was assumed that 4,000 procedures using one advanced energy device each were performed annually, and the cost impact of operating room time, length of stay, and transfusions were considered. A probabilistic budget impact analysis with 10,000 iterations was conducted for generalizability to other hospitals in Spain and Europe. Secondary analysis assessed whether cost savings from the Ethicon advanced energy device portfolio could offset costs of adopting smoke evacuation and reusable dispersive electrodes (Full Ethicon energy portfolio). RESULTS In the main analysis, the annual budget impact of introducing the Ethicon advanced energy device portfolio was cost saving in 79.8% of probabilistic iterations (mean: -€945,214; 95% credible interval [CrI]: -€3,242,710; €1,285,942) with a mean budget impact per procedure of -€236 (95% CrI: -€811; €321). In the secondary analysis, adding smoke evacuation and reusable dispersive electrodes was still cost saving in 75.3% of iterations compared to Non-Ethicon advanced energy devices (mean: -€778,208; 95% CrI: -€3,075,086; €1,464,728) with a mean budget impact per procedure of -€97 (95% CrI: -€384; €183). Savings resulted from differences in operating room time, length of hospital stay, and volume of disposable electrodes. CONCLUSIONS Adopting Ethicon advanced energy devices demonstrated economic benefits compared to non-Ethicon devices. Introducing the advanced portfolio may improve surgical care quality and the full portfolio was cost saving while improving OR safety for staff and patients.
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Affiliation(s)
- Alessandra Piemontese
- EMEA Health Economics & Market Access, Johnson & Johnson Medical Devices Companies, Diegem, Belgium
| | | | | | | | - Nadine Jamous
- EMEA Health Economics & Market Access, Johnson & Johnson Medical Devices Companies, Diegem, Belgium
| | | | - Thibaut Galvain
- Global Health Economics, Johnson and Johnson Medtech, New Brunswick, NJ, USA
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A Comparative Study of an Integrated Ultrasonic/Bipolar Sealing Device Versus an Articulating Bipolar Sealing Device for Laparoscopic Liver Surgery. World J Surg 2022; 46:2963-2972. [PMID: 36131184 DOI: 10.1007/s00268-022-06734-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Sealing devices (SD) seal and cut tissue through different energy modalities, and are routinely used in laparoscopic liver surgery (LLS). The aim of this study is to compare the outcome of Thunderbeat (TB), an integrated ultrasonic/bipolar SD, versus Enseal (ES), an articulating bipolar SD, in LLS. METHODS A retrospective analysis was conducted in a single center from December 2013 to September 2020. The primary endpoint was difference in blood loss (BL) between ES and TB. Secondary endpoints were complications, operative time, hospital stay, and 90-day mortality. RESULTS 352 patients were identified: TB (n = 105) and ES (n = 247). Median BL was significantly lower with TB (50 mL [20-120]) compared to ES (100 mL [50-250]) (p < 0.0001). Significant differences were identified for median operative time (TB 115 min [45-300]) vs. ES 140 min [40-370]; p = 0.0008) and median hospital stay (TB 2 days [1-4] vs. ES 4 days [3-6]; p < 0.0001). No major differences were encountered for postoperative bleeding (TB 0% vs. ES 1%; p = 0.5574), biliary leak (TB 1% vs. ES 2%; p = 1.0000), and 90-day mortality (TB 0% vs. ES 1%; p = 1.0000). CONCLUSION The integrated ultrasonic/bipolar SD is superior to the articulating bipolar SD in LLS for intraoperative BL without an increase in complications.
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Is There Indication for the Use of Biological Mesh in Cancer Patients? J Clin Med 2022; 11:jcm11206035. [PMID: 36294356 PMCID: PMC9605183 DOI: 10.3390/jcm11206035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 12/01/2022] Open
Abstract
Up to 28% of all patients who undergo open surgery will develop a ventral hernia (VH) in the post-operative period. VH surgery is a debated topic in the literature, especially in oncological patients due to complex management. We searched in the surgical database of the Hepatobiliary Unit of the National Cancer Institute of Naples “G. Pascale Foundation” for all patients who underwent abdominal surgery for malignancy from January 2010 to December 2018. Our surgical approach and our choice of mesh for VH repair was planned case-by-case. We selected 57 patients that fulfilled our inclusion criteria, and we divided them into two groups: biological versus synthetic prosthesis. Anterior component separation was used in 31 patients (54.4%) vs. bridging procedure in 26 (45.6%). In 41 cases (71.9%), we used a biological mesh while a synthetic one was adopted in the remaining patients. Of our patients, 57% were male (33 male vs. 24 female) with a median age of 65 and a mean BMI of 30.8. We collected ventral hernia defects from 35 cm2 to 600 cm2 (mean 205.2 cm2); 30-day complications were present in 24 patients (42.1%), no 30-day mortality was reported, and 21 patients had a recurrence of pathology during study follow-up. This study confirms VH recurrence risk is not related with the type of mesh but is strongly related with BMI and type of surgery also in oncological patients.
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Giglio NC, Fried NM. Nondestructive optical feedback systems for use during infrared laser sealing of blood vessels. Lasers Surg Med 2022; 54:875-882. [PMID: 35391495 PMCID: PMC9276627 DOI: 10.1002/lsm.23548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/01/2022] [Accepted: 03/28/2022] [Indexed: 11/15/2022]
Abstract
Objectives High‐power infrared lasers are capable of sealing blood vessels during surgery. A real‐time diagnostic feedback system utilizing diffuse optical transmission is characterized by nondestructive identification of vessel seals. Materials and Methods For real‐time diffuse optical transmission experiments, two approaches were studied. First, a low‐power (1.2 mW) visible aiming beam (635 nm) was used for diagnostics, co‐aligned with the therapeutic high‐power infrared beam (1470 nm). Second, the 1470 nm beam was used simultaneously for both therapy and diagnostics. For both studies, the 1470‐nm laser delivered 5 W for 5 seconds for unsuccessful seals (control) versus 30 W for 5 seconds for successful seals, using a linear beam profile (8.4 × 2 mm). Diffuse optical transmission signals were correlated with vessel burst pressures measured using a standard burst pressure setup. Results Diffuse optical transmission studies using the low‐power, 635‐nm aiming beam were promising. A decrease in the visible transmitted signal of 59 ± 11% was measured for successful seals versus 23 ± 8% for failed seals (p = 5.4E−8). The use of the high‐power, 1470‐nm infrared laser for simultaneous therapeutics and diagnostics proved inconsistent and unreliable, due in part to the dynamic and rapid changes in water content and absorption during the seal. Conclusions A low‐power, visible aiming beam, integrated with the therapeutic high‐power infrared diode laser, may be used as a real‐time diagnostic system for indicating successful laser seals, based on significant changes in optical scattering and diffuse optical transmission between native and coagulated compressed vessels. With further development, this simple and inexpensive optical feedback system may be integrated into a laparoscopic device for laser de‐activation upon successful vessel sealing.
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Affiliation(s)
- Nicholas C Giglio
- Department of Physics and Optical Science, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Nathaniel M Fried
- Department of Physics and Optical Science, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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Giglio NC, Grose HM, Fried NM. Optical Coherence Tomography Feedback System for Infrared Laser Sealing of Blood Vessels. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 11948:119480R. [PMID: 35950053 PMCID: PMC9361300 DOI: 10.1117/12.2612035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Infrared (IR) lasers have recently been tested as an alternative to electrosurgical and ultrasonic laparoscopic devices for optical sealing of blood vessels. IR laser technology previously demonstrated faster sealing times, reduced thermal spread, and lower device temperatures during experimental studies. However, current commercial laparoscopic devices incorporate electrical impedance and/or temperature sensors as real-time, closed-loop, feedback to indicate successful blood vessel seals. This preliminary study explores an infrared laser system for sealing and optical coherence tomography (OCT) as a potential feedback system for successful vessel seal verification. A 1470-nm diode laser delivered an incident power of 30 W for an irradiation time of 5 s using an 8 × 2 mm linear beam, for creating strong seals in porcine renal blood vessels under compression. After sealing the blood vessels, OCT was performed on unsealed and sealed vessel regions for comparison. Standard vessel burst pressure (BP) measurements confirmed successful seals after OCT. Integrated reflectance intensity in OCT A-scans decreased by an average of 20 ± 6% in sealed versus native vessels of 2.4 ± 0.4 mm diameter. Vessel BP measured 532 ± 239 mmHg, with all vessels (n = 25) recording a successful BP > 180 mmHg (hypertensive blood pressure). Unsealed vessels demonstrated significantly deeper imaging marked by a continuous decay in reflected intensity, while sealed vessels showed subsurface reflectance intensity peaks, immediately followed by a rapid decay in reflectance intensity. These markers are consistent with increased light scattering and decreased optical penetration depth upon thermal coagulation of tissues. A-line OCT data consistently differentiated between sealed and unsealed blood vessel regions. Future work will involve OCT integration into the laparoscopic device for real-time optical feedback during IR laser sealing.
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Affiliation(s)
- Nicholas C. Giglio
- Department of Physics and Optical Science, University of North Carolina at Charlotte, NC
| | - Haleigh M. Grose
- Department of Mechanical Engineering, University of North Carolina at Charlotte, NC
| | - Nathaniel M. Fried
- Department of Physics and Optical Science, University of North Carolina at Charlotte, NC
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Giglio NC, Fried NM. Real-Time, Nondestructive Optical Feedback Systems for Infrared Laser Sealing of Blood Vessels. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 11936:1193605. [PMID: 35949201 PMCID: PMC9361299 DOI: 10.1117/12.2605600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
High-power infrared (IR) diode lasers are capable of sealing blood vessels during surgery. This study characterizes an optical feedback system for real-time, nondestructive identification of vessel seals. A low power, red aiming beam (635 nm) was used for diagnostics, co-aligned with a therapeutic high-power IR beam (1470 nm). The IR laser delivered either 30 W for 5 s for successful seals or 5 W for 5 s for unsuccessful seals (control). All studies used a linear beam measuring 8.4 × 2.0 mm. Optical signals for successful and failed seals were correlated with vessel burst pressures (BP) using destructive testing via a standard BP setup. Light scattering increased significantly as vessels were coagulated. Successful seals correlated with a percent decrease in optical transmission signal of 59 ± 11 % and seal failures to a transmission decrease of 23 ± 8% (p < 0.01). With further development, the real-time optical feedback system may be integrated into a laparoscopic device to de-activate the laser upon successful vessel sealing.
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Affiliation(s)
- Nicholas C Giglio
- Department of Physics and Optical Science, University of North Carolina at Charlotte, NC
| | - Nathaniel M Fried
- Department of Physics and Optical Science, University of North Carolina at Charlotte, NC
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A comparison of the Thunderbeat and standard electrocautery devices in head and neck surgery: a prospective randomized controlled trial. Eur Arch Otorhinolaryngol 2021; 278:4987-4996. [PMID: 33740084 PMCID: PMC8553711 DOI: 10.1007/s00405-021-06739-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/05/2021] [Indexed: 11/22/2022]
Abstract
Purpose New energy-based sutureless vessel ligation devices, such as the Thunderbeat (Olympus Medical Systems Corp., Tokyo, Japan), could reduce operative time and limit blood loss in head and neck surgery; however, efficacy and safety in major head and neck surgery have not been investigated in a prospective, randomized study. Methods This prospective, double-arm, randomized controlled trial consisted of two parts: total laryngectomy (TL) and neck dissection (ND). Thirty patients planned for TL were randomized in two groups. For the ND part, forty-two operative sides were likewise randomized. In both parts, Thunderbeat was used in addition to the standard instrumentation in the intervention groups, while only standard instrumentation was used in the control groups. Primary outcome values were blood loss, operative time and complication rate. Results For the TL part there was no difference in mean blood loss (p = 0.062), operative time (p = 0.512) and complications (p = 0.662) between both hemostatic techniques. For the neck dissection part, there was a reduction in blood loss (mean 210 mL versus 431 mL, p = 0.046) and in operative time (median 101 (IQR 85–130) minutes versus 150 (IQR 130–199) minutes, p = 0.014) when Thunderbeat was used. There was no difference in complication rate between both hemostatic systems (p = 0.261). Conclusion The Thunderbeat hemostatic device significantly reduces operative blood loss and operative time for neck dissections, without increase in complications. In TL, blood loss using Thunderbeat was comparable with the standard technique, but the operative time tended to be shorter. Trial registration UMCG Research Register, Reg. no. 201700041, date of registration: 18/1/2017
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Patrone R, Granata V, Belli A, Palaia R, Albino V, Piccirillo M, Fusco R, Tatangelo F, Nasti G, Avallone A, Izzo F. The safety and efficacy of Glubran 2 as biliostatic agent in liver resection. Infect Agent Cancer 2021; 16:19. [PMID: 33726798 PMCID: PMC7968309 DOI: 10.1186/s13027-021-00358-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 03/03/2021] [Indexed: 12/13/2022] Open
Abstract
Background Biloma, an encapsulated collection of bile outside the biliary tree, supported by a predominantly iatrogenic biliary fistula, and bile likeage are two of the most important surgical complications after liver resection. We, hypothesized to conduct a project aimed to prevent, or reduce, the formation of biloma or biliary fistula applying on the hepatic resection area the cyanoacrylate glue (Glubran2). Methods We searched in our surgical database all patients underwent liver resection for mCRC from January 2013 to December 2018 and we found a total of 510 patients. 205 patients for Group A (study population: included patients in which we have used Glubran2 during surgical procedure) and 113 patients for Group B (control group), were enrolled. Results In both Groups no patients died during hospitalization and the 30-day mortality was 0 %. During follow-up in Group A, a biliary fistula was found in 2 patients (1 %) versus 3 patients in the Group B (2,6 %). In patients enrolled in Group A no adverse event were reported relate to the use of Glubran2. Conclusions It is possible to affirm that the use of Glubran2 as biliostatic agent after liver resection is useful to prevent bile leakage complication and biloma formation and its use demonstrated to be safe and feasible during liver surgery.
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Affiliation(s)
- Renato Patrone
- PhD ICTH, University Federico II, Via Sergio Pansinin 5, 80131, Naples, Italy
| | - Vincenza Granata
- Department of Support to Cancer Pathways Diagnostics Area, Radiology Unit, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy. .,Radiology Division, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy.
| | - Andrea Belli
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Raffaele Palaia
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Vittorio Albino
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Mauro Piccirillo
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
| | - Roberta Fusco
- Department of Support to Cancer Pathways Diagnostics Area, Radiology Unit, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
| | - Fabiana Tatangelo
- Department of Support to Cancer Pathways Diagnostics Area, Pathology and Cytopathology Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - IRCCS Napoli", Naples, Italy
| | - Guglielmo Nasti
- Department Corp-S Care and Research of Cancer of the Abdominal District, Oncology Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - IRCCS Napoli", Naples, Italy
| | - Antonio Avallone
- Department Corp-S Care and Research of Cancer of the Abdominal District, Oncology Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - IRCCS Napoli", Naples, Italy
| | - Francesco Izzo
- Department Corp-S Care and Research of Cancer of the Abdominal District, Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione G. Pascale - Napoli", Naples, Italy
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Fujisaki A, Takayama T, Suzuki M, Kubo T, Teratani T, Kurokawa S, Kameda T, Komatsubara M, Morita T, Fujimura T. Mechanism of hypertensive crisis during energy device ablation of the adrenal gland: An experimental animal study. Int J Urol 2021; 28:598-604. [PMID: 33615568 DOI: 10.1111/iju.14517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To elucidate the mechanism of hypertensive crisis during energy device ablation of the adrenal gland. METHODS Electrocoagulation on the adrenal glands of six pigs was carried out with the same energy device (VIO300D) using four methods: (i) monopolar coagulation; (ii) monopolar soft coagulation using IO-advanced ball-type electrodes; (iii) bipolar soft coagulation by pinching; and (iv) bipolar soft coagulation by non-pinching (surface contact) using Bipolar forceps Premium. After electrocoagulation for 5 s, blood pressure and pulse changes were monitored, and adrenal hormones were measured from a central vein. The adrenal glands were removed, and the degree of tissue damage was scored histologically. RESULTS Hypertensive crisis occurred with electrocoagulation of the adrenal gland by the monopolar coagulation, monopolar soft coagulation and bipolar soft coagulation pinching methods. Blood pressure did not change with the bipolar soft coagulation non-pinching method. Pathologically, tissue damage to the adrenal medulla was associated with elevated blood pressure and adrenaline and noradrenaline release. CONCLUSIONS Hypertensive crisis caused by energy device ablation to the adrenal gland is caused by the release of catecholamines due to heat damage to the adrenal medulla rather than the type of energy device. Proper use of an energy device that does not cause thermal degeneration of the medulla is required to prevent hypertensive crisis.
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Affiliation(s)
- Akira Fujisaki
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | | | - Motofumi Suzuki
- Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan.,Department of Urology, The University of Tokyo Hospital, Tokyo, Japan
| | - Taro Kubo
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Takumi Teratani
- Division of Translational Research, Jichi Medical University, Tochigi, Japan
| | | | - Tomohiro Kameda
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | | | - Tatsuo Morita
- Department of Urology, Jichi Medical University, Tochigi, Japan
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Ferko N, Wright GWJ, Syed I, Naoumtchik E, Tommaselli GA, Gangoli G. A device category economic model of electrosurgery technologies across procedure types: a U.S. hospital budget impact analysis. J Med Econ 2021; 24:524-535. [PMID: 33851557 DOI: 10.1080/13696998.2021.1915626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS The electrosurgical technology category is used widely, with a diverse spectrum of devices designed for different surgical needs. Historically, hospitals are supplied with electrosurgical devices from several manufacturers, and those devices are often evaluated separately; it may be more efficient to evaluate the category holistically. This study assessed the health economic impact of adopting an electrosurgical device-category from a single manufacturer. METHODS A budget impact model was developed from a U.S. hospital perspective. The uptake of electrosurgical devices from EES (Ethicon Electrosurgery), including ultrasonic, advanced bipolar, smoke evacuators, and reusable dispersive electrodes were compared with similar MED (Medical Energy Devices) from multiple manufacturers. It was assumed that an average hospital performed 10,000 annual procedures 80% of which involved electrosurgery. Current utilization assumed 100% MED use, including advanced energy, conventional smoke mitigation options (e.g. ventilation, masks), and single-use disposable dispersive electrode devices. Future utilization assumed 100% EES use, including advanced energy devices, smoke evacuators (i.e. 80% uptake), and reusable dispersive electrodes. Surgical specialties included colorectal, bariatric, gynecology, thoracic and general surgery. Systematic reviews, network meta-analyses, and meta-regressions informed operating room (OR) time, hospital stay, and transfusion model inputs. Costs were assigned to model parameters, and price parity was assumed for advanced energy devices. The costs of disposables for dispersive electrodes and smoke-evacuators were included. RESULTS The base-case analysis, which assessed the adoption of EES instead of MED for an average U.S. hospital predicted an annual savings of $824,760 ($101 per procedure). Savings were attributable to associated reductions with EES in OR time, days of hospital stay, and volume of disposable electrodes. Sensitivity analyses were consistent with these base-case findings. CONCLUSIONS Category-wide adoption of electrosurgical devices from a single manufacturer demonstrated economic advantages compared with disaggregated product uptake. Future research should focus on informing comparisons of innovative electrosurgical devices.
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Affiliation(s)
| | | | | | - Elena Naoumtchik
- Johnson & Johnson Medical Devices Companies, Cincinnati, OH, USA
| | | | - Gaurav Gangoli
- Johnson & Johnson Medical Devices Companies, Cincinnati, OH, USA
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Zippel D, Yalon T, Nevo Y, Markel G, Asher N, Schachter J, Goitein D, Segal TA, Nissan A, Hazzan D. The non-responding adrenal metastasis in melanoma: The case for minimally invasive adrenalectomy in the age of modern therapies. Am J Surg 2020; 220:349-353. [DOI: 10.1016/j.amjsurg.2019.11.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
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