Large-Vessel Sealing in Laparoscopic Colectomy with an Ultrasonic Device

Ultrasonic surgical and electrosurgical system (USES) with conventional ultrasonic scalpel (CUS) in gastrectomy: a retrospective cohort study

Background

Harmonic ACE +7 Shears with Advanced Hemostasis is an upgraded ultrasonic device, an ultrasonic surgical and electrosurgical system (USES). The study aimed to evaluate the economic and clinical effectiveness of the USES compared with the conventional ultrasonic scalpel (CUS) in gastrectomy.

Methods

We conducted a single-center, retrospective cohort study using the electronic medical records in China. We collected intraoperative and postoperative data from gastric cancer patients who underwent the endoscope-assisted distal gastrectomy from 2018 to June 30, 2019. Procedure-related costs were estimated. We used linear regression by controlling a set of covariates to assess the effect of USES on outcomes.

Result

Out of 87 eligible patients, the USES group (40 patients) and CUS group (47 patients) were comparable in terms of age, medical history and stages of cancer. Compared with the CUS, the USES saved 4.27 hemoclips per person (95% CI 0.57–7.97, p < 0.05) and 34.18 ml intraoperative blood per person (95% CI 8.74–59.62 ml, p < 0.05), respectively. Postoperative length of stay (LOS) was shorter in the USES group (7.90 ± 1.95 vs. 9.26 ± 2.81 days) but the difference was not statistically significant (p = 0.05).

Conclusions

The USES group was associated with fewer hemoclips use and intraoperative blood loss in patients undergoing laparoscopic gastrectomy at comparable costs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12962-022-00344-5.

Endoscopy-Assisted Resection of Benign Lesions on the Base of the Tongue via the Transoral Approach Using a Harmonic Scalpel

PURPOSE

Surgical removal of lesions from the base of the tongue can be challenging for head and neck surgeons. This study evaluated the clinical outcomes of patients with benign lesions at the base of the tongue who underwent endoscopy-assisted resection through the transoral approach using an ultrasonic harmonic scalpel.

PATIENTS AND METHODS

This retrospective observational study was conducted from May 2013 to January 2016. Data collected for each patient included age, gender, chief complaints, clinical symptoms, diagnostic imaging, complications after resection, and reported outcomes of resection. Diagnoses were made based on patient complaints, clinical symptoms, and computed tomography or magnetic resonance imaging. Diagnoses were confirmed by permanent pathologic sections.

RESULTS

Twelve patients with benign lesions on the base of the tongue were identified who had undergone endoscopy-assisted resection through the transoral approach using an ultrasonic harmonic scalpel. The patients had a mean age of 38.9 years. The benign lingual lesions consisted of lingual thyroid masses, squamous papillomas, schwannomas, pleomorphic adenomas, myoepithelioma, and lymphoid hyperplasia. Tumor size varied from 2.0 × 1.8 to 3.0 × 2.8 cm. All tumors were completely removed, and no complications occurred during or after surgery. The patients were followed for 6 to 30 months; 1 recurrence was found and was treated using a second endoscopy-assisted transoral resection.

CONCLUSIONS

Under endoscopic assistance, use of the harmonic scalpel through the transoral approach is a safe and feasible surgical technique for the removal of benign lesions at the base of the tongue.