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Kloosterman R, Wright GWJ, Salvo-Halloran EM, Ferko NC, Mennone JZ, Clymer JW, Ricketts CD, Tommaselli GA. An umbrella review of the surgical performance of Harmonic ultrasonic devices and impact on patient outcomes. BMC Surg 2023; 23:180. [PMID: 37386399 PMCID: PMC10308659 DOI: 10.1186/s12893-023-02057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/25/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND For thirty years, the Harmonic scalpel has been used for precise dissection, sealing and transection. There are numerous meta-analyses on individual surgical procedures with Harmonic, but no overarching review covering all the areas. This umbrella review seeks to summarize the clinical results from the use of Harmonic across surgical fields and broadly quantify its effects on patient outcomes. METHODS MEDLINE, EMBASE, and Cochrane Databases were searched for meta-analyses (MAs) of randomized controlled trials (RCTs) comparing Harmonic devices to conventional techniques or advanced bipolar (ABP) devices. For each procedure type, the most comprehensive MAs were evaluated. RCTs not already analysed in a MA were also included. Operating time, length of stay, intraoperative blood loss, drainage volume, pain, and overall complications were evaluated, and the methodological quality and certainty of evidence were assessed. RESULTS Twenty-four systematic literature reviews were identified on colectomy, hemorrhoidectomy, gastrectomy, mastectomy, flap harvesting, cholecystectomy, thyroidectomy, tonsillectomy, and neck dissection. There were also 83 RCTs included. In every MA evaluated, Harmonic devices were associated with either statistically significant or numerical improvements in every outcome compared with conventional techniques; most MAs reported a reduction in operating time of ≥ 25 min. Harmonic versus ABP device MAs in colectomy and thyroidectomy showed no significant differences in outcomes. CONCLUSION Across surgical procedures, Harmonic devices demonstrated improved patient outcomes for operating time, length of stay, intraoperative bleeding, drainage volume, pain, and overall complications compared to conventional techniques. Additional studies are required to assess differences between Harmonic and ABP devices.
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Affiliation(s)
| | | | | | - Nicole C. Ferko
- EVERSANA, 113-3228 South Service Rd., Burlington, ON L7N 3H8 Canada
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Leto Barone AA, Arun A, Samaha GJ, Shallal CC, Redett RJ, Steinberg JP. Design of a Novel Reproducible Cartilage-Sparing Autologous Technique for Microtia Repair. Facial Plast Surg Aesthet Med 2020; 23:224-229. [PMID: 33185490 DOI: 10.1089/fpsam.2020.0457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Microtia reconstruction through manual carving of autologous rib cartilage has a steep learning curve, is operator dependent, is time consuming, requires multiple stages, and frequently results in suboptimal results with poor patient satisfaction. The use of temporoparietal fascia over polypropylene implants achieves excellent cosmetic outcomes in a single stage, although is burdened by infection and extrusion in some cases. We describe the development of a hybrid technique with a novel device that allows for standardization of the cartilaginous construct, minimization of the need for donor cartilage and operative time, and minimization of the number of stages. Clinical Trial: NCT03624608.
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Affiliation(s)
- Angelo A Leto Barone
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anirudh Arun
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Georges J Samaha
- Division of Plastic, Aesthetic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Christopher C Shallal
- Department of Biomedical Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland, USA
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jordan P Steinberg
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Toral Guisasola I, Formigo Couceiro J, Alonso Bidegain M. [Selective ultrasound-guided hydrodissection of gastrocnemius nerve branch after post-surgical entrapment: Apropos of a case]. Rehabilitacion (Madr) 2020; 54:292-295. [PMID: 32680689 DOI: 10.1016/j.rh.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 06/11/2023]
Abstract
Chronic or recalcitrant plantar fasciitis is a cause of persistent plantar pain. These cases are usually resistant to conventional treatments consisting of exercises, orthoses, shock waves and infiltrations and require a surgical approach. Proximal medial gastrocnemius release is a surgical option that provides satisfactory results, but is not free of complications, which include injuries and nerve entrapment. We report the first published case of symptomatic medial gastrocnemius branch entrapment in the post-surgical scar of a tenotomy for the treatment of recalcitrant plantar fasciitis. We propose ultrasound-guided hydrodissection with local anesthetic as a treatment with promising results.
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Affiliation(s)
- I Toral Guisasola
- Servicio de Medicina Física y Rehabilitación, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, España.
| | - J Formigo Couceiro
- Servicio de Medicina Física y Rehabilitación, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, España
| | - M Alonso Bidegain
- Servicio de Medicina Física y Rehabilitación, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, España
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Schlosshauer T, Kiehlmann M, Ramirez P, Riener M, Djedovic G, Rieger UM. Comparative analysis on the effect of low-thermal plasma dissection device (PEAK PlasmaBlade) versus conventional electro surgery in post-bariatric body-contouring procedures: A retrospective randomised clinical study. Int Wound J 2019; 16:932-939. [PMID: 30938101 PMCID: PMC7949418 DOI: 10.1111/iwj.13124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/15/2019] [Accepted: 03/15/2019] [Indexed: 11/28/2022] Open
Abstract
Postoperative wound-healing problems are relatively high in post-bariatric body-contouring procedures, partly because of electrosurgery and the associated thermal tissue damage. This study is a retrospective randomised evaluation of the effect of a low-thermal plasma dissection device (PEAK PlasmaBlade, Medtronic, Minneapolis, Minnesota) in comparison with conventional electrosurgery. A total of 24 patients undergoing upper arm or medial thigh lifting were randomised to PEAK PlasmaBlade on one side and to monopolar electrosurgery on the other side of the same patient. Wounds of 10 patients were examined histologically for acute thermal injury depth. Significantly lower total volume of drain output (61,1 ± 70,2 mL versus 95,1 ± 176,0 mL; P = .04) was found on the PEAK PlasmaBlade side compared with the electrosurgery side. Furthermore, the PEAK PlasmaBlade side showed fewer seromas (no case of seroma versus three seromas in the electrosurgery group) and less thermal damage (40% versus 70%; P = .26). Acute thermal injury depth from the PEAK PlasmaBlade was less than from monopolar electrosurgery (425 ± 171 μm versus 686 ± 1037 μm; P = .631). PEAK PlasmaBlade appears to be superior to traditional monopolar electrosurgery for post-bariatric body-contouring procedures because it demonstrated less tissue damage, lower total volume of drain output, and fewer postoperative seromas resulting in faster wound healing.
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Affiliation(s)
- Torsten Schlosshauer
- Department of Plastic and AestheticReconstructive and Hand Surgery at AGAPLESION Markus HospitalFrankfurt am MainGermany
| | - Marcus Kiehlmann
- Department of Plastic and AestheticReconstructive and Hand Surgery at AGAPLESION Markus HospitalFrankfurt am MainGermany
| | - Pablo Ramirez
- Department of Plastic and AestheticReconstructive and Hand Surgery at AGAPLESION Markus HospitalFrankfurt am MainGermany
| | | | - Gabriel Djedovic
- Department of Plastic and AestheticReconstructive and Hand Surgery at AGAPLESION Markus HospitalFrankfurt am MainGermany
| | - Ulrich M. Rieger
- Department of Plastic and AestheticReconstructive and Hand Surgery at AGAPLESION Markus HospitalFrankfurt am MainGermany
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Mattei TA, Perret CM, Nunes JC. Development of a New Coupled Cobb-Suction Instrument for Posterior Spinal Approaches: Technical Note. World Neurosurg 2019; 125:333-337. [PMID: 30776516 DOI: 10.1016/j.wneu.2019.01.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND During dissection of paraspinal muscles in posterior surgical approaches, the spine surgeon usually holds a subperiosteal (Cobb) elevator in 1 hand and a monopolar cautery in the other hand. In such a scenario, both the surgical smoke generated by the monopolar and eventual bleeding constitute a significant hindrance to simultaneous bilateral dissection of the paraspinal muscles by 2 surgeons. METHODS To address the identified shortcomings in the currently available instrumentation, we initially analyzed the most common surgical techniques employed by residents and fellows at our institution for paraspinal muscle dissection during posterior spinal approaches. Additionally, we collected trainees' feedback regarding the efficacy of available strategies for dealing with surgical smoke. RESULTS A new coupled Cobb elevator-suction instrument was designed, manufactured, and tested by residents, fellows, and experienced spine surgeons, and small additional design modifications were performed. CONCLUSIONS We present what we believe is the first description of a new coupled Cobb-suction instrument that has been developed to enable simultaneous retraction and suction with 1 hand, while allowing the spine surgeon to use the monopolar cautery with the other hand. In our preliminary institutional experience, this new tool has been proven to be especially useful in long posterior spinal approaches in the thoracolumbar region.
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Affiliation(s)
- Tobias A Mattei
- Department of Neurological Surgery, Saint Louis University, Saint Louis, Missouri, USA.
| | - Caio M Perret
- Federal University of Rio de Janeiro (UFRJ), Fundação Osvaldo Cruz (FioCruz), Laboratory for Neuroprotection and Regenerative Strategies, Rio de Janeiro, Brazil
| | - Julio C Nunes
- Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
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Abstract
INTRODUCTION The Harmonic scalpel ("Focus" and the new version "Focus+") is one of the first devices for surgical simultaneous cutting and tissue coagulation which allows to obtain dissection and hemostasis by direct application of ultrasound and allows minimally invasive surgical procedures with minimal lateral thermal spread and, thus, minimal adjacent tissue destruction. The aim of the study is to complete the previous study that we made in 2014, based on the TT performed between January 2008 and December 2013, with new data about TT performed in our Surgical Division between January 2014 and December 2016 and compare the outcome using the Ultrasonic scalpel versus the device Ligasure in term of safety, operative time, overall drainage volume, complications, hospital stay. PATIENTS AND METHODS 250 patients were randomized into two groups: Group A where Ultracision were used and Group B where the Ligasure device was used. RESULTS The results of the group A and of the Group B 2014-2016 have been compared with the results of the previous study and we found that they are similar, but asymptomatic hypocalcaemia increased in the patients of the new study. CONCLUSIONS We found that the use of Ultrasonic scalpel and Ligasure is effective both in the hemostasis of all vessels and in dissection of tissues and confirm the results of our first study without significant difference in the rate of post-operative morbidity with these two different energy based devices used.
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Allanson BM, Kumarasinghe MP. Processing of Surgical Specimen (Esophagogastrectomy) for Esophageal Adenocarcinoma. Methods Mol Biol 2018; 1756:85-92. [PMID: 29600362 DOI: 10.1007/978-1-4939-7734-5_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
An esophagogastrectomy is a surgical procedure that is performed for treatment of confirmed localized esophageal and esophagogastric junction adenocarcinoma. Proper macroscopic assessment and cut-up technique is essential to ensure that the overall assessment is correct and reproducible. Here, we describe a standard for macroscopic assessment and dissection to be used for routine handling of esophagogastrectomy specimens in the clinical laboratory.
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Affiliation(s)
- Benjamin M Allanson
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
| | - M Priyanthi Kumarasinghe
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, WA, Australia
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Affiliation(s)
- Süleyman Tas
- Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul Kemerburgaz University, Istanbul, Turkey
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Ohara Y, Toyonaga T, Hoshi N, Tanaka S, Baba S, Takihara H, Kawara F, Ishida T, Morita Y, Umegaki E, Azuma T. Usefulness of a novel slim type FlushKnife-BT over conventional FlushKnife-BT in esophageal endoscopic submucosal dissection. World J Gastroenterol 2017; 23:1657-1665. [PMID: 28321167 PMCID: PMC5340818 DOI: 10.3748/wjg.v23.i9.1657] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/28/2016] [Accepted: 01/11/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigated the usefulness of a novel slim type ball-tipped FlushKnife (FlushKnife-BTS) over ball-tipped FlushKnife (FlushKnife-BT) in functional experiments and clinical practice.
METHODS In order to evaluate the functionality of FlushKnife-BTS, water aspiration speed, resistance to knife insertion through the scope, and waterjet flushing speed were compared between FlushKnife-BTS and BT. In clinical practice, esophageal endoscopic submucosal dissection (ESD) performed using FlushKnife-BTS or BT by an experienced endoscopist between October 2015 and January 2016 were retrospectively reviewed. The treatment speed and frequency of removing and reinserting the knife to aspirate fluid and air during ESD sessions were analyzed.
RESULTS Functional experiments revealed that water aspiration speed by the endoscope equipped with a 2.8-mm working channel with FlushKnife-BTS was 7.7-fold faster than that with conventional FlushKnife-BT. Resistance to knife insertion inside the scope with a 2.8-mm working channel was reduced by 40% with FlushKnife-BTS. The waterjet flushing speed was faster with the use of FlushKnife-BT. In clinical practice, a comparison of 6 and 7 ESD using FlushKnife-BT and BTS, respectively, revealed that the median treatment speed was 25.5 mm2/min (range 19.6-30.3) in the BT group and 44.2 mm2/min (range 15.5-55.4) in the BTS group (P = 0.0633). However, the median treatment speed was significantly faster with FlushKnife-BTS when the resection size was larger than 1000 m2 (n = 4, median 24.2 mm2/min, range 19.6-27.7 vs n = 4, median 47.4 mm2/min, range 44.2-55.4, P = 0.0209). The frequency of knife replacement was less in the BTS group (median 1.76 times in one hour, range 0-5.45) than in the BT group (7.02 times in one hour, range 4.23-15) (P = 0.0065).
CONCLUSION Our results indicate that FlushKnife-BTS enhances the performance of ESD, particularly for large lesions, by improving air and fluid aspiration and knife insertion during ESD and reducing the frequency of knife removal and reinsertion.
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Pogorelić Z, Katić J, Mrklić I, Jerončić A, Šušnjar T, Jukić M, Vilović K, Perko Z. Lateral thermal damage of mesoappendix and appendiceal base during laparoscopic appendectomy in children: comparison of the harmonic scalpel (Ultracision), bipolar coagulation (LigaSure), and thermal fusion technology (MiSeal). J Surg Res 2017; 212:101-107. [PMID: 28550895 DOI: 10.1016/j.jss.2017.01.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 12/23/2016] [Accepted: 01/18/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim of this study was to compare lateral thermal damage of mesoappendix and appendiceal base using three different instruments for sealing and cutting of mesoappendix. MATERIALS AND METHODS A total number of 99 patients (54 males and 45 females) who underwent laparoscopic appendectomy because of suspected appendicitis between December 2013 and May 2015 were enrolled in the study. The patients were divided in three groups based on instrument used for sealing of mesoappendix: group 1 (Ultracision; n = 36), group 2 (LigaSure; n = 32), and group 3 (MiSeal; n = 31). Lateral thermal damage, intraoperative and postoperative complications, duration of surgery, hospital stay, and economic value were compared within groups. RESULTS The median age of patients was 14 y (range 3-17). A histopathologic analysis revealed a positive diagnosis of appendicitis in 84 patients (85%). The median lateral thermal damage on appendiceal base using Ultracision, LigaSure, and MiSeal was 0.10 mm, 0.16 mm, and 0.10 mm respectively, and on mesoappendix, 0.08 mm, 0.13 mm, and 0.08 mm, respectively. Significantly higher thermal damage was found on mesoappendix (P = 0.015) and appendiceal base (P = 0.012) in patients treated with LigaSure than in patients from other groups. There were no statistical differences among the groups regarding intraoperative and postoperative complications (P = 0.098). No significant difference in thermal damage between appendicitis and nonappendicitis group was found (P = 0.266). CONCLUSIONS Using of Ultracision, LigaSure, and MiSeal for sealing of mesoappendix in laparoscopic appendectomy in children is safe and useful. LigaSure produces significantly greater lateral thermal damage compared with other instruments.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia; School of Medicine, University of Split, Split, Croatia.
| | - Josip Katić
- School of Medicine, University of Split, Split, Croatia
| | - Ivana Mrklić
- School of Medicine, University of Split, Split, Croatia; Department of Pathology, Forensic Medicine and Cytology, University Hospital of Split, Split, Croatia
| | - Ana Jerončić
- Department for Research in Biomedicine and Health, School of Medicine, University of Split, Split, Croatia
| | - Tomislav Šušnjar
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
| | - Miro Jukić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
| | - Katarina Vilović
- School of Medicine, University of Split, Split, Croatia; Department of Pathology, Forensic Medicine and Cytology, University Hospital of Split, Split, Croatia
| | - Zdravko Perko
- School of Medicine, University of Split, Split, Croatia; Department of Surgery, University Hospital of Split, Split, Croatia
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Abstract
The objective of the present work was to study the specific endoscopic anatomical features of the middle ear using the dissected temporal bones with the intact tympanic membrane. The 18 cm long endoscopes 4 mm in diameter with a visual angle from 0 to 45 degrees in the combination with some other microinstruments, such as ear pincers, needles, curettes, elevators, and suction tubes, were used during the examination. It was shown that endomeato-transtympanic endosopy provides a panoramic view of almost all structures of the middle ear. After the resection of the posterior bone edge of 'annulus tympanicus', the use of the 45o endoscope ensured the panoramic view not only of certain structures of the middle ear (e.g. the tympanic chord, the stapedius muscle tendon, the entire pyramidal process) but also of the structures of the retrotympanic and anterior epitympanic spaces.
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Affiliation(s)
- R M Rzaev
- Department of Otorhinolaryngology - Head and Neck Surgery, Central Azerbaijan Railway Hospital, Baku, Azerbaijan, AZ1117
| | - R R Rzaev
- State Scientific Clinical Centre of Otorhinolaryngology, Federal Medico-Biological Agency, Moscow, Russia, 125310
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Kurganov IA, Emelyanov SI, Bogdanov DY, Agafonov OA, Mamistvalov MS, Matveev NL, Fedorov AV, Kusin AN. [Pectoral-retroauricular approach for endoscopic parathyroidectomy (experimental study)]. Khirurgiia (Mosk) 2017:32-36. [PMID: 29186094 DOI: 10.17116/hirurgia20171132-36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM To develop and investigate in the experiment the method of endoscopic parathyroidectomy in order to prevent intraoperative 'conflict of the instruments' and to reduce surgical trauma via extracervical approach. MATERIAL AND METHODS The results of 10 experimental endoscopic parathyroidectomies with original pectoral-retroauricular approach were analyzed. RESULTS Mean time of surgery was 77.8±10.2 minutes (65-97), mean time of surgical exposure - 50.3±6.7 minutes (41-59). Visualization and identification of parathyroid glands were achieved in 100% of cases. Recurrent laryngeal nerve was preserved in 100% of cases. CONCLUSION Original endoscopic pectoral-retroauricular approach for parathyroidectomy is methodologically and technically justified and can be recommended for clinical application.
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Affiliation(s)
- I A Kurganov
- Chair of Endoscopic Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - S I Emelyanov
- Chair of Endoscopic Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - D Yu Bogdanov
- Chair of Endoscopic Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - O A Agafonov
- Tsentrosoyuz Hospital of the Russian Federation, Moscow, Russia ,Chair of Operative Surgery and Topographic Anatomy, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - M Sh Mamistvalov
- Chair of Endoscopic Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - N L Matveev
- Chair of Endoscopic Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - A V Fedorov
- Chair of Endoscopic Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
| | - A N Kusin
- Chair of Operative Surgery and Topographic Anatomy, Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Healthcare of Russia, Moscow, Russia
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Pioche M, Lépilliez V, Ciocîrlan M, Rivory J, Miaglia C, Hervieu V, Poncet G, Valette PJ, Saurin JC, Ponchon T. Endoscopic submucosal dissection with the Nestis ® jet injector system with a bifunctional catheter: first prospective clinical trial (NCT: 2012-A00272-41). Surg Endosc 2016; 30:5140-5146. [PMID: 26944726 DOI: 10.1007/s00464-016-4827-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 02/09/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Enki-2 water jet system (Nestis SAS®, Lyon, France) with dual injection and dissection capability significantly reduced ESD procedure time and perforation rates in animal studies. The study aim was to evaluate its efficacy and safety in patients with superficial neoplastic lesions. METHODS A prospective study including 18 patients with esophageal, gastric and rectal superficial neoplasms treated by ESD using Enki-2 was designed. RESULTS Eighteen lesions (6 esophageal, 3 gastric, 9 rectal, mean diameter 43.5 mm) in 17 patients (10 men, mean age 65.9) were included. The mean procedure time was 65.6 min. One patient needed clipping for an incomplete muscle tear during procedure; there were neither delayed bleedings nor perforation. The "en bloc" resection rate was 100 %, the R0 resection rate was 88.9 % (16/18 lesions), and the curative resection rate was 77.8 %. The 3-month disease-free rate was 92.3 % (12/13 patients, 13/14 lesions, 1 patient lost to follow-up). The 12-month disease-free rate was 69.2 % (9/13 patients, 10/14 lesions, 4 patients lost to follow-up). CONCLUSIONS ESD with Enki-2 water jet system is effective and safe for superficial neoplastic digestive lesions.
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Affiliation(s)
- Mathieu Pioche
- Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon Cedex, France.
- Nestis, Lyon, France.
- LabTau, Inserm U1032, Lyon Cedex, France.
| | - Vincent Lépilliez
- Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon Cedex, France
| | - Mihai Ciocîrlan
- Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon Cedex, France
- Fundeni Gastroenterology Clinic, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Jérôme Rivory
- Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon Cedex, France
| | - Clothilde Miaglia
- Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon Cedex, France
| | - Valérie Hervieu
- Pathology Department, Edouard Herriot Hospital, Lyon, France
| | - Gilles Poncet
- Visceral Surgery Department, Edouard Herriot Hospital, Lyon Cedex, France
| | - Pierre-Jean Valette
- Digestive Radiology Department, Edouard Herriot Hospital, Lyon Cedex, France
| | | | - Thierry Ponchon
- Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon Cedex, France
- LabTau, Inserm U1032, Lyon Cedex, France
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Marcus HJ, Payne CJ, Kailaya-Vasa A, Griffiths S, Clark J, Yang GZ, Darzi A, Nandi D. A "Smart" Force-Limiting Instrument for Microsurgery: Laboratory and In Vivo Validation. PLoS One 2016; 11:e0162232. [PMID: 27622693 PMCID: PMC5021258 DOI: 10.1371/journal.pone.0162232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 08/21/2016] [Indexed: 12/20/2022] Open
Abstract
Residents are required to learn a multitude of skills during their microsurgical training. One such skill is the judicious application of force when handling delicate tissue. An instrument has been developed that indicates to the surgeon when a force threshold has been exceeded by providing vibrotactile feedback. The objective of this study was to validate the use of this “smart” force-limiting instrument for microsurgery. A laboratory and an in vivo experiment were performed to evaluate the force-limiting instrument. In the laboratory experiment, twelve novice surgeons were randomly allocated to use either the force-limiting instrument or a standard instrument. Surgeons were then asked to perform microsurgical dissection in a model. In the in vivo experiment, an intermediate surgeon performed microsurgical dissection in a stepwise fashion, alternating every 30 seconds between use of the force-limiting instrument and a standard instrument. The primary outcomes were the forces exerted and the OSATS scores. In the laboratory experiment, the maximal forces exerted by novices using the force-limiting instrument were significantly less than using a standard instrument, and were comparable to intermediate and expert surgeons (0.637N versus 4.576N; p = 0.007). In the in vivo experiment, the maximal forces exerted with the force-limiting instrument were also significantly less than with a standard instrument (0.441N versus 0.742N; p <0.001). Notably, use of the force-limiting instrument did not significantly impede the surgical workflow as measured by the OSATS score (p >0.1). In conclusion, the development and use of this force-limiting instrument in a clinical setting may improve patient safety.
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Affiliation(s)
- Hani J. Marcus
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, United Kingdom
- * E-mail:
| | - Christopher J. Payne
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Ahilan Kailaya-Vasa
- Department of Neurosurgery, Barking, Havering and Redbridge University Hospitals NHS Trust, Essex, United Kingdom
| | - Sara Griffiths
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - James Clark
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Guang-Zhong Yang
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Ara Darzi
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Dipankar Nandi
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, United Kingdom
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Abstract
Advances in endoluminal instrumentation and technology are enabling endoscopists to perform increasingly sophisticated procedures. Indications for these procedures are likely to expand as outcomes studies show they are efficacious and cost-effective. This article highlights several recent advances in endoluminal suturing, dissecting, and ligating and discusses the impact of these advances on the practice of gastrointestinal surgery. Endoluminal suturing offers select patients with gastroesophageal reflux disease a safe and effective alternative to laparoscopic surgery. Devices designed for endoluminal hemostasis and endoscopic mucosal resection can be used effectively for a broader range of applications and are already being used to perform transluminal surgery in animal models; human trials are forthcoming. Gastrointestinal surgeons should support efforts to critically evaluate endoluminal techniques because they have an opportunity to improve care. Surgical residents planning careers in gastrointestinal surgery need to understand endoscopic techniques and consider their training opportunities.
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Affiliation(s)
- James Ellsmere
- Section of Minimally Invasive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
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17
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Abstract
OBJECTIVE: The aim of our study was to assess the rate of reactionary and secondary posttonsillectomy hemorrhage using “cold” dissection and bipolar diathermy and to determine whether there was any difference in the postoperative hemorrhage rate between the 2 methods. METHODS: This was a prospective study of all patients undergoing tonsillectomy between November 8, 1999 and November 7, 2000 in a tertiary medical centre. The data collected included patient identity, age, gender, date of surgery, method of operation, and complications (if any). The timing of reactionary or secondary posttonsillectomy hemorrhage and the treatment were recorded. We hypothesized no difference in posttonsillectomy hemorrhage rates using the 2 methods. X 2 test was used for statistical analysis. RESULTS: A total of 349 patients underwent tonsillectomy in the period (134 males, 215 females, mean age was 16.7 years). Of these, 337 were bilateral procedures, 145 patients had tonsillectomy using cold dissection, and 192 patients had bipolar diathermy. Reactionary hemorrhage occurred in 1 patient (0.3%) and 31 patients (9.2%) developed secondary hemorrhage. The hemorrhage rates using cold dissection (n = 8) and bipolar diathermy (n = 24) were 5.5% and 12.5%, respectively ( P < 0.05). CONCLUSIONS: The primary and secondary posttonsillectomy hemorrhage rates were 0.3 and 9.2%, respectively. Tonsillectomy using bipolar diathermy has a statistically significant higher secondary hemorrhage rate than using cold dissection (12.5% vs. 5.5%, P < 0.05). (Otolaryngol Head Neck Surg 2004;131:833–6.)
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Affiliation(s)
- Michael S W Lee
- Department of Otolaryngology, Ninewells Hospital and Medical School, Dundee, United Kingdom
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18
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Bahls T, Frohlich FA, Hellings A, Deutschmann B, Albu-Schaffer AO. Extending the Capability of Using a Waterjet in Surgical Interventions by the Use of Robotics. IEEE Trans Biomed Eng 2016; 64:284-294. [PMID: 27101592 DOI: 10.1109/tbme.2016.2553720] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In waterjet surgery, a thin high-pressure jet is used for dissections and surface abrasion of soft tissue. This selective preparation method preserves nerves and vessels, whereas the surrounding soft tissue is washed away. OBJECTIVE The aim of this study is to enhance the application field of this technique by resolving technological limitations. METHODS A technical task definition of handling a hand-guided waterjet applicator is derived from the literature. All reported procedures require to follow a trajectory superimposed with an oscillating movement. By introducing a robotic system and a specialized kinematic approach, the limited dexterity of the waterjet applicator is increased. Additionally, the system provides assistance by automatically performing parts of the task. RESULTS The method is applied to two different procedures: a minimally invasive dissection and a surface abrasion for open medical treatments. On the basis of experiments with gelatine phantoms, the performance of the method is shown for both procedures. CONCLUSION In the minimally invasive use case, the reachability limited by the conventional manual tools is extended by the capabilities of the robotic system. Simultaneously, the handling is simplified by automation of the superimposed oscillation. In the surface abrasion case, a dense coverage of the treated area is achievable. The risk of cross infections could be reduced by spatial separation of patient and staff. SIGNIFICANCE Thus, the waterjet technology can be fully integrated into robotic surgery systems and benefit from their inherent abilities.
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Suzuki T, Hara T, Kitagawa Y, Yamaguchi T. Usefulness of IT knife nano for endoscopic submucosal dissection of large colo-rectal lesions. Acta Gastroenterol Belg 2016; 79:186-190. [PMID: 27382935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM Endoscopic submucosal dissection (ESD) is currently widely conducted for the treatment of early gastrointestinal -cancers. Due to the characteristic anatomy of the large intestine, needle- tip type devices such as Dual knife are mainly used in colorectal ESD. On the other hand, the non- needle-tip type IT knife is a unique device with an insulated tip, and has been reported to be safe, efficacious and speedy when used in gastric ESD. A new model of IT knife, IT knife nano, anticipated to be useful for esophageal and colorectal ESD has become available, but its usefulness has not been reported. Therefore, we performed this study to evaluate the usefulness of IT knife nano for ESD of large colorectal lesions. METHOD Previous studies have shown that a tumor size of 40 mm or above significantly prolongs treatment time and is a factor of treatment difficulty. We selected colorectal lesions of 40 mm and above, and compared 32 lesions treated with Dual knife alone before IT knife nano was available (No-IT group) and 40 cases treated with IT knife nano as a second knife after IT knife nano became available (IT group). We assessed en bloc resection rate, complete en bloc resection rate, complication rate and treatment time. RESULTS The en bloc resection rates in No-IT group and IT group were 100% and 97.5%, respectively, with no significant difference. The respective median treatment time was 70 min and 51 min, and was significantly shortened in IT group (P < 0.05). The respective rates of procedure- related perforation were 3.1% and 0% ; in IT group suggesting a tendency of reduced incidence. CONCLUSIONS Use of IT knife nano in ESD for large colorectal -lesions achieves the same levels of efficacy and safety as conventional device, with the additional merit of shortening treatment time.
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van Rutte PWJ, Lup SL, Luyer MD, Jakimowicz JJ, Goossens RHM, Nienhuijs SW. Comparative Study of Performance in Ultrasonic Tissue Dissection for Sleeve Gastrectomy: Wired versus Cordless. Surg Technol Int 2016; 28:111-116. [PMID: 27175810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The sleeve gastrectomy is being performed increasingly as a primary procedure for the treatment of morbid obesity. A minimally invasive approach is currently applied to the procedure. The two major steps are dissection and stapling. For dissection, several tools have been developed. The goal of this study was to compare the efficiency and the ergonomics of two ultrasonic devices during the sleeve gastrectomy. MATERIALS AND METHODS Thirty patients were randomised for the use of a cordless Sonicision™ (Covidien, Mansfield, MA) or a cord-containing HARMONIC ACE®+ (Ethicon Endo-Surgery Inc., Cincinnati, OH) during dissection. Both devices were assessed for objective and subjective measures. RESULTS There was no significant difference in duration of the procedures. The assembly and installation time of the Sonicision™ were significantly shorter; however, the dismantle time was not. No difference in plume formation or dissection failures was found between the devices. Scrub nurses scored the Sonicision™ significantly clearer and easier in use and more reliable. The surgeons, however, did not find one of the devices easier in use, more reliable or precise, but they did report better manoeuvrability of the Sonicision™. CONCLUSION In comparison to the wired HARMONIC ACE®+, during sleeve gastrectomy, the cordless Sonicision™ was considered easier to use, faster during assembling and installation, and more reliable with better manoeuvrability. Surgeons scored both devices equally effective. Both ultrasonic devices can be used easily and safely for a sleeve gastrectomy.
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Affiliation(s)
- Pim W J van Rutte
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Sandra L Lup
- Faculty of Industrial Design Engineering, Technical University of Delft, Delft, The Netherlands
| | - Misha D Luyer
- Surgical Department, Catharina Hospital, Eindhoven, The Netherlands
| | - Jack J Jakimowicz
- Faculty of Industrial Design Engineering, Technical University of Delft, Delft, The Netherlands
| | - Richard H M Goossens
- Faculty of Industrial Design Engineering, Technical University of Delft, Delft, The Netherlands
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Huang R, Yan H, Ren G, Pan Y, Zhang L, Liu Z, Guo X, Wu K. Comparison of O-Type HybridKnife to Conventional Knife in Endoscopic Submucosal Dissection for Gastric Mucosal Lesions. Medicine (Baltimore) 2016; 95:e3148. [PMID: 27043675 PMCID: PMC4998536 DOI: 10.1097/md.0000000000003148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) has been accepted as a minimal invasive alternative to surgery for localized superficial gastrointestinal neoplasms recently. However, the procedure remains to be technically challenging and time consuming. A new dissecting knife with partially insulated tip has been recently developed with built-in injection capability. The purpose of this study was to investigate whether the efficiency of ESD procedure could be improved with this new device. A total of 78 patients, who underwent ESD with gastric mucosal lesions including flat type polyps, adenoma or early gastric cancer, were randomly assigned to either ESD with O-type HybridKnife or conventional ESD knives without waterjet. Procedure time and related factors of ESD were analyzed. ESD procedure time was 43.0 (interquartile range, IQR 27.0-60.0) minutes in HybridKnife group compared to 60.5 (IQR 44.0-86.3) minutes in the control group (P = 0.001). There was no difference in the clinical outcome and the adverse event rate. The former demonstrated more favorable results in lesions ≤4 cm of specimen size (P ≤ 0.0001) and when located in the distal stomach (P = 0.001), also in lesions with fibrosis (P = 0.008). Multivariate regression analysis showed that O-type Knife (P ≤ 0.0001), specimen size (P ≤ 0.0001), and fibrosis (P ≤ 0.0001) were independent predictors of procedure time. The O-type HybridKnife yielded faster procedure time compared to the conventional knives in gastric ESD with a similar safety profile.
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Affiliation(s)
- Rui Huang
- From the Xijing Hospital of Digestive Diseases, Fourth Military Medical University (RH, GR, YP, LZ, ZL, XG, KW), and The First Affiliated Hospital of Xi'an Medical University, Xi'an, China (HY)
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22
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Vale MR. Surveillance cameras and their use as a dissecting microscope in the teaching of biological sciences. Adv Physiol Educ 2016; 40:116-118. [PMID: 26873899 DOI: 10.1152/advan.00040.2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Marcus R Vale
- Department of Physiology and Pharmacology and Seara da Ciência, Federal University of Ceará, Ceará, Brazil
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23
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Huang J, Yu Y, Wei C, Qin Q, Mo Q, Yang W. Harmonic Scalpel versus Electrocautery Dissection in Modified Radical Mastectomy for Breast Cancer: A Meta-Analysis. PLoS One 2015; 10:e0142271. [PMID: 26544716 PMCID: PMC4636213 DOI: 10.1371/journal.pone.0142271] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite the common use of conventional electrocautery in modified radical mastectomy for breast cancer, the harmonic scalpel is recently emerging as a dominant surgical instrument for dissection and haemostasis, which is thought to reduce the morbidity, such as seroma and blood loss. But the results of published trials are inconsistent. So we made the meta-analysis to assess the intraoperative and postoperative endpoints among women undergoing modified radical mastectomy with harmonic scalpel or electrocautery. METHODS A comprehensive literature search of case-control studies from PubMed, MEDLINE, EMBASE and Cochrane Library databases involving modified radical mastectomy with harmonic scalpel or electrocautery was performed. We carried out a meta-analysis of primary endpoints including postoperative drainage, seroma development, intraoperative blood loss and secondly endpoints including operative time and wound complications. We used odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the effect size for categorical outcomes and standardised mean differences (SMDs) for continuous outcomes. RESULTS A total of 11 studies with 702 patients were included for this meta-analysis. There was significant difference in total postoperative drainage (SMD: -0.74 [95%CI: -1.31, -0.16]; P< 0.01), seroma development[OR: 0.49 (0.34, 0.70); P < 0.01], intraoperative blood loss(SMD: -1.14 [95%CI: -1.81,-0.47]; P < 0.01) and wound complications [OR: 0.38 (0.24, 0.59); P < 0.01] between harmonic scalpel dissection and standard electrocautery in modified radical mastectomy for breast cancer. No difference was found as for operative time between harmonic scalpel dissection and standard electrocautery (SMD: 0.04 [95%CI: -0.41, 0.50]; P = 0.85). CONCLUSION Compared to standard electrocautery, harmonic scalpel dissection presents significant advantages in decreasing postoperative drainage, seroma development, intraoperative blood loss and wound complications in modified radical mastectomy for breast cancer, without increasing operative time. Harmonic scalpel can be recommended as a preferential surgical instrument in modified radical mastectomy.
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Affiliation(s)
- Jinbo Huang
- The Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Yinghua Yu
- The Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Changyuan Wei
- The Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Qinghong Qin
- The Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Qinguo Mo
- The Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Weiping Yang
- The Department of Ultrasound Diagnosis, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
- * E-mail:
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24
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Toyama Y, Yoshida S, Saito R, Iwase R, Haruki K, Okui N, Shimada JI, Kitamura H, Matsumoto M, Yanaga K. Efficacy of a half-grip technique using a fine tip LigaSure™, Dolphin Tip Sealer/Divider, on liver dissection in swine model. BMC Res Notes 2015; 8:362. [PMID: 26289073 PMCID: PMC4543461 DOI: 10.1186/s13104-015-1316-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 08/03/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Recently, a lot of energy devices in the surgical field, especially in the liver surgery, have been developed, and a fine tip LigaSure™, Dolphin Tip Sealer/Divider (DT-SD) also has been used frequently to dissect liver parenchyma as well as ultrasonically activated device (USAD). However, the utility of this instrument for liver dissection (LD) is still unknown. Moreover, to reduce bleeding during LD, a half-grip technique (HGT) was contrived. We herein report an experimental study in swine model to evaluate the feasibility and effectiveness of HGT using DT-SD for LD. METHODS The swine model experiment was carried out under general anesthesia by veterinarians. LD was performed repeatedly by DT-SD with the HGT (Group A, n = 6), or the conventional clamp-crush technique (CCT) (Group B, n = 6), and by variable mode USAD (Group C, n = 6). The dissection length and depth (cm) as well as bleeding volume (g) were measured carefully, and the dissection area (cm(2)) and speed (cm(2)/min) were calculated precisely. Histological examinations of the dissection surfaces were also executed. Mann-Whitney's U test was used for Statistical analyses with variance at a significance level of 0.05. RESULTS Among the three groups, the three averages of dissection lengths were unexpectedly equalized to 8.3 cm. The dissection area (cm(2)) was 9.9 ± 5.1 in Group A, 9.8 ± 4.7 in Group B, and 9.9 ± 4.5 in Group C. The mean blood loss during LD was 10.6 ± 14.8 g in Group A, 41.4 ± 39.2 g in Group B, and 34.3 ± 39.2 g in Group C. For Group A, the bleeding rate was the least, 0.9 ± 1.0 g/cm(2), and the average depth of coagulation was the thickest, 1.47 ± 0.29 mm, among the three groups (p < 0.05). The dissection speed in Group A (1.3 ± 0.3 cm(2)/min) was slower, than that in Group C (p < 0.05). CONCLUSIONS This report indicates firstly that the HGT using DT-SD bring the least blood loss when compared with CCT or USAD. Although the HGT is feasible and useful for LD, to popularize the HGT, further clinical studies will be needed.
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Affiliation(s)
- Yoichi Toyama
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Seiya Yoshida
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Ryota Saito
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1, Kashiwashita, Kashiwa, Chiba, 277-8567, Japan.
| | - Ryota Iwase
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Koichiro Haruki
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Norimitsu Okui
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Jun-ichi Shimada
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Hiroaki Kitamura
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Michinori Matsumoto
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Katsuhiko Yanaga
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
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Lubna H, Masoom MR. Hydro-dissection - A simple Solution in Difficult Laparoscopic Cholecystectomy. Mymensingh Med J 2015; 24:592-595. [PMID: 26329960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This Quasi-experimental study was done to assess the effectiveness of hydro-dissection in difficult laparoscopic cholecystectomies in Hamdard University Hospital, Karachi, Pakistan, from April 2012 to March 2014. All consecutive patients who presented with cholelithiasis and planned for laparoscopic cholecystectomy were enrolled in this study. Per-operatively the degree of difficulty of the operation was assessed by Cuschieri's scale after grading; Grade II, III and IV cholecystectomies were included in this study. Hydro dissection with saline jet through 5mm simple irrigation and suction probe was used, Operative findings and the total number of patients, in whom anatomy of calot's triangle was clearly displayed with hydro-dissection, was recorded. A total 55 patients were included in the study after assessing the degree of difficulty per operatively by Cuschieri Scale. Thirty one (31) patients were in Group II, 22 in Group III and 02 were included in group IV of Cuschieri scale in which hydro-dissection was used. This method cleared the obscure anatomy in all patients in Group II but in 3 patients of Group III, dense adhesions required sharp dissection to clear the operative field. Two patients, in whom conversion was required, were grouped in Cuschieri's scale IV. Methods of dissection in difficult cholecystectomies are of paramount importance to avoid iatrogenic injuries. Hydro-dissection using suction irrigation probe is a safe and effective technique to clear the difficult anatomy.
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Affiliation(s)
- H Lubna
- Professor Dr Lubna Habib, Professor of Surgery, Hamdard College of Medicine & Dentistry, Hamdard University Hospital, Karachi, Pakistan; E-mail: lubnahabib98@ gmail.com
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Bassan MS, Cirocco M, Kandel G, May GR, Kortan PP, Haber GB, Marcon NE. A second chance at EMR: the avulsion technique to complete resection within areas of submucosal fibrosis. Gastrointest Endosc 2015; 81:757. [PMID: 25028269 DOI: 10.1016/j.gie.2014.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 06/03/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Milan S Bassan
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Gastroenterology and Hepatology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Maria Cirocco
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Gabor Kandel
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Gary R May
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Paul P Kortan
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Gregory B Haber
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Gastroenterology, Lenox Hill Hospital, New York, New York, USA
| | - Norman E Marcon
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, Toronto, Ontario, Canada
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Yamada N, Amano R, Kimura K, Murata A, Yashiro M, Tanaka S, Wakasa K, Hirakawa K. Two-surgeon technique for liver transection using precoagulation by a soft-coagulation system and ultrasonic dissection. Hepatogastroenterology 2015; 62:389-392. [PMID: 25916069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS A soft-coagulation system (SCS) was introduced as an effective device to reduce blood loss in hepatectomy. Here we evaluated the efficacy of a two-surgeon technique using precoagulation by an SCS and the Cavitron Ultrasonic Surgical Aspirator (CUSA) for liver transection. METHODOLOGY The 163 patients with liver tumors were divided into two groups (conventional group and two-surgeon group). Liver transection was conducted using saline-coupled bipolar electrocautery and CUSA in 102 patients (conventional group). In 61 patients (the two-surgeon group), a two-surgeon technique using precoagulation by an SCS and CUSA for liver resection was performed. RESULTS The median blood loss was significantly less in the two-surgeon group compared to the conventional group (354.8 mL vs. 557.8 mL, respec tively: p = 0.0011). The postoperative hospital stay was significantly shorter in the two-surgeon group compared to the conventional group (12.7 days vs. 15.5 days, p = 0.0035). CONCLUSIONS The two-surgeon technique using precoagulation by an SCS and CUSA was significantly reduced blood loss during liver transection, and associated with low morbidity and mortality. This technique may be useful for many hepatobiliary surgeons.
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Knyazev MV, Duvanskiy VA. [ENDOSCOPIC MUCOSAL RESECTION WITH SUBMUCOSAL DISSECTION ESD AND THE FIRST LONG-TERM RESULTS OF APPLYING THIS METHOD]. Eksp Klin Gastroenterol 2015:53-58. [PMID: 26415266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This review discusses the advantages and disadvantages of endoscopic mucosal resection with submucosal dissection ESD and the first long-term results of applying this method.
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Laquière A, Grandval P, Arpurt JP, Boulant J, Belon S, Aboukheir S, Laugier R, Penaranda G, Curel L, Boustière C. Interest of submucosal dissection knife for endoscopic treatment of Zenker's diverticulum. Surg Endosc 2014; 29:2802-10. [PMID: 25475517 DOI: 10.1007/s00464-014-3976-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 10/25/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Dual-Knife(®) (Olympus) and Hydride-Knife(®) are new needle knives frequently used for submucosal dissection because of their safety and precision. In this study we aimed to evaluate the efficacy and safety of such devices in the diverticulopexy by flexible endoscopy. METHODS From February 2009 to March 2013, 42 patients (25 men), mean age 74.5, with symptomatic Zenker's diverticulum, were included in a non-randomized prospective multicenter study. The symptoms described by all patients include dysphagia, regurgitation and/or swallowing disorders. The diverticulopexy was performed with the Dual-Knife(®) or Hydrid-Knife(®), after septum exposure with the diverticuloscope, and terminated with distal tip clips positioning. All complications were noted. Patients' symptoms were regularly assessed during follow-up visits or telephone interviews. RESULTS The first endoscopy treatment was successful for all patients. Thirty-seven patients (88%) had symptoms improvement after the first treatment. The recurrence rate was 14% (6 patients); a second endoscopic treatment was required 12 months on average after the first treatment, with 100% efficiency. Mid-term (16 months) efficiency was 91.67% after 1 to 3 endoscopic treatments. A total of 55 procedures were performed without perforation or significant bleeding and 3 patients underwent surgery. In multivariate analysis, the diverticulum size and the type of dissection knife were not risks factors for recurrence. CONCLUSIONS Endoscopic diverticuloscope-assisted diverticulotomy with submucosal dissection knives is a safe and effective alternative treatment for patients with a symptomatic Zenker's diverticulum measuring between 2 and 10 cm.
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Affiliation(s)
- A Laquière
- Hepato-Gastro-Enterology Department, Hôpital Saint Joseph, 26 bd de Louvain, 13008, Marseille, France,
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Good DW, Khan A, Hammer S, Scanlan P, Shu W, Phipps S, Parson SH, Stewart GD, Reuben R, McNeill SA. Tissue quality assessment using a novel direct elasticity assessment device (the E-finger): a cadaveric study of prostatectomy dissection. PLoS One 2014; 9:e112872. [PMID: 25384014 PMCID: PMC4226612 DOI: 10.1371/journal.pone.0112872] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 10/15/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction Minimally invasive radical prostatectomy (RP) (robotic and laparoscopic), have brought improvements in the outcomes of RP due to improved views and increased degrees of freedom of surgical devices. Robotic and laparoscopic surgeries do not incorporate haptic feedback, which may result in complications secondary to inadequate tissue dissection (causing positive surgical margins, rhabdosphincter damage, etc). We developed a micro-engineered device (6 mm2 sized) [E-finger]) capable of quantitative elasticity assessment, with amplitude ratio, mean ratio and phase lag representing this. The aim was to assess the utility of the device in differentiating peri-prostatic tissue types in order to guide prostate dissection. Material and Methods Two embalmed and 2 fresh frozen cadavers were used in the study. Baseline elasticity values were assessed in bladder, prostate and rhabdosphincter of pre-dissected embalmed cadavers using the micro-engineered device. A measurement grid was created to span from the bladder, across the prostate and onto the rhabdosphincter of fresh frozen cadavers to enable a systematic quantitative elasticity assessment of the entire area by 2 independent assessors. Tissue was sectioned along each row of elasticity measurement points, and stained with haematoxylin and eosin (H&E). Image analysis was performed with Image Pro Premier to determine the histology at each measurement point. Results Statistically significant differences in elasticity were identified between bladder, prostate and sphincter in both embalmed and fresh frozen cadavers (p = <0.001). Intra-class correlation (ICC) reliability tests showed good reliability (average ICC = 0.851). Sensitivity and specificity for tissue identification was 77% and 70% respectively to a resolution of 6 mm2. Conclusions This cadaveric study has evaluated the ability of our elasticity assessment device to differentiate bladder, prostate and rhabdosphincter to a resolution of 6 mm2. The results provide useful data for which to continue to examine the use of elasticity assessment devices for tissue quality assessment with the aim of giving haptic feedback to surgeons performing complex surgery.
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Affiliation(s)
- Daniel W. Good
- Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, EH2 4XU, United Kingdom
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom
- * E-mail:
| | - Ashfaq Khan
- Department of Anatomy, University of Edinburgh, Edinburgh, United Kingdom
| | - Steven Hammer
- School of Engineering and Physical Sciences, Heriot Watt University, Edinburgh, United Kingdom
| | - Paul Scanlan
- School of Engineering and Physical Sciences, Heriot Watt University, Edinburgh, United Kingdom
| | - Wenmiao Shu
- School of Engineering and Physical Sciences, Heriot Watt University, Edinburgh, United Kingdom
| | - Simon Phipps
- Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, EH2 4XU, United Kingdom
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom
| | - Simon H. Parson
- Department of Anatomy, University of Edinburgh, Edinburgh, United Kingdom
| | - Grant D. Stewart
- Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, EH2 4XU, United Kingdom
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom
| | - Robert Reuben
- School of Engineering and Physical Sciences, Heriot Watt University, Edinburgh, United Kingdom
| | - S. Alan McNeill
- Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, EH2 4XU, United Kingdom
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom
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Vo MN, Ravandi A, Grantham JA. Subintimal space plaque modification for "balloon-uncrossable" chronic total occlusions. J Invasive Cardiol 2014; 26:E133-E136. [PMID: 25274869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Novel techniques for percutaneous revascularization of chronic total occlusions or other complex coronary lesions utilize the subintimal space to safely and efficiently traverse the occluded coronary segment. Antegrade and retrograde dissection reentry is gaining popularity, and is an elegant method to successfully cross coronary chronic total occlusions. We describe a "subintimal space plaque modification" that involves use of antegrade and retrograde dissection reentry techniques to treat "balloon-uncrossable" coronary lesions.
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Affiliation(s)
- Minh N Vo
- University of Manitoba, 409 Tache Ave, Winnipeg, Manitoba R2H 2A6, Canada.
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Esposito C, Iaquinto M, Escolino M, Farina A, La Manna A, Savanelli A, Settimi A, Di Mezza A. Is retroperitoneoscopic renal ablative surgery easier and safer using a new hemostatic device compared with clips and monopolar coagulation? A comparative study. MINERVA UROL NEFROL 2014; 66:101-105. [PMID: 24988200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The aim of study was to retrospectively analyze our series of total and partial retroperiotoneoscopic nephrectomies performed in the last 5 years. METHODS Twenty-two procedures were performed, 20 patients underwent nephrectomy and 2 patients underwent partial nephrectomy. The 20 patients who underwent nephrectomy were divided in 2 groups: group 1 (G1) patients-1-10, for whom we performed the procedure using monopolar coagulation, and group 2 (G2) patients 11-20 for whom we used a new hemostatic device to perform dissection and hemostasis. The results were analyzed using χ2 test. The results of partial nephrectomies were analyzed separately. RESULTS No conversion were reported. We analyzed 6 parameters to compare the results: operative time (OT), estimated blood loss (EBL), need for transfusion (NT), complications, time to oral intake (TOI), hospital stay (HS). OT in G1 was in median 85 minutes, in G2 65 minutes (P=0.004); EBL was 15 mL for G1 and 5 mL for G2 (P=0.000.), NT was not necessary in both, in G1 we had 2 complications and 1 complication in G2; TOI was day 1 for both groups; median HS was 3 days for both. As for heminephrectomy, OT was 120 and 140 min, EBL 30 mL in both, NT not necessary, TOI was 1 day and HS 4 and 5 days respectively. CONCLUSION Our study shows that the use of a new hemostatic devices reduce significantly OT and EBL in children underwent renal ablative surgery for benign pathologies compared with the use of monopolar coagulation.
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Affiliation(s)
- C Esposito
- "Federico II" Pediatric Surgery University of Naples, Naples, Italy -
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33
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Cornwall J. The "hands together" method of nonsterile scalpel blade mounting and removal. Anat Sci Educ 2014; 7:161-166. [PMID: 24150922 DOI: 10.1002/ase.1414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/15/2013] [Accepted: 09/29/2013] [Indexed: 06/02/2023]
Abstract
Scalpels are utilized by many different user groups for such purposes as medical procedures and dissection. Injuries caused by scalpels are a potential risk for scalpel users, and include injuries that may occur while mounting and removing the scalpel blade. Between 10% and 20% of all scalpel injuries in education and healthcare settings are reported to occur while scalpel blades are being mounted or removed. At present there are few published or "best practice" demonstrations of safe technique for scalpel blade mounting and removal. This brief article outlines a variation of the procedure for scalpel blade mounting and removal. It includes strategies developed to minimize risk or injury for the scalpel user, including providing a stable base for the hands and arms so as to prevent unnecessary large amplitude movements that may lead to injury of the scalpel user or a third party. Such a technique may promote scalpel safety, contribute to the development of "best practice" scalpel use, and help decrease injuries that may be caused while mounting or removing scalpel blades.
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Affiliation(s)
- Jon Cornwall
- Faculty of Law, University of Otago, Dunedin, New Zealand; Department of Anatomy, University of Otago, Dunedin, New Zealand
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Das K, Uzun AS, Bozkurt H, Karateke F, Menekse E, Nacar H, Ozdogan M. Diathermy versus scalpel in Limberg flap in pilonidal sinus surgery. A prospective randomized trial. Ann Ital Chir 2014; 85:148-152. [PMID: 24902075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Rhomboid excision with Limberg flap repair (RELIF) is an effective surgical procedure in pilonidal sinus disease (PSD) treatment. This study aimed to compare outcome of diathermy and scalpel in RELIF procedure in PSD surgery. METHODS Patients undergoing RELIF procedure due to PSD at Adana Numune Training and Research Hospital between January 2012 and September 2012 were randomly assigned to diathermy (n=30) or scalpel (n=30) groups. The primary outcomes measured were duration of operation, drainage volume, postoperative numerical pain intensity scale (NPIS) scores, complications, duration of hospitalization length and time to return to daily activity. RESULTS The mean age was 26.2 years (17-44 years). The mean operation duration was significantly lower in diathermy group (p=0.0001). Postoperative total NPIS score within the first 24 h was significantly lower in diathermy group (p=0.001). However, there were not any significant differences in term of NPIS scores in day 3 and day 7. There were no significant differences in terms of total drain output, drain removal time and length of hospital stay. There were no significant differences between groups in terms of duration to sit comfortably, return to daily activity and work. Recurrence of PSD was emerged in one patient in the diathermy group. CONCLUSION Diathermy dissection in RELIF procedure in pilonidal sinus surgery is a safe technique and decreased operation time and postoperative pain.
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Villard PF, Koenig N, Perrenot C, Perez M, Boshier P. Toward a realistic simulation of organ dissection. Stud Health Technol Inform 2014; 196:452-456. [PMID: 24732555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Whilst laparoscopic surgical simulators are becoming increasingly realistic they can not, as yet, fully replicate the experience of live surgery. In particular tissue dissection in one task that is particularly challenging to replicate. Limitation of current attempts to simulate tissue dissection include: poor visual rendering; over simplification of the task and; unrealistic tissue properties. In an effort to generate a more realistic model of tissue dissection in laparoscopic surgery we propose a novel method based on task analysis. Initially we have chosen to model only the basic geometrics of this task rather than a whole laparoscopic procedure. Preliminary work has led to the development of a real time simulator performing organ dissection with a haptic thread at 1000Hz. A virtual cutting tool, manipulated through a haptic device, in combination with 1D and 2D soft-tissue models accuratelyreplicatetheprocessoflaparoscopictissuedissection.
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Affiliation(s)
| | | | - Cyril Perrenot
- University Hospital of Nancy, Lorraine University, Nancy, France
| | - Manuela Perez
- University Hospital of Nancy, Lorraine University, Nancy, France
| | - Piers Boshier
- Department of Surgery and Cancer, Imperial College London, UK
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Ciocîrlan M, Lupu A, Ciora C, Fanică D, Ispas M, Preda C, Mănuc M, Diculescu M. Endoscopic therapy with curative intent for neoplastic epithelial lesions: indications rewiew and the role of "water-jet" technology. Rev Med Chir Soc Med Nat Iasi 2013; 117:916-923. [PMID: 24502069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Neoplastic lesions of the gastrointestinal tract have a large prevalence worldwide and in Romania. Their therapy is tailored to their TNM stage, which can be estimated using non invasive or minimally invasive imaging studies. Precursor lesions and superficial carcinomas are amenable to endoscopic therapy, providing that their endoscopic and/or endoscopic ultrasound aspect suggest a maximal extension to the submucosal layer. Polypectomy, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are ablative techniques used for their curative intent treatment. Large superficial carcinomas are to be removed by ESD as "en bloc" resection is essential to post procedure histological appraisal of the curative oncology nature of their resection. ESD complications rates and duration are nowadays reduced with the aid of "water-jet" technology, by combining submucosal fluid jet injection and electro-resection in a single knife.
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Matsumoto K, Nagahara A, Ueyama H, Konuma H, Morimoto T, Sasaki H, Hayashi T, Shibuya T, Sakamoto N, Osada T, Ogihara T, Yao T, Watanabe S. Development and clinical usability of a new traction device "medical ring" for endoscopic submucosal dissection of early gastric cancer. Surg Endosc 2013; 27:3444-51. [PMID: 23525882 PMCID: PMC3751377 DOI: 10.1007/s00464-013-2887-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 02/15/2013] [Indexed: 12/19/2022]
Abstract
Background Although various traction devices exist for endoscopic submucosal dissection (ESD), the effects of the material used in the devices on the human body has not been considered. Moreover, there has been no report on a device that facilitates dissection both on the oral and anal side of the lesion. We made a traction device that has no deleterious effects on the body and is noninvasive, easy to use, and enables a bilateral approach in ESD. We report the process of its creation and a prospective evaluation of its usage in actual ESD procedures. Methods This study is prospective case control study. Thirty-seven patients for whom the device would be used were consecutively and prospectively enrolled (device used group). Control subjects in whom the device would not be used and who had lesions matched for size and location with those of the device used group were randomly selected (device not used group). Both groups were classified into three subgroups according to treatment difficulty: group A: easy; group B: intermediate; and group C: difficult. The dissection time per cm2 in each group was examined. Results Dissection times in the device not used group/device used group were as follows: group A, 5.8/2.1 min/cm2 (p < 0.01); group B, 6.1/3.8 min/cm2 (p < 0.05); and group C, 7.9/3.6 min/cm2 (p < 0.01), respectively. Conclusions The newly developed medical ring was shown to be feasible and safe and allowed excellent visualization through suitable tension and facilitated rapid gastric ESD. Electronic supplementary material The online version of this article (doi:10.1007/s00464-013-2887-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kenshi Matsumoto
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Hironori Konuma
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Takasi Morimoto
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Hitoshi Sasaki
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Takuo Hayashi
- Department of Human Pathology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Tomoyoshi Shibuya
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Naoto Sakamoto
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Taro Osada
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Tatsuo Ogihara
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Sumio Watanabe
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
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Sukhin IA, Khudets'kyĭ II, Kachan SH, Bilylovets' OM. [Investigation on the impact of hot temperature methods of the tissue dissection and coagulation on parenchymatous organs in experiment]. Klin Khir 2013:76-78. [PMID: 23610953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
There are adduced the results of experimental operations on mongrel rabbits with dissection and coagulation of the liver and the spleen, using highly temperature coagulation apparatuses of various kinds. There was established, that while application of various highly temperature technologies a typical process occurs, consisting of the heat spreading inside the organ. The temperature raising grade depends on the method and duration of the impact.
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40
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Sukhin IA. [Consequences of influence of a high-pressure liquid stream on a hollow organ wall]. Klin Khir 2012:61-63. [PMID: 23610824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
There are adduced the results of histological investigation of preparations, obtained in experiment intraoperatively on a mongrel rabbits, with the objective to study up the consequences of influence of a high-pressure liquid stream towards a wall of a hollow organ. There was established, that in application of a stream, measured 0.1 mm in diameter under pressure of 30 atmospheres a pathological changes in the organ do not occur and the reparative processes course is typical.
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Kim FJ, Sehrt D, Pompeo A, Molina WR. Comparison of surgical plume among laparoscopic ultrasonic dissectors using a real-time digital quantitative technology. Surg Endosc 2012; 26:3408-12. [PMID: 22660839 PMCID: PMC3505554 DOI: 10.1007/s00464-012-2351-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 04/17/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study aimed to analyze the effect of surgical plume generation from various ultrasonic dissectors on laparoscopic visibility, including the first cordless ultrasonic dissector, using a novel real-time digital quantification technique. METHODS The Covidien Cordless Sonicision, the Harmonic ACE, and the Olympus SonoSurg were applied to bovine liver with industry-specified settings. Consecutive activations were digitally captured from a laparoscope positioned to replicate the clinical setting. Plume was recognized by ImageJ software, and the percentage of pixels containing plume in each video frame was calculated. Analysis of variance statistical multi-analysis and Welch's t test were computed for all p values. RESULTS The average maximum plume produced by the Sonicision, ACE, and SonoSurg with the maximum setting were respectively 8.76% (range, 4.32-17.41%), 18.04% (range, 9.07-55.12%), and 9.46% (range, 5.68-22.12%) (p = 0.026). The deviations between the ACE and the other devices were significant (p < 0.05). The average maximum plumes produced with the coagulation setting were 4.80% (range, 0.24-19.83%) for the Sonicision, 26.63% (range, 8.12-73.50%) for the ACE, and 0.21% (range, 0.06-1.05%) for the SonoSurg (p < 0.001). The differences between all the instruments in the coagulation setting were significant. CONCLUSION To the authors' knowledge, this is the first report on a real-time digital analysis of surgical plume generation using ImageJ software. In the coagulation setting, the SonoSurg generated minimal plume. The Sonicision obstructed approximately 4%, whereas the ACE generated plume that obstructed 25% of the laparoscopic field. In the cutting setting, the SonoSurg and Sonicision generated the least obstruction, whereas the ACE caused the most obstruction.
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Affiliation(s)
- Fernando J. Kim
- Division of Urology, Denver Health Medical Center, 777 Bannock Street, MC0206, Denver, CO 80204 USA
- Division of Urology, University of Colorado Health Sciences Center, Aurora, CO USA
| | - David Sehrt
- Division of Urology, Denver Health Medical Center, 777 Bannock Street, MC0206, Denver, CO 80204 USA
| | - Alexandre Pompeo
- Division of Urology, Denver Health Medical Center, 777 Bannock Street, MC0206, Denver, CO 80204 USA
| | - Wilson R. Molina
- Division of Urology, Denver Health Medical Center, 777 Bannock Street, MC0206, Denver, CO 80204 USA
- Division of Urology, University of Colorado Health Sciences Center, Aurora, CO USA
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Thorlacius H, Uedo N, Toth E. [Endoscopic submucosal dissection in colorectal polyps. Promising minimally invasive technique that allows larger resections]. Lakartidningen 2012; 109:2019-2023. [PMID: 23240310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Arain NA, Cadeddu JA, Hogg DC, Bergs R, Fernandez R, Scott DJ. Magnetically anchored cautery dissector improves triangulation, depth perception, and workload during single-site laparoscopic cholecystectomy. J Gastrointest Surg 2012; 16:1807-13. [PMID: 22744636 DOI: 10.1007/s11605-012-1926-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 05/30/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION This study evaluated operative outcomes and workload during single-site laparoscopy (SSL) using a magnetically anchored cautery dissector (MAGS) compared with a conventional laparoscopic hook cautery (LAP). METHODS Each cautery was used to perform six SSL porcine cholecystectomies. For MAGS, the cautery device was inserted through the umbilical incision, magnetically coupled, and deployed; two graspers and a laparoscope were used. For LAP, two percutaneous retraction sutures, one grasper, a hook cautery dissector, and a laparoscope were used. Operative outcomes, surgeon ratings (scale, 1-5; 1 = superior), and workload (scale, 1-10; 1 = superior) were evaluated. RESULTS No significant differences were detected for operative outcomes and surgeon ratings, however, trends were detected favoring MAGS. Surgeon workload ratings were significantly better for MAGS (2.6 ± 0.2) vs. LAP (5.6 ± 1.1; p < 0.05). For MAGS, depth perception and triangulation were excellent and the safe handling protocol was followed with no complications. For LAP, the parallelism of instruments and lack of triangulation hindered depth perception, caused instrument conflicts, and resulted in two minor complications (one superficial liver laceration and one inadvertent burn to the diaphragm). CONCLUSION These data suggest that using the MAGS device for SSL cholecystectomy results in equivalent (or better) operative outcomes and less workload compared with LAP.
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Affiliation(s)
- Nabeel A Arain
- Department of Surgery, Southwestern Center for Minimally Invasive Surgery, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9156, USA
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Nonaka S, Saito Y, Fukunaga S, Sakamoto T, Nakajima T, Matsuda T. Impact of endoscopic submucosal dissection knife on risk of perforation with an animal model-monopolar needle knife and with a bipolar needle knife. Dig Endosc 2012; 24:381. [PMID: 22925297 DOI: 10.1111/j.1443-1661.2012.01249.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Skoryĭ DI. [Functional state of liver before and after its resection using various dissection methods]. Klin Khir 2012:17-21. [PMID: 23285646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Today a few randomized investigations have been accomplished, in which advantages and disadvantages of various methods of hepatic resection are compared. The investigation objective was to estimate the hepatic functional state before and after its resection, using various methods of parenchymal dissection. Randomized investigation was conducted in 90 patients, to whom hepatic resection, using scalpel, with its preliminary suturing by the block-like sutures with the Vycril thread, applying radiofrequency coagulator, "clamp crushing" procedure, ultrasonic (Sonoca 300) and a water-jet (Hydrojet) dissectors. The dissection was not combined with the hepatic vessels exclusion. Coefficient of elimination of indocyangreen and a speciphic coefficient of its elimination were estimated. There was established, that putting the block-like sutures and radiofrequency coagulation, concerning the hermetization peculiarities, causes the resection area ischemia, what is accompanied by persisting degradation of hepatocytes and hepatic functional reserve reduction as a result of its resection performance. While the extended hepatic resection conduction it is expedient to apply the methods of ultrasonographic, the jet-like dissection or a "clamp crushing", which guarantee minimization of risk of postoperative hepatic insufficiency occurrence.
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Vargas C G, Chávez R M, Sanchez V, Rojas R P, Verona R R. [Therapy for early gastric cancer with submucosal endoscopic disection using the IT-Knife 2]. Rev Gastroenterol Peru 2012; 32:297-302. [PMID: 23128951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
70 years old woman, without history of illness, came to the Digestive Endoscopic Center of the Gastroenterology department of Arzobispo Loayza hospital, with the diagnosis of Abdominal pain syndrome, in which Upper Endoscopy was practiced. Upper endoscopy concludes the diagnosis of a malignant lesion probably an Early gastric cancer type IIa+IIc, which was confirmed with pathology. Endoscopic treatment was done with Endoscopic submucosal dissection (ESD). The lesion was totally removed, in accordance with the pathologist. Endoscopic controls at 10 weeks showed retractable red scar and a negative biopsy for neoplasm. This case is reported for being the first one published in our literature in which therapeutic ESD with IT-Knife2, was done in Early Gastric cancer.
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Affiliation(s)
- Gloria Vargas C
- Servicio Gastroenterologia Hospital Nacional Arzobispo Loayza Lima.
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Sukhin IA. [Experimental investigation of possibilities of the ultrasound and liquid-stream dissector in operations on parenchymatous organs]. Klin Khir 2012:53-57. [PMID: 22950278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The results of experimental investigations were adduced, concerning studying of possibilities and the outcomes analysis of the ultrasound and a liquid-stream dissector application while operating on parenchymatous organs. There was established, that while operating on liver, there was not any essential difference between application of the ultrasound and stream of a liquid concerning the achievement of a quality of the stroma elements isolation; while performing operations on the spleen a liquid-stream dissector have had evolved as a more effective one, permitting to isolate a significantly more quantity of unaffected elements of stroma. The hemostasis methods are the main, which influence the organs stump formation and the typical cellular structure restoration, and they must be applied, using the both methods of dissection.
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Chen CC, Hsu WC. Microdebrider-assisted endoscopic excision for congenital laryngeal cysts in infants. Kaohsiung J Med Sci 2012; 28:61-2. [PMID: 22226064 DOI: 10.1016/j.kjms.2011.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Swain CP, Bally K, Park PO, Mosse CA, Rothstein RI. New methods for innovation: the development of a toolbox for natural orifice translumenal endoscopic surgery (NOTES) procedures. Surg Endosc 2011; 26:1010-20. [PMID: 22052424 DOI: 10.1007/s00464-011-1987-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 10/04/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Devices used for flexible intralumenal procedures are inadequate when used for intraperitoneal surgical procedures such as cholecystectomy. OBJECTIVE To assess/address limitations of flexible endoscopic devices in intraperitoneal surgery. DESIGN To describe processes used to invent new devices to facilitate this new surgical genre. SETTING Engineering laboratory. PATIENTS None. INTERVENTIONS AND INVENTIONS: Reviews of the limitations of flexible endoscopic instruments and instrumentation/invention needs for a "NOTES cholecystectomy" were completed. MAIN OUTCOME MEASURES The appropriateness of existing methods of device innovation was evaluated against an inventory of new technologies necessary to perform NOTES. The deficiencies in traditional innovation methods led to the creation of a novel process for invention of new medical devices: the "Inventorama." METHODS Cooperation between clinicians and industry to develop device concepts to enable NOTES. RESULTS The devices included: (1) steerable flex trocar, (2) rotary access needle, (3) bipolar hemostasis forceps, (4) Maryland dissectors, (5) articulating hook knife, (6) rotating hook knife, (7) articulating graspers, (8) scissors, (9) ligating clip applier, and (10) tissue apposition system. Six of these ten were built and tested as initial crude prototypes in the Inventorama process; two underwent major modifications. Three were invented via alternate methods, including by independent clinicians. CONCLUSIONS A new method for efficient medical device invention and development was created to address key technology needs for NOTES. The result was a "toolbox" of devices designed to address the key surgical activities necessary for advanced intralumenal and translumenal flexible endoscopic procedures.
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Affiliation(s)
- C Paul Swain
- Department of Bio Surgery & Surgical Technology, Imperial College London, St. Mary's Hospital, London, UK.
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Anik I, Ceylan S, Koc K, Tugasaygi M, Sirin G, Gazioglu N, Sam B. Microsurgical and endoscopic anatomy of Liliequist's membrane and the prepontine membranes: cadaveric study and clinical implications. Acta Neurochir (Wien) 2011; 153:1701-11. [PMID: 21380853 DOI: 10.1007/s00701-011-0978-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 02/15/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Liliequist's membrane is mostly described as having a diencephalic leaf, mesencephalic leaf, and diencephalic-mesencephalic leaves in the literature. Also different descriptions of the prepontine membranes were reported. In this study, we visualized the regular structural forms of membranes without disturbing any attachments and defined infrachiasmatic and prepontine safety zones. We discussed the clinical significance of these structures. MATERIALS AND METHODS The study was carried out on 24 adult human cadavers at the Morgue Specialization Department of the Forensic Medicine Institution following the initial autopsy examination. Liliequist's membrane and the prepontine membranes were explored after retraction of the frontal lobes. Dissections were performed under the operative microscope. A 0- and 30-degree, 2.7-mm angled rigid endoscope (Aesculap, Tuttlingen, Germany) was advanced through the prepontine cistern from the natural holes of membranes, or small holes were opened without damaging the surrounding structures. RESULTS The basal arachnoid membrane (BAM) continued as Liliequist's membrane (LM) without any distinct separation in all specimens. The LM coursed over the posterior clinoids and split into two leaves as the diencephalic leaf (DL) and mesencephalic leaf (ML) in 18 specimens; the medial pontomesencephalic membrane (MPMM) coursed anterolaterally as a continuation of the ML and attached to the medial surfaces of the fifth and sixth nerves, joining with the lateral pontomesencephalic membrane (LPMM), which was also a posterolateral continuation of the ML in all specimens. The medial pontomedullar membrane (MPMdM) and lateral pontomedullar membrane (LPMdM) were observed in 21 specimens. The MPMdM membrane was a continuation of the MPMM, and the LPMdM was a continuation of the LPMM in all 21 specimens. CONCLUSION We observed that the LM is a borderless continuation of the BAM. The MPMM and LPMM split from the ML without any interruptions. The MPMdM and LPMdM were a single membrane continuing from the MPMM and LPMM. We determined infrachiasmatic and prepontine areas that can be important for inferior surgical approaches.
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Affiliation(s)
- Ihsan Anik
- Department of Neurosurgery, Kocaeli University, School of Medicine, 41380, Umuttepe, Kocaeli, Turkey
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