Case series summary
Adrenal tumors are rare in cats and reports of laparoscopic adrenalectomy in cats are limited. This case series describes two cats that underwent laparoscopic adrenalectomy using ...a Harmonic scalpel for dissection and coagulation. Both surgeries were successful, with minimal hemorrhage, smoke production and lateral thermal damage. Vessels were appropriately sealed and surgical times were appropriate. Both cats recovered without complications postoperatively.
Relevance and novel information
To our knowledge, this is the first veterinary report to describe the use of the Harmonic scalpel for laparoscopic adrenalectomy as the sole device in cats. Owing to the absence of hemorrhage, there was no indication for irrigation, suction or hemostatics. The Harmonic scalpel is an ultrasonic vessel-sealing device with benefits over conventional electrosurgery, including less lateral thermal damage, less smoke production and improved safety due to the lack of an electrical current. This case report aims to highlight the usefulness of ultrasonic vessel-sealing devices for laparoscopic adrenalectomy in cats.
To compare clinical outcomes in patients with and without history of tobacco use who underwent Zenker's diverticulotomy (ZD).
Single institution retrospective review.
Tertiary care academic hospital.
...A retrospective review of patients who underwent ZD via an open stapler, rigid endoscopic CO2 laser, stapler or harmonic scalpel, and flexible endoscopic technique from January 2006 to December 2020 was performed. Data were abstracted for patient demographics, diverticular features, and rates of adverse events and symptomatic recurrence.
Out of 424 patients, 146 (34.4 %) had a history of tobacco use: 126 (29.7 %) were former smokers, and 20 (4.7 %) were active smokers. In univariable cross-sectional analyses, the likelihood of postoperative bleeding, perforation, emergency department visits, unplanned readmission, or recurrence did not demonstrate an association with tobacco use history even after adjustment for age, sex, and surgical approach. Similarly, in Cox Proportional Hazards regression, tobacco use was not associated with an increased risk of recurrence, even after correcting for age, sex, and type of surgery. The median time to recurrence observed in our cohort was 11.5 years amongst non-smokers, 8.7 years amongst former smokers, and 1.2 years amongst active smokers (p = 0.94).
There were no significant differences in post-operative adverse events or frequency of recurrence of ZD between active, former, and non-smokers. Although underpowered and not statistically significant, median time to recurrence appears to be shorter in smokers when compared with former and non-smokers following surgery.
We aimed to assess whether the use of the harmonic scalpel (HS) in axillary dissection would reduce long-term shoulder-arm morbidity compared to traditional instruments (TIs).
A retrospective ...analysis on 180 patients who underwent standard axillary dissection for breast cancer between 2007 and 2015 was carried out. All patients were evaluated for postoperative pain, impairment of shoulder-arm mobility, seroma formation in axilla, frozen shoulder, and lymphedema.
HS procedure on average was 50% shorter compared to the TI technique. HS reduced by 4.5 times the risk of axillary seroma. TIs were associated with 4 times higher risk of developing a painful frozen shoulder.
Use of the HS was associated with reduced costs and a positive long-term effect on shoulder-arm morbidity. Axillary seromas are not the only reason of later postoperative shoulder-arm morbidity: other mechanisms are hypothesized in the onset of this very disabling disorder.
Myocardial bridge is defined as epicardial coronary arteries that course through the myocardium. While frequently asymptomatic, it can present on a spectrum from stable to life threatening angina. ...Medical management is often successful, but failure requires stenting or bypass, both of which are inferior to myotomy in appropriate surgical candidates, the former due to morbidity and the later theoretically due to competitive flow.
We present an otherwise healthy 50 year old gentleman with myocardial bridge refractory to medical management who was effectively managed via myotomy performed with the harmonic scalpel, enjoying complete relief of previous exertional chest pain.
Historically, myotomy has been described sharply and with electrocautery. Compared to the harmonic scalpel, these techniques risk poor hemostasis and damage to the underlying left anterior descending artery, not to mention their inefficiency in terms of operative speed.
In appropriately diagnosed patients, who are also suitable surgical candidates, myotomy, specifically with the harmonic scalpel, has short-term, intra-operative benefits of better hemostasis, protection of underlying left anterior descending artery and heart cavity, and improved operative efficiency. Given the lack of long-term symptomatic data on different myotomy techniques it is difficult to make comparisons of this nature.
•50 year old man with exertional chest pain secondary to left anterior descending myocardial bridge•Failed medical management•Underwent myotomy using Harmonic Scalpel versus traditional sharp or electrocautery methods•Enjoyed resolution of symptoms
Background
The aim of this study was to investigate Harmonic scalpel performance in laparoscopic appendectomy for sealing the base of the appendix in children.
Methods
During the study period, a ...total of 312 patients who underwent laparoscopic appendectomy were included in prospective bicenter clinical trial. The patients were divided in two study groups in regard to technique used for appendiceal base closure. In the first group (
n
= 197) the appendiceal base was secured using a polymeric clip while in the second group (
n
= 115) the Harmonic scalpel was used for sealing the base in a stepwise manner, without placing any clip or suture. Outcomes of treatment, including complication rates, duration of surgery and length of hospital stay were compared between the groups.
Results
A total of 312 patients with a median age of 11 years (IQR 8, 15) were included in study. Of these, 191 were males (61.2%). Both groups were symmetric in regard to baseline characteristics of the patients. A total of 10 (5.1%) postoperative complications (postoperative abscess
n
= 7 and ileus
n
= 3) were recorded in the polymeric clip group while none of the patients from the clipless group had postoperative complications (
P
= 0.015). In the group who received a polymeric clip appendectomy, fever lasting 0–72 h and > 72 h was recorded in 16 (8.1%) and 12 (6.1%) children, respectively, while in the clipless group, it was observed in 2 (1.7%) and 5 (4.3%) children, respectively (
P
= 0.048). Significantly shorter surgical times were found in the clipless group compared to the polymeric clip group (21 min (IQR 18, 25) vs. 30 min (IQR 22, 40),
P
< 0.0001). Also, length of hospital stay was significantly shorter in the clipless group of the patients (2 days (IQR 2, 3) vs. 3 days (IQR 2, 4),
P
< 0.0001).
Conclusion
Clipless harmonic scalpel laparoscopic appendectomy is a safe and effective method in children for treatment of acute appendicitis with lesser number of complications and shorter duration of surgery compared to laparoscopic appendectomy in which the appendiceal base is secured with clip.
Background
The aim of this study was to compare lateral thermal damage of the appendix and clinical outcomes after laparoscopic appendectomy using new versus reused Harmonic scalpels.
Methods
A total ...of 100 consecutive patients with acute appendicitis who underwent laparoscopic appendectomy were enrolled in the two-center, randomized clinical trial. Using a computer random number generator, patients were allocated to
new
or
reused
group. Histopathological measurement of lateral thermal damage of the appendiceal base and mesoappendix, speed of transection of the appendiceal base, duration of surgery, subjective rating of device functionality, length of hospital stay, and complications were compared within groups.
Results
The median lateral thermal damage on the appendiceal base in the
new
group (
N
= 49) was 0.2 mm (IQR 0.1–0.2) and 0.1 mm (IQR 0.1–0.3) in the
reused
group (
N
= 51) (
P
= 0.644), while on the mesoappendix for both groups, thermal damage was 0.1 mm (IQR 0.1–0.2) (
P
= 0.418). The median time required for base transection in both groups was 8 s (IQR 7–9) (
P
= 0.776). The median duration of surgery was also comparable between the groups (22 min, IQR 20–30 vs 25 min, IQR 21–35;
P
= 0.233). Two postoperative complications in the new group and one in the reused group were recorded (4% vs 2%;
P
= 0.536). Surgeons’ subjective assessment of the instrument did not reveal significant difference between the groups in all of the investigated categories.
Conclusions
The results of our study support the reuse of Harmonic scalpels especially in the settings where economic constraints might hamper access to minimally invasive surgery to a larger number of patients. The results obtained on laparoscopic appendectomy might not be reproducible to other more demanding surgical procedures.
Trial registration
ClinicalTrials.gov
registry under identifier NCT04226482
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