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.
Summary
An 18‐year‐old Warmblood gelding was presented for investigation of a large, firm mass over the medial and plantar aspect of the left distal metatarsal and fetlock region. The mass was first ...identified 4 months prior to referral, following a traumatic incident, and had over time gradually increased in size. Clinical examination and diagnostic imaging revealed a large soft tissue mass adjacent to the metatarsophalangeal joint and digital flexor tendon sheath, with no overt involvement of underlying bone. The mass was surgically excised under general anaesthesia using a harmonic scalpel with limited margins to avoid compromise of adjacent anatomical structures. Following histology, the mass was diagnosed as a fibrosarcoma. Twelve months after surgical resection, no signs of recurrence were evident. This report demonstrates that fibrosarcoma of the equine distal limb may be successfully managed with surgical excision. The use of a harmonic scalpel should be considered as an alternative to sharp excision when treating fibrosarcoma or other infiltrative tumours, particularly those located in regions where only limited surgical margins may be achieved.
Background
In the past three decades, different High Energy Devices (HED) have been introduced in surgical practice to improve the efficiency of surgical procedures. HED allow vessel sealing, ...coagulation and transection as well as an efficient tissue dissection. This survey was designed to verify the current status on the adoption of HED in Italy.
Methods
A survey was conducted across Italian general surgery units. The questionnaire was composed of three sections (general information, elective surgery, emergency surgery) including 44 questions. Only one member per each surgery unit was allowed to complete the questionnaire. For elective procedures, the survey included questions on thyroid surgery, lower and upper GI surgery, proctologic surgery, adrenal gland surgery, pancreatic and hepatobiliary surgery, cholecystectomy, abdominal wall surgery and breast surgery. Appendectomy, cholecystectomy for acute cholecystitis and bowel obstruction due to adhesions were considered for emergency surgery. The list of alternatives for every single question included a percentage category as follows: “ < 25%, 25–50%, 51–75% or > 75%”, both for open and minimally-invasive surgery.
Results
A total of 113 surgical units completed the questionnaire. The reported use of HED was high both in open and minimally-invasive upper and lower GI surgery. Similarly, HED were widely used in minimally-invasive pancreatic and adrenal surgery. The use of HED was wider in minimally-invasive hepatic and biliary tree surgery compared to open surgery, whereas the majority of the respondents reported the use of any type of HED in less than 25% of elective cholecystectomies. HED were only rarely employed also in the majority of emergency open and laparoscopic procedures, including cholecystectomy, appendectomy, and adhesiolysis. Similarly, very few respondents declared to use HED in abdominal wall surgery and proctology. The distribution of the most used type of HED varied among the different surgical interventions. US HED were mostly used in thyroid, upper GI, and adrenal surgery. A relevant use of H-US/RF devices was reported in lower GI, pancreatic, hepatobiliary and breast surgery. RF HED were the preferred choice in proctology.
Conclusion
HED are extensively used in minimally-invasive elective surgery involving the upper and lower GI tract, liver, pancreas and adrenal gland. Nowadays, reasons for choosing a specific HED in clinical practice rely on several aspects, including surgeon’s preference, economic features, and specific drawbacks of the energy employed.
Background and objective
In spite of being one of the most common surgical procedures performed in adults, laparoscopic cholecystectomy (LC) is relatively uncommon in the pediatric age group. Most ...surgeons prefer to dissect the cystic duct using a monopolar electrosurgical hook and occlude it with simple metal clips. Although the safety of using the ultrasonically-activated shears, e.g., harmonic scalpel for dissection of the gallbladder is confirmed in many studies, its efficacy in the closure of the cystic artery and duct in adults is still debatable. Furthermore, very few reports studied its safety in children during LC. The aim of our work is to study the safety and efficacy of ultrasonic shears in controlling the cystic duct and artery during LC in children.
Materials and methods
A prospective study was conducted from May 2017 to April 2020, where all children having symptomatic gallbladder stone disease were included in the study. HS was used as a sole instrument in gallbladder dissection as well as in controlling cystic duct and artery. No metal clips or sutures were used throughout the procedure.
Results
A total of forty-two children having symptomatic gallstone disease were included in the study. The main indication for LC was hemolytic anemia. Their age ranged from 3 to 13 years with a mean of 8.4 ± 3.25 years. All operations were completed laparoscopically, i.e., no conversion to open surgery was needed. The mean operative time was 40 ± 10.42 min. There were no intraoperative complications apart from gall bladder perforation in two cases during dissection from the liver bed while the postoperative recovery was smooth in all patients. Patients started oral feeding after 11.30 ± 3.01 h. The mean time for discharge was 25.47 ± 7.49 h, ranging from 14 to 48 h. Postoperative ultrasound for all cases showed no evidence of minor or major bile leaks or CBD injuries.
Conclusion
This is the first report to evaluate the use of HS as a sole instrument during LC in the pediatric age group. HS is a safe and efficient instrument that can be used alone in gallbladder dissection as well as in controlling cystic duct and artery during LC in children.
Objective: To estimate the frequency of gallbladder perforation with conventional Monopolar Diathermy versus Harmonic scalpel in laparoscopic cholecystectomy.
Study Design: Quasi-experimental study.
...Place and Duration of Study: Department of Surgery, Combined Military Hospital, Quetta Pakistan, from Sep 2018 to Sep 2019.
Methodology: A total of 160 patients undergoing laparoscopic cholecystectomy for symptomatic gallstones were included in the study and were randomly allocated into two groups based on the surgical technique of dissecting gall bladder from the liver bed. In Group-A, Monopolar Diathermy was used, and in Group-B Harmonic scalpel was used. Frequency of gall bladder perforation and demographic details were recorded on predefined proforma.
Results: In our study, mean age was 48.21±8.94 years and 49.14±9.31 years in Group-A and Group-B respectively. Comparison of Gallbladder perforation in both groups showed 17(21.25%) cases in Group-A and 5(6.25%) cases in Group-B, (p-value <0.001).
Conclusion: In laparoscopic cholecystectomy, the frequency of gallbladder perforation with conventional monopolar diathermy is significantly higher compared to the harmonic scalpel.
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