BACKGROUNDUltrasonic devices are widely used in many surgical fields, including hepatectomy; however, the negative effects of tissue pad degradation of ultrasonic devices, including those in liver ...surgery, remain unknown. The Harmonic® 1100 (H-1100) scalpel has advanced heat control technology than previous models, such as the Harmonic® HD1000i (H-HD1000i). We hypothesized that, because of its advanced temperature-control technology, the H-1100 scalpel would show less tissue pad degradation, resulting in superior sealing performance, compared to that with the H-HD1000i scalpel. AIMTo elucidate ultrasonic device tissue pad degradation effects on instrument temperature and sealing performance using ex vivo porcine liver/vessel models. METHODSTwo different harmonic scalpels were used and compared: A newer model, the H-1100 scalpel, and an older model, the H-HD1000i scalpel. Using ex vivo porcine livers, each instrument was activated until the liver parenchyma was dissected. The device temperature (passive jaw temperature) was measured after every 10 consecutive activations, until 300 transections of the porcine liver were performed. Tissue pad degradation was evaluated after 300 activations. Sealing performance was evaluated using excised porcine carotid vessels; vessel sealing speed and frequency of vessel burst pressure below 700 mmHg were determined after 300 transections of porcine liver parenchyma. RESULTSThe temperature of the H-HD1000i scalpel was approximately 10°C higher than that of the H-1100 scalpel, and gradually increased as the number of activations increased. The median passive jaw temperature of the H-HD1000i scalpel was significantly higher than that of the H-1100 scalpel (73.4°C vs 65.1°C; P < 0.001). After 300 transections of porcine liver parenchyma, less tissue pad degradation was observed with the H-1100 scalpel than with the H-HD1000i scalpel (0.08 mm vs 0.51 mm). The H-1100 scalpel demonstrated faster vessel-sealing speed (4.9 sec. vs 5.1 sec.) and less frequent vessel burst pressure < 700 mmHg (0% vs 40%) after 300 activations than the H-HD1000i scalpel; however, the difference did not reach statistical significance (P = 0.21 and P = 0.09, respectively). CONCLUSIONIn an ex vivo porcine hepatectomy model, the H-1100 scalpel shows lower passive jaw temperature and maintains its sealing performance by avoiding tissue pad degradation compared to that with the H-HD1000i.
Alternative energy devices have become a popular alternative to conventional hemostasis in thyroid surgery. These devices have been shown to reduce operative time and thermal nerve injury. As ...hemostasis is paramount in thyroid surgery, we sought to examine the relative efficacy of 2 alternate energy devices compared to conventional hemostasis in preventing postoperative hematoma following total thyroidectomy.
Ovid MEDLINE, EMBASE, PubMed, and Cochrane Central Register of Controlled Trials.
A systematic literature search was performed for all relevant English-language studies published between 1946 and July 2018. Two authors independently extracted data and analyzed articles for quality using the National Institute of Health Quality Assessment Scale. Our primary outcome of interest was hematoma requiring reoperation.
A total of 348 studies were screened, with 23 meeting the inclusion criteria. We found no significant difference in postoperative hematoma rates using alternate energy devices compared to conventional hemostasis (
= .370, .317). Network meta-analysis echoed the results of conventional meta-analysis, demonstrating no significant difference in hematoma rates.
We found no significant difference in postoperative hematoma rates following total thyroidectomy for any indication with the use of alternate energy devices compared to conventional hemostatic techniques. This suggests that hematoma occurrence does not necessarily need to be considered when choosing between these hemostatic devices. This information may help guide surgeons' decisions regarding choice of hemostatic technique during thyroid surgery.
The carrying energy of a harmonic scalpel determines biological tissue coagulation quality, and is related to the clamping force between the blade of a harmonic scalpel and the biological tissue. The ...objective of this study is to investigate the effect of clamping force on the carrying energy ability of a harmonic scalpel. First, the carrying energy model of a harmonic scalpel transducer is developed, which is regarded as a mass-spring-damper oscillator. Then, the characteristic parameters at various clamping forces are determined by a least-square parameter identification method, which represent the carrying energy ability of harmonic scalpel. Furthermore, the carrying energy ability relative to clamping force is evaluated by coagulating biological tissue in vitro. The results show that mass, force resistance and stiffness of mass-spring-damper oscillator increase with increasing clamping force, which reflects the increase of the harmonic scalpel carrying energy ability. This trends plateaus with the continuous increase of clamping force. Correspondingly, the coagulation depth of biological tissue increases with the increase of clamping force, and an optimal clamping force exists. The results of the histological investigations are in good agreement with carrying energy under different clamping force conditions.
Background
We have developed a new approach for endoscopic minimally invasive thyroidectomy (eMIT) in anatomical studies. Safety and feasibility were demonstrated in an animal study and then the eMIT ...technique was applied for the first time successfully in humans on the 18 March 2009.
Methods
In a prospective study, we performed this eMIT technique on eight patients suffering from nodular change of the thyroid gland. All patients were evaluated regarding recurrent laryngeal nerve function, intra- and postoperative complications, and postoperative outcome, particularly with respect to swallowing disorders.
Results
A total thyroidectomy and a partial resection were performed in four cases each. In three cases, a conversion to open surgery was necessary due to specimen size. No local infection at the incision site or within the cervical spaces occurred within the direct postoperative course. No intraoperative bleeding necessitating conversion to open surgery was observed. In one case, a permanent palsy of the right recurrent laryngeal nerve was noted. Voice function and breathing were not affected. Paresthesia of the mental nerve did not occur in all patients and in those in which it did occur, it resolved within 3 weeks. Mean follow-up time was 10.9 months.
Conclusions
The experimental development of the eMIT technique has led to its first clinical application in humans. In this prospective proof-of-concept study in humans, the thyroid gland was reached via the transoral endoscopic approach in an anatomically defined layer without any relevant damage to vessels. Limitations to this technique are determined by specimen volume (up to 30 ml) and nodule size (up to 20 mm).
Background
Instruments that apply energy to cut, coagulate, and dissect tissue with minimal bleeding facilitate surgery. The improper use of energy devices may increase patient morbidity and ...mortality. The current article reviews various energy sources in terms of their common uses and safe practices.
Methods
For the purpose of this review, a general search was conducted through NCBI, SpringerLink, and Google. Articles describing laparoscopic or minimally invasive surgeries using single or multiple energy sources are considered, as are articles comparing various commercial energy devices in laboratory settings. Keywords, such as laparoscopy, energy, laser, electrosurgery, monopolar, bipolar, harmonic, ultrasonic, cryosurgery, argon beam, laser, complications, and death were used in the search.
Results
A review of the literature shows that the performance of the energy devices depends upon the type of procedure. There is no consensus as to which device is optimal for a given procedure. The technical skill level of the surgeon and the knowledge about the devices are both important factors in deciding safe outcomes.
Conclusions
As new energy devices enter the market increases, surgeons should be aware of their indicated use in laparoscopic, endoscopic, and open surgery.
Purpose
Juvenile angiofibroma (JA) is a benign, but locally invasive tumor of the nasopharynx. Surgical resection of JA is performed through endoscopic (EA), endoscopic-assisted (EAA), or open ...approaches (OA). The management of these tumors is constantly evolving. We aimed to compare the surgical efficiency and morbidity of EA, EAA, and OA in JA treatment by conducting a systematic review of the literature published over the last 10 years.
Methods
A systematic review of the English literature on surgical cases of JA published between 2012 and 2022 was performed. Eligible articles were analyzed for individual patient data (IPD) and aggregate patient data (APD). The primary predictor variable was the surgical approach. The primary outcome variable was recurrence rate.
Results
The search retrieved 75 articles reporting 1586 JA surgical cases; 129 in IPD, and 1457 in APD data sets. Within the IPD data set, recurrence rates were significantly lower in cases completed by EA than that by OA (
p
< 0.05). There was no significant difference in recurrence rates between the EA and EAA groups (
p
> 0.05). EAA had a lower recurrence rate than that of OA (
p
< 0.05). For the APD data set, the recurrence rate following EA was significantly lower than that following OA (
p
< 0.05). There was no significant difference in recurrence between the EA and EAA groups (
p
> 0.05), and between the EAA and OA groups (
p
> 0.05).
Conclusions
EA represents the method of choice for mild and moderately advanced JA. EAA and OA still play important roles in the treatment of advanced-stage JA.
Objectives
Surgical procedures for vaginal hydroceles have been varied with the aims of preventing recurrence, hematoma and edema formation and providing a better cosmetic outcome. The Jaboulay’s ...procedure remains a preferred procedure owing to its simplicity and good long term outcome. However, sac eversion during the procedure leads to scrotal edema and mass sensation due to remnant sac in cases of large or secondary hydrocele sacs. Sac excision in these cases may provide better outcomes by removing the excess tissue. We aimed to compare the postoperative outcome after Jaboulay’s procedure and harmonic scalpel excision of the sac in terms of scrotal edema, hematoma formation and the final cosmetic appearance.
Patients and methods
72 adult patients with vaginal hydrocele were randomized into two groups, who underwent harmonic scalpel sac excision and Jaboulay’s procedure respectively, performed by a single surgeon. Preoperatively, patient demographics were noted. Postoperatively, data was recorded on the 1st day, 3rd day & 10th day about postoperative complications, and outcomes. Satisfaction on final cosmetic outcome was compared between the groups at the 3rd month.
Results
Post operative edema and sensation of mass in the scrotum were more (but not significant) in the Jaboulay’s procedure group. Seroma and wound infection rates were similar in both groups. Patient satisfaction on cosmesis was better in the sac excision group.
Conclusion
Hydrocelectomy with excision of the sac using a harmonic scalpel results in a lower incidence of postoperative oedema and better patient satisfaction in terms of cosmetic outcome compared to Jaboulay’s procedure in the treatment of adult hydroceles.
Background
Bipolar electrosurgical devices and ultrasonic devices are routinely used in open and advanced laparoscopic surgery for hemostasis. New electrosurgical and ultrasonic instruments ...demonstrate improved quality and efficiency in blood vessel sealing.
Methods
The 5-mm laparoscopic Gyrus PKS™ Cutting Forceps (PK), Gyrus Plasma Trissector™ (GP), Harmonic Scalpel
®
(HS), EnSeal™ Tissue Sealing and Hemostasis System (RX), LigaSure™ V with LigaSure™ Vessel Sealing Generator (LS), LigaSure™ V with Force Triad™ Generator (FT), and Ligamax™ 5 Endoscopic Multiple Clip Applier (LM) were tested to compare burst pressure, sealing time, and failure rate. Each device was used to seal 13 small (2–3 mm diameter), 13 medium (4–5 mm diameter), and 13 large (6–7 mm diameter) arteries from euthanized pigs. A
p
value <0.05 was considered statistically significant.
Results
Mean burst pressures were not statistically different for 2–3 mm or 6–7 mm vessels. For 4–5 mm vessels, LS had the highest mean burst pressure recorded. Mean seal times were shorter for every vessel size when FT was compared with LS (
p
< 0.05). The shortest sealing times for 2–3 mm vessels were recorded for GP. The shortest sealing times for medium and large vessels were observed with FT. The highest percentage failure rate for each vessel size occurred with GP. For 4–5 mm diameter vessels, the failure rate was 48% for GP, 41% for PK, and 22% for HS. For 6–7 mm diameter vessels, the failure rate was 92% for GP, 41% for PK, and 8% for HS. LM and FT had no recorded failures.
Conclusion
Among the new 5-mm laparoscopic electrosurgical and ultrasonic instruments available for testing, RX, LS, and FT produced the highest mean burst pressures. FT had the shortest mean seal times for medium and large vessels. Minimal or no seal failures occurred with HS, RX, LS, LM, and FT.
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