Aerosol exposure from an ultrasonically activated (Harmonic) device

Ott, Douglas E.; Moss, Eugene L.; Martinez, Kenneth

doi:10.1016/s1074-3804(98)80007-8

Cited by 58 publications

(65 citation statements)

References 5 publications

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“…11 Previous reports have shown that Harmonic Scalpels generate particles 350 to 650 nm in diameter at approximately a quarter of the particle concentration seen with electrocautery. 12 The bimodal distribution of particles produced by surgical instruments has been described previously. 3 The smaller spherical particles result from vaporization followed by nucleation, a process by which vapors are converted to tiny particles (droplets) of fluid.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Surgical Smoke Produced by Various Energy-Based Instruments and Effect on Laparoscopic Visibility

Weld

Dryer

Ames

et al. 2007

Journal of Endourology

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,"Analysis of surgical smoke produced by various energy-based instruments and effect on laparoscopic visibility." Journal of Endourology.21,3. 347-351. (2007 ABSTRACT Purpose:We analyzed the smoke plume produced by various energy-based laparoscopic instruments and determined its effect on laparoscopic visibility. Materials and Methods:The Bipolar Macroforceps, Harmonic Scalpel, Floating Ball, and Monopolar Shears were applied in vitro to porcine psoas muscle. An Aerodynamic Particle Sizer and Electrostatic Classifier provided a size distribution of the plume for particles Ͼ500 nm and Ͻ500 nm, and a geometric mean particle size was calculated. A Condensation Particle Counter provided the total particle-number concentration. Electron microscopy was used to characterize particle size and shape further. Visibility was calculated using the measured-size distribution data and the Rayleigh and Mie light-scattering theories.Results: The real-time instruments were successful in measuring aerosolized particle size distributions in two size ranges. Electron microscopy revealed smaller, homogeneous, spherical particles and larger, irregular particles consistent with cellular components Conclusions: Surgical smoke is composed of two distinct particle populations caused by the nucleation of vapors as they cool (the small particles) and the entrainment of tissue secondary to mechanical aspects (the large particles). High concentrations of small particles are most responsible for the deterioration in laparoscopic vision. Bipolar and ultrasonic instruments generate a surgical plume that causes the least deterioration of visibility among the instruments tested.

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Section: Discussionmentioning

confidence: 99%

Analysis of Surgical Smoke Produced by Various Energy-Based Instruments and Effect on Laparoscopic Visibility

Weld

Dryer

Ames

et al. 2007

Journal of Endourology

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“…Furthermore, bioaerosols can sustain biologic activity. They can contain live organisms or cells posing as potentially contaminated material [5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

How to Prevent Lateral Thermal Damage to Tissue Using the Harmonic Scalpel: Experimental Study on Pig Small Intestine and Abdominal Wall

Pogorelić¹,

Perko²,

Družijanić³

et al. 2009

Eur Surg Res

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Introduction: When using a harmonic scalpel, the lower amount of energy that is transduced to the tissue reduces the chance of lateral thermal damage. Methods: Pigs (weight: 40 kg) were used as the experimental model. After anesthesia, tissue was coagulated using different application regimens for each group. The width of tissue necrosis was measured from the point of incision by the harmonic scalpel. Results: The pig abdominal tissues suffered mean thermal damage of 0.0825 (output power 3) and 0.2969 mm (output power 5) when used for 5 s; at 10 s these values were 0.3850 and 0.4793 mm, respectively. In a third experimental condition, with 10 s of application broken down into 2 parts of 5 s with a 5-second pause in-between, these values were 0.1876 and 0.2013 mm, respectively. The small intestine tissues suffered mean thermal damage of 0.1302 (output power 3) and 0.1771 mm (output power 5) at a duration of 5 s. After 10 s of application, these values changed to 0.2655 (output power 3) and 0.2983 mm (output power 5). In the third condition (activity for 5 s, pause for 5 s, activity for 5 s), they were 0.2011 and 0.2258 mm, respectively. Conclusion: Coagulation necrosis is bigger if the usage is continuous rather than if it is disconnected/reconnected.

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“…The surgical plume quantification from an ultrasonic scalpel was compared with that from electrocautery by Ott et al [13] which described large quantities of cellular debris ([1 9 107 particles/mL) in the plume generated by the ultrasonic scalpel but had approximately one-fourth the amount of particle concentration which was further substantiated in the review exclusively on surgical smoke wherein the instrument and its effect on different types of tissue was described. Plume aerosol generated by ultrasonic dissectors can be identified up to 40 cm from the point of production and usually is composed of tissue, blood, and blood products.…”

Section: Analysis Of Obstruction Generated By Laparoscopic Dissectorsmentioning

confidence: 99%

“…Plume aerosol generated by ultrasonic dissectors can be identified up to 40 cm from the point of production and usually is composed of tissue, blood, and blood products. The surgical plume production from an ultrasonic scalpel was compared with that from electrocautery by Ott et al [13], which described large quantities of cellular debris ([1 9 107 particles/mL) in the plume generated by the ultrasonic scalpel but had approximately one-fourth the amount of particle concentration which was further substantiated in the review exclusively on surgical smoke wherein the instrument and its effect on different types of tissue was also described [9,13]. Fatty tissue was found to generate 17-23 times more particles than lean tissue did [13].…”

Section: Analysis Of Obstruction Generated By Laparoscopic Dissectorsmentioning

confidence: 99%

“…The surgical plume production from an ultrasonic scalpel was compared with that from electrocautery by Ott et al [13], which described large quantities of cellular debris ([1 9 107 particles/mL) in the plume generated by the ultrasonic scalpel but had approximately one-fourth the amount of particle concentration which was further substantiated in the review exclusively on surgical smoke wherein the instrument and its effect on different types of tissue was also described [9,13]. Fatty tissue was found to generate 17-23 times more particles than lean tissue did [13]. In an effort to quantify surgical smoke and laparoscopic visibility, Weld et al [14] measured plume concentration from the peritoneal cavity in the light scattering equation to determine the level of reduction in visibility at surgery.…”

Section: Analysis Of Obstruction Generated By Laparoscopic Dissectorsmentioning

confidence: 99%

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Surgical Efficacy Among Laparoscopic Ultrasonic Dissectors: Are We Advancing Safely? A Review of Literature

Devassy

Gopalakrishnan

Wilde

2015

J Obstet Gynecol India

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The specialty of laparoscopy has evolved with the advent of new technologies over the last few years. Energy-based devices and Ultrasonic dissectors are used with a lot of factors in play-including ergonomics and economics during surgery. Here an attempt is based to review the surgical efficacy and safety of these dissectors with importance to plume production and lateral thermal damage. The factors contributing to adversities to the dissectors are also to be noted. The strategy adopted was aimed at finding relevant studies from PubMed from 1995 to 2014. The basic principle of plume production and thermal damage are studied in this review. Factors contributing to the same that can lead to adversities during laparoscopic surgeries are identified. Summarizing key points that increase lateral thermal damage and plume production amongst different ultrasonic shears and suggesting a technique to identify the right balance between the existing dissectors was possible. The RF Device and USS are both useful and widely used and are more safer than monopolar devices. RF Device is considerably slower than USS, as it cannot achieve coagulation and cutting at the same time. Although USS definitely improvises dissection and has less thermal injury than RF Device, the clinical implications in balancing dissection efficacy with hemostasis need to be investigated further. The ideal haemostatic energy-based shear device would be one with excellent hemostatic results and visual acuity while allowing none or minimal thermal energy escape at the point of application. In our current setting, a combined use of both RF and USS device usage as applied in the particular situations has potential.

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Aerosol exposure from an ultrasonically activated (Harmonic) device

Cited by 58 publications

References 5 publications

Analysis of Surgical Smoke Produced by Various Energy-Based Instruments and Effect on Laparoscopic Visibility

Analysis of Surgical Smoke Produced by Various Energy-Based Instruments and Effect on Laparoscopic Visibility

How to Prevent Lateral Thermal Damage to Tissue Using the Harmonic Scalpel: Experimental Study on Pig Small Intestine and Abdominal Wall

Surgical Efficacy Among Laparoscopic Ultrasonic Dissectors: Are We Advancing Safely? A Review of Literature

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