Comparison of blood vessel sealing among new electrosurgical and ultrasonic devices

Newcomb, William L.; Hope, William W.; Schmelzer, Thomas M.; Heath, Jessica J.; Norton, H. James; Lincourt, Amy E.; Heniford, B. Todd; Iannitti, David A.

doi:10.1007/s00464-008-9932-x

Cited by 166 publications

(129 citation statements)

References 17 publications

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“…Both technologically advanced, they have been suggested to have excellent results and minimal lateral thermal injury. [1][2][3][4][5][6]10,12,13 The Harmonic scalpel controls bleeding by tamponating the vessel and sealing it with a protein coagulum at temperatures ranging from 50°C to 100°C. The Harmonic scalpel works at lower temperatures than electrosurgical devices, since it denatures proteins by mechanically breaking the hydrogen bounds in protein molecules when the blade vibrates at 55.5 kHz, thus generating much less heat from tissue friction.…”

Section: Discussionmentioning

confidence: 99%

Comparison of lateral thermal damage of the human peritoneum using monopolar diathermy, Harmonic scalpel and LigaSure

et al. 2012

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Background: New hemostatic technologies are often employed in open and laparoscopic surgery to reduce duration of surgery and complications. Monopolar diathermy, Harmonic scalpel and LigaSure are routinely used in open and laparoscopic surgery for tissue cutting and hemostasis. We compared lateral thermal damage following in vivo application of 3 commonly used instruments. Methods:We used monopolar diathermy, Harmonic scalpel and LigaSure to coagulate and divide the peritoneum of patients who underwent median laparotomy. After anesthesia, median supraumbilical laparotomy was performed, and the peritoneum of each patient was coagulated using different devices. Using light microscopy and morphometric imaging analysis, the width of tissue lateral thermal damage was measured from the point of the peritoneal incision. Results:We included 100 patients in our study. After a peritoneal incision, the mean lateral thermal damage of monopolar diathermy, Harmonic scalpel (output power 3), Harmonic scalpel (output power 5) and LigaSure were 215.79 μm, 90.42 µm, 127.48 µm and 144.18 μm, respectively. Conclusion:The degree of lateral thermal spread varied by instrument type, power setting and application time. LigaSure and Harmonic scalpel were the safest and most efficient methods of tissue coagulation. Monopolar diathermy resulted in the greatest degree of thermal damage in tissues. Contexte :On utilise souvent les nouvelles technologies hémostatiques lors de chirurgies ouvertes et laparoscopiques afin d'abréger l'intervention et de prévenir les complications. La diathermie monopolaire, le scalpel Harmonic et le système LigaSure servent couramment lors des chirurgies ouvertes et laparoscopiques pour inciser et cautériser les tissus. Nous avons comparé les lésions thermiques latérales consécutives à l'application in vivo de ces 3 instruments d'usage courant.Méthodes : Nous avons utilisé la diathermie monopolaire, le scalpel Harmonic et le système LigaSure pour cautériser et séparer le péritoine de patients soumis à une laparotomie médiane. Une fois les patients anesthésiés, la laparotomie supraombilicale médiane a été effectuée et le péritoine de chaque patient a été cautérisé à l'aide de différents instruments. Par microscopie optique et analyse morphométrique, nous avons mesuré la largeur des lésions thermiques latérales des tissus à partir du point d'incision du péritoine. Résultats :Nous avons inclus 100 patients dans notre étude. Après l'incision du péri-toine, les atteintes thermiques latérales moyennes associées à la diathermie monopolaire, au scalpel Harmonic (puissance 3), au scalpel Harmonic (puissance 5) et au système Liga Sure ont été respectivement de 215,79 μm; 90,42 μm; 127,48 μm; et 144,18 The Harmonic scalpel incorporates piezoelectric transducers that induce a vibration frequency at the functional tip and transduces a lower amount of energy to the tissue than high-frequency current or laser techniques, resulting in reduced lateral thermal damage and penetration depth owing to lower temperatures. 4,5 Ultras...

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Section: Discussionmentioning

confidence: 99%

Comparison of lateral thermal damage of the human peritoneum using monopolar diathermy, Harmonic scalpel and LigaSure

et al. 2012

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“…Rapid development in minimally invasive techniques has driven the need for concomitant advances in instrumentation. Currently, available instruments with tissue-sensing technology can seal blood vessels with supraphysiological burst pressures equal to those obtained with surgical clips or ligatures (19,20). PTG is one of the new electrosurgical devices that can provide vessel sealing.…”

Section: Discussionmentioning

confidence: 99%

Comparison of different ligation techniques in laparoscopic varicocelectomy*

Akın¹,

Ateş²,

Yücel³

et al. 2014

Turk J Med Sci

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IntroductionWheat quality is simply defined as its suitability for a given final product. For durum wheat, quality means its suitability for pasta processing. The quality of pasta products is strongly correlated with the physical and chemical properties of durum wheat. Kernel vitreousness, protein content and quality (proper gluten strength), milling properties (semolina yield and ash content), yellow pigment content, and activities of lipoxygenase (LOX), peroxidase (POD), and polyphenol oxidase (PPO) enzymes are among the well-documented quality parameters (Clarke et al. 1998;Borrelli et al. 1999;Troccoli et al. 2000;Morris 2004). Of these quality parameters, protein content and quality, yellow pigment content, and the activities of the oxidative enzymes are of vital importance for pasta quality, as they overwhelmingly determine the so-called al dente cooking characteristics and bright yellow color of pasta products (Troccoli et al. 2000;Aalami et al. 2007).However, protein content and gluten quality (including gliadin and glutenin proteins) are the 2 most important variables in determining pasta cooking properties (D'Edigio

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“…At the highest power setting, we found slightly less thermal injury caused by the Harmonic scalpel (127.48 lm) than LigaSure (144.18 lm), but that difference was nonsignificant. Certain studies, e.g., Diamantis et al; Sutton et al [26,28] in their studies, found that LigaSure (197.79 lm) might cause less thermal injury than Harmonic scalpel (205.61 lm) but that difference was not significant. Sartori and colleagues [18] found that the only real advantage between LigaSure and Harmonic scalpel was a shorter duration of surgery with the Harmonic scalpel, probably owing to its ability to coagulate and cut at the same time.…”

Section: Thermal Damage In Laparoscopy-an In-depth Reviewmentioning

confidence: 94%

“…Minimizing thermal damage to surrounding tissues without compromising safety and tissue integrity is of importance in surgery. Ultrasonic instruments are tried to be safer than traditional diathermy [7,20,[24][25][26]. The Ultrasonic shears incorporate piezoelectric transducers that induce a vibration frequency at the functional tip and transduces a lower amount of energy to the tissue than high-frequency current or laser techniques, resulting in reduced lateral thermal damage and penetration depth owing to lower temperatures [7,20,27].…”

Section: Thermal Damage In Laparoscopy-an In-depth Reviewmentioning

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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Comparison of blood vessel sealing among new electrosurgical and ultrasonic devices

Abstract: 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.

Cited by 166 publications

References 17 publications

Comparison of lateral thermal damage of the human peritoneum using monopolar diathermy, Harmonic scalpel and LigaSure

Comparison of lateral thermal damage of the human peritoneum using monopolar diathermy, Harmonic scalpel and LigaSure

Comparison of different ligation techniques in laparoscopic varicocelectomy*

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

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