Comparison of the safety of electrotome, Harmonic scalpel, and LigaSure for management of thyroid surgery

Yang, Xiaodong; Cao, Jian; Yan, Yichao; Liu, Fangfang; Li, Tao; Han, Long; Ye, Chunxiang; Zheng, Shuying; Wang, Shan; Ye, Yingjiang; Jiang, Kewei

doi:10.1002/hed.24701

Cited by 27 publications

(16 citation statements)

References 27 publications

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“…For example, in neurosurgery, the application of ES is limited, which may cause acute and subacute nerve damage. In thyroid surgery, the thermal damage induced by electrosurgical equipment may cause damage to the recurrent laryngeal nerves, resulting in dysphonia or even potentially life-threatening asphyxia (22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

Comparative healing of swine skin following incisions with different surgical devices

et al. 2021

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Background: Electrosurgical technology is widely used in surgical dissection and hemostasis, but the generated heat creates thermal injury to adjacent tissues and delays wound healing. The plasma blade (PB) applies pulsed radiofrequency (RF) to generate electrical plasma along the edge of a thin, flat, insulated electrode, minimizing collateral tissue damage. This study aimed to evaluate wound healing in swine skin following incision with a new surgical system that applies low-temperature plasma (NTS-100), a foreign PB, conventional electrosurgery (ES), and a scalpel blade.Methods: In vitro porcine skin and an in vivo porcine skin model were used in this study. Full-thickness skin incisions 3 cm in length were made on the dorsum of each animal for each of the 5 surgical procedures at 0, 21, 28, 35, and 42 days. The timing of the surgical procedures allowed for wound-healing data points at 1, 2, 3, and 6 weeks accordingly. Local operating temperature and blood loss were quantified. Wounds were harvested at designated time points, tested for wound tensile strength, and examined histologically for scar formation and tissue damage. Results: Local operating temperature was reduced significantly with NTS-100 (cut mode 83.12±23.55 ℃; coagulation mode 90.07±10.6 ℃) compared with PB (cut mode 94.46±11.48 ℃; coagulation mode 100.23±6.58 ℃, P<0.05) and ES (cut mode 208.99±34.33 ℃, P<0.01; coagulation mode 233.37±28.69 ℃, P<0.01) in vitro. Acute thermal damage from NTS-100 was significantly less than ES incisions (cut mode: 247.345±42.274 versus 495.295±103.525 μm, P<0.01; coagulation mode: 351.419±127.948 versus 584.516±31.708 μm, P<0.05). Bleeding, histological scoring of injury, and wound strength were equivalent for the NTS-100 and PB incisions. Conclusions:The local operating temperature of NTS-100 was lower than PB, and NTS-100 had similarly reliable safety and efficacy.

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Section: Discussionmentioning

confidence: 99%

Comparative healing of swine skin following incisions with different surgical devices

et al. 2021

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“…Clinical practice has also proven that this method is relatively reliable in controlling bleeding. However, interrupting blood flow to the entire liver will cause ischaemia-reperfusion injury in the non-resected liver lobe, which is not conducive to postoperative recovery of the liver function (Yang et al 2017); therefore, the above methods were evolved and improved in this study. During the operation, only the base of the resected liver lobe was treated by penetrating ligation to block blood flow into and out of the liver.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic left hemihepatectomy in small dogs: an easy and effective new technique

et al. 2020

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The present report describes a novel approach to and presents the surgical results for laparoscopic hepatectomy of the left lobes in small dogs. A purely laparoscopic four-port approach was used in seven beagles. The left triangular ligament was cut first, then the base of the left medial lobe (LMB) was ligated with silk thread using a needle, and the liver parenchyma of the LMB approximately 0.5 cm above the ligation site was removed with LigaSure. The left lateral lobe (LLB) was removed in the same manner. Blood was collected on postoperative days 1, 3, 7, and 14 for laboratory testing. Left hepatic lobe resection was successfully completed in all dogs, with an average operation time of 102.53 ± 9.07 min and an average blood loss of 32.10 ± 6.43 ml. Serious postoperative complications were not observed. The white blood cell (WBC) count and alkaline phosphatase (ALP) level were significantly increased in experimental dogs 1 day after surgery (P < 0.05); aspartate transferase (AST) and alanine transaminase (ALT) were significantly different before and after surgery (P < 0.01); and all the indicators were basically normal seven days after the operation. Exploratory laparoscopy at 28 days revealed adhesion of the surface of the liver section to the omentum or the gastric wall, but there were no other abnormal findings. The combined application of liver pedicle ligation and LigaSure for liver lobectomy provides a simple and effective method for generating liver lobectomy models for research on liver disease and regeneration and a feasible laparoscopic liver lobectomy operation scheme for small dogs (10–15 kg).

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“…(III) Thermal injury associated with improper use of energy devices: (i) energy devices can be too close to the RLN while in use. The use of an electric knife within 3 mm of RLN has been shown to lead to RLN injury (14). Owaki et al noted that postoperative RLN palsy occurred when an ultrasonic scalpel was used in thyroid surgery, which may be related to thermal damage to surrounding tissues (15).…”

Section: Causes Of Rln Injury (8)mentioning

confidence: 99%

Clinical observation of end-to-end neuroanastomosis in the treatment of complete injury of the unilateral recurrent laryngeal nerve

Wu¹,

Zhang²,

Wang³

et al. 2020

Gland Surg

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Background: Complete injury of the recurrent laryngeal nerve (RLN) is a serious complication of thyroid surgery. Increasingly researches focus on the voice recovery of patients with RLN injury. This paper studied the effect of immediate end-to-end neuroanastomosis after complete injury of the unilateral RLN during thyroid surgery on postoperative vocal function.Methods: Thirteen patients who underwent end-to-end neuroanastomosis for the treatment of complete injury of the unilateral RLN caused by thyroid surgery in Hunan Provincial People's Hospital between October 2009 and January 2020 were selected. The basic information, cause of RLN injury, postoperative voice recovery, recovery time, and subjective assessment of voice by auditory perception results (Grade, Roughness, Breathiness, Asthenia, and Strain, the GRBAS score) of the patients were recorded.Results: Among the 13 cases with RLN injury, the cause of RLN injury in 10 cases was transection by sharp instruments, and the voice was recovered one day after the operation. The cause of RLN injury in one case was suture of the RLN branch, and the voice was recovered one day after the operation. The cause of RLN injury in two cases was thermal injury, and the times for voice recovery after end-to-end neuroanastomosis were 3 and 4 months. The patients with a GRBAS score of 0 or 1 recovered their voice one day after the operation. The GRBAS score reached 1 in the two thermal injury cases, with voice recovery at 3 and 4 months after surgery. By 6 months, the voice recovery rate of the patients was 100%.Conclusions: After complete injury of the unilateral RLN, immediate end-to-end anastomosis of the RLN can maximally preserve the postoperative vocal function of patients.

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Comparison of the safety of electrotome, Harmonic scalpel, and LigaSure for management of thyroid surgery

Abstract: LigaSure and the Harmonic scalpel might be safer than electrotome when used in thyroid operations. LigaSure generates less heat than the Harmonic scalpel and electrotome. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1078-1085, 2017.

Cited by 27 publications

References 27 publications

Comparative healing of swine skin following incisions with different surgical devices

Comparative healing of swine skin following incisions with different surgical devices

Laparoscopic left hemihepatectomy in small dogs: an easy and effective new technique

Clinical observation of end-to-end neuroanastomosis in the treatment of complete injury of the unilateral recurrent laryngeal nerve

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