Comparison of the vessel sealer Extend® with harmonic ACE® in robotic bilateral axillary-breast approach thyroid surgery

Abstract

Background: Harmonic ACE ® (Harmonic) Curved Shears are frequently used for vessel sealing in patients undergoing robotic thyroidectomy. Unlike other robotic devices with articulation, the Harmonic device can only move in a straight-forward direction without articulation. The recently introduced Vessel Sealer Extend ® (VSE) provides bipolar sealing and cutting with articulation movement. This study compared the VSE and Harmonic devices in robotic bilateral axillary-breast approach (BABA) thyroid surgery. Methods: From December 2018 to March 2019, 35 consecutive patients underwent robotic BABA thyroidectomy, 20 using the VSE and 15 using the Harmonic device. Patient characteristics, pathologic results, and clinical outcomes, including complications, were evaluated. Results: The characteristics of patients in the two groups were similar. Surgical time from robot docking to completion of lobectomy was longer in the VSE than in the Harmonic group (45.00±9.52 vs. 39.72±12.76 min; P=0.170). The number of camera cleanings during lobectomy was significantly lower in the VSE group (0.55±0.51 vs. 1.93±1.71; P=0.002). Intraoperative blood loss (53.00±43.29 vs. 28.67±41.03 mL; P=0.102), hospital stay after surgery (3.55±0.95 vs. 3.67±0.90 days; P=0.715), and pain scores on the first (2.85±0.37 vs. 2.93±0.26; P=0.458) and second (2.55±0.51 vs. 2.60±0.51; P=0.775) postoperative days were similar in the VSE and Harmonic groups. No patient experienced vocal cord palsy or postoperative bleeding.Conclusions: VSE can be safely applied to robotic BABA thyroid surgery.

Initial Experience With Robotic Modified Radical Neck Dissection Using the da Vinci Xi System Through the Bilateral Axillo-Breast Approach

“…The flexible energy device enables safe dissection around all lateral neck node levels. As a result, the number of LNs retrieved in all LN areas did not differ significantly between the two groups [13,17]. The number of retrieved LNs in our study was smaller than in previous studies, which may have resulted from differences between pathologists.…”

“…To our knowledge, this study is the first to assess robotic MRND via BABA using a new robotic operating system, the da Vinci Xi. The results with this system were comparable to those using the da Vinci S or da Vinci Si system [ 7 , 12 , 17 ]. Baseline clinical characteristics, including patient age, sex ratio, main tumor location, operation site, and tumor size, did not differ significantly in patients who underwent robotic and open surgery.…”

“…Another limitation of robotic MRND was the inability to articulate the ultrasonic shear device (Harmonic), limiting the approach of Harmonic ACE to the lower neck node levels. The da Vinci Xi system, however, allows use of the vessel sealer extend instrument and the bipolar energy coagulator with robot EndoWrist function [ 17 ]. The flexible energy device enables safe dissection around all lateral neck node levels.…”

Evaluation of PIC 181 and Mn:PIN-PMN-PT thickness extensional rings for use in power ultrasonic devices for minimally invasive surgery

“…The transducer is axially constrained with the robot and only limited movement is permitted. In order to enable more degrees of freedom at the end effector, the transducer should be attached to a wristed joint to replicate the experience of open-surgery [1]- [3]. Currently this is not achievable if rigid waveguides, and materials conventionally used in ultrasound, are adopted.…”

Progress Towards the Miniaturization of an Ultrasonic Scalpel for Robotic Endoscopic Surgery Using Mn:PIN-PMN-PT High Performance Piezocrystals

“…These advantages often contribute to reducing the overall procedure time and faster patient recovery through reductions in intra-and post-operative complications. Hence, it is attractive to consider how to increase the use of ultrasonic energy devices in RES [1]- [5].…”