Comparison of thermal damage of the internal thoracic artery using ultra high radiofrequency and monopolar diathermy

Bulat, Cristijan; Pešutić-Pisac, Valdi; Čapkun, Vesna; Marović, Zlatko; Pogorelić, Zenon; Družijanić, Nikica

doi:10.1016/j.surge.2013.09.005

Cited by 7 publications

(4 citation statements)

References 19 publications

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“…The main possible disadvantage is thermal damage or opening of the pyloric mucosa, if the electrocautery hook is inserted too deep, or lateral thermal damage to surrounding organs [22,36]. Care should be taken to avoid thermal damage as it does not have to be seen immediately, and delayed complications develop [22,27,[36][37][38][39][40].…”

Section: Discussionmentioning

confidence: 99%

The Safety and Effectiveness of Laparoscopic Pyloromyotomy Using 3-mm Electrocautery Hook versus Open Surgery for Treatment of Hypertrophic Pyloric Stenosis in Infants

et al. 2021

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Background: The standard of treatment for infants with hypertrophic pyloric stenosis is still pyloromyotomy. Recently, in most of the pediatric surgery centers laparoscopic pyloromyotomy has become popular. The aim of the present study is to compare the outcomes of treatment in infants with hypertrophic pyloric stenosis between traditional open approach and laparoscopic pyloromyotomy using 3-mm electrocautery hook. Methods: A total of 125 infants, 104 (83.2%) males, with median age 33 (interquartile range, IQR 24, 40) days, who underwent pyloromyotomy because of hypertrophic pyloric stenosis, between 2005 and 2021, were included in the retrospective study. Of that number 61 (48.8%) infants were allocated to the open group and 64 (51.2%) to the laparoscopic group. The groups were compared in regards to time to oral intake, duration of surgery, the type and rate of complications, rate of reoperations, frequency of vomiting after surgery, and the length of hospital stay. Results: No differences were found with regards to baseline characteristics between two investigated groups. Laparoscopic approach was associated with significantly better outcomes compared to open approach: shorter duration of surgery (35 min (IQR 30, 45) vs. 45 min (40, 57.5); p = 0.00008), shorter time to oral intake (6 h (IQR 4, 8) vs. 22 h (13.5, 24); p < 0.00001), lower frequency of postoperative vomiting (n = 10 (15.6%) vs. n = 19 (31.1%)), and shorter length of postoperative hospital stay (3 days (IQR 2, 3) vs. 6 days (4.5, 8); p < 0.00001). In regards to complications and reoperation rates, both were lower in the laparoscopic pyloromyotomy group but the differences were not statistically significant (p = 0.157 and p = 0.113, respectively). The most common complication in both groups was mucosal perforation (open group, n = 3 (4.9%); laparoscopic group, n = 2 (3.1%)) followed by wound infection in open group, n = 3 (4.9%). No cases of wound infection were recorded in the laparoscopic group. Conclusion: Open and laparoscopic pyloromyotomy are equally safe and effective in treatment of hypertrophic pyloric stenosis. Laparoscopic technique is associated with faster recovery, shorter duration of surgery and shorter duration of hospital stay.

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Section: Discussionmentioning

confidence: 99%

The Safety and Effectiveness of Laparoscopic Pyloromyotomy Using 3-mm Electrocautery Hook versus Open Surgery for Treatment of Hypertrophic Pyloric Stenosis in Infants

et al. 2021

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“…Fukata et al investigated the histological effects of an ultrasonic scalpel on blood vessel walls and found that thermal damage was limited to the depth of the connective tissue of the tunica externa of the blood vessels ( 31 ). Bulat et al further investigated the effect of thermal damage on vascular endothelial cells using electrocautery and a high-frequency ultrasonic scalpel for harvesting IMAs, and reported that the degree of endothelial damage was 2.8 times greater in the electrocautery than in the high-frequency ultrasonic scalpel group ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

Clipless internal mammary artery harvesting for minimally invasive coronary artery bypass grafting using the shear-tip harmonic scalpel

Jung,

Chong,

Kang

et al. 2024

J Thorac Dis

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“…Over time, preparation of ITA grafts has evolved from the use of dissecting scissors and hemostatic clips, to conventional electrosurgery with continuous radiofrequency energy with different settings and output levels, to ultra-high radiofrequency “cold” knifes, and the use of ultrasonic devices [ 17 – 19 ]. Nevertheless, the established technique of using the conventional electrosurgical device at low output levels in many centers is still considered the standard procedure, which may be due to the generally low cost of the device, the non-superiority of other devices, further disadvantages of new devices and absent data concerning histological samples, long term outcomes results, or control groups [ 15 – 17 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Skeletonized internal thoracic artery harvesting: a low thermal damage electrosurgical device provides improved endothelial layer and tendency to better integrity of the vessel wall compared to conventional electrosurgery

Zientara

Komminoth

Seifert

et al. 2018

J Cardiothorac Surg

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BackgroundElectrosurgery is fundamental to the precise, fast and bloodless preparation of internal thoracic artery grafts in cardiac surgery. The PEAK PlasmaBlade is a monopolar electrosurgical device that uses pulsed radiofrequency energy to generate a plasma-mediated discharge along an insulated electrode, creating a cutting edge while the blade stays near body temperature. The aim of this study is to compare the histological samples, cardiac computed-tomography of graft patency, and clinical outcomes of patients after off-pump coronary artery bypass grafting with preparation of the internal thoracic arteries by a conventional electrosurgical device and the PlasmaBlade.MethodsIn twenty subjects one internal thoracic artery was prepared with PlasmaBlade and the other artery with a conventional electrosurgical device. Histological samples were evaluated for three factors for potential graft failure: endothelial damage, integrity of the vessel wall and adventitial hemorrhage. Five samples per artery were evaluated by a novel scoring method based on the exposed circumference of the histological sample (“0”: 0%, “1”: 1–25%, “2”: 26–50%, “3”: 51–75%, “4”: ≥76% of the circumference). The Wilcoxon signed ranks test for mean scores within subjects was performed. Six-month-follow up by cardiac computed tomography for evaluation of graft patency was completed in 16 patients.ResultsHistological results demonstrated significantly less endothelial damage after PlasmaBlade (83% vs 60%, absolute: 75/90 vs. 53/89 samples with score “0–1”, p = 0.04). PlasmaBlade samples demonstrated a tendency to better wall integrity (72% vs. 54%, absolute: 64/89 vs. 47/87 samples with score “0–1”, p = 0.32). There were no differences in endothelial bleeding (PlasmaBlade 46% vs. electrosurgery 53%, absolute: 41/88 vs. 48/90 samples with score “0–1”, p = 0.63). Computed tomography confirmed non-inferiority of the PlasmaBlade to conventional electrosurgery with a patency rate of 94%.ConclusionHistologically, internal thoracic arteries harvested with PlasmaBlade demonstrate a more intact endothelial layer and a tendency to better wall integrity. Computed tomography of graft patency speaks for non-inferiority to conventional electrosurgery. PlasmaBlade may be preferable to conventional electrosurgery, if further follow-up confirms patency of internal thoracic arteries.Trial registrationNCT03510026, registered 4th April 2018 (retrospectively registered).

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Comparison of thermal damage of the internal thoracic artery using ultra high radiofrequency and monopolar diathermy

Cited by 7 publications

References 19 publications

The Safety and Effectiveness of Laparoscopic Pyloromyotomy Using 3-mm Electrocautery Hook versus Open Surgery for Treatment of Hypertrophic Pyloric Stenosis in Infants

The Safety and Effectiveness of Laparoscopic Pyloromyotomy Using 3-mm Electrocautery Hook versus Open Surgery for Treatment of Hypertrophic Pyloric Stenosis in Infants

Clipless internal mammary artery harvesting for minimally invasive coronary artery bypass grafting using the shear-tip harmonic scalpel

Skeletonized internal thoracic artery harvesting: a low thermal damage electrosurgical device provides improved endothelial layer and tendency to better integrity of the vessel wall compared to conventional electrosurgery

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