Comparison of Tissue Injury between Laparosonic Coagulating Shears and Electrosurgical Scissors in the Sheep Model

Kwok, Adrian; Nevell, David; Ferrier, Alan; Graf, Nicole; Lam, Alan; Ford, Robert M.

doi:10.1016/s1074-3804(05)60334-9

Cited by 15 publications

(11 citation statements)

References 12 publications

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“…[18][19][20] LS was the most efficient method of hemostasis 12 and UC required re-application in only one animal. UC demonstrated better efficiency than ME and BE, in agreement with the report by Kwok et al 21 The slight superiority of LS over UC in our series reflects the findings of previous studies. 1,3 Safety is indicated by involvement of the adjacent gastric wall, either as free or contained perforation or as remarkable histologic evidence of gastric wall thermal injury.…”

Section: Discussionsupporting

confidence: 94%

Comparison of Monopolar Electrocoagulation, Bipolar Electrocoagulation, Ultracision, and Ligasure

et al. 2006

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Section: Discussionsupporting

confidence: 94%

Comparison of Monopolar Electrocoagulation, Bipolar Electrocoagulation, Ultracision, and Ligasure

et al. 2006

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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%

“…Other investigators have reached the same conclusions. 1,3,6,[10][11][12] Thermal spread caused by LigaSure and Harmonic scalpel is limited to areas less than 1.5 mm and 1.6 mm beyond the tissue bundle or vessel, respectively. 4,5,17,18 Ultrasonic energy delivered through a harmonic scalpel has been shown to be safe and to produce minimal damage to the surrounding tissues.…”

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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“…In our review of most studies, thermal injury of the surrounding tissue was much more evident after monopolar diathermy than after Radiofrequency devices or even than ultrasonic shears [18,24,25,34,35]. Ultrasonic energy delivered through a harmonic scalpel has been shown to be safe and to produce minimal damage to the surrounding tissues but high-power and prolonged ultrasonic dissection may result in considerable heat production and collateral tissue damage, especially when the activation time exceeds 10 s [4,7,20].…”

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

confidence: 94%

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 Tissue Injury between Laparosonic Coagulating Shears and Electrosurgical Scissors in the Sheep Model

Cited by 15 publications

References 12 publications

Comparison of Monopolar Electrocoagulation, Bipolar Electrocoagulation, Ultracision, and Ligasure

Comparison of Monopolar Electrocoagulation, Bipolar Electrocoagulation, Ultracision, and Ligasure

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

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

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