Efficacy and cost effectiveness of harmonic scalpel compared with electrocautery in posterior instrumentation of the spine

Cakir, Balkan; Ulmar, Benjamin; Schmidt, René; Kelsch, G.; Geiger, Peter; Mehrkens, H.-H.; Puhl, W.; Richter, Marcus

doi:10.1007/s00586-004-0812-3

Cited by 14 publications

(6 citation statements)

References 26 publications

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“…While not reaching significance (possibly due to the small numbers of dogs in each group), lower blood loss occurred in the HOB group compared to the TRAD group (p = 0.063, Table 2 ). These data are consistent with human clinical studies that have documented a significant decrease in blood loss when using an ultrasonic surgical blade compared to electrocautery [ 19 – 25 ]. Excessive bleeding rarely occurs during the approach to the canine spine and is more likely encountered after access to the spinal canal through bleeding from the venous sinus, vertebral artery or intervertebral vascular branches.…”

Section: Discussionsupporting

confidence: 89%

“…While this study included a relatively small number of cases, it is the first of its kind to evaluate use of the HOB in a clinical setting. While previous experimental and clinical studies have demonstrated clear advantages of harmonic surgical blades over electrocautery [ 13 – 25 , 32 – 34 ], the HOB design differs from previous blades and the spade like form is specifically aimed at improving soft tissue dissection from bone. The modifications are also designed to prevent blade breakage if the blade comes in contact with bone.…”

Section: Discussionmentioning

confidence: 99%

“…To maintain a similar degree of soft tissue dissection among the two groups, dogs were only eligible if no more than 1 disc space was affected and required surgery. Evaluation of larger patients requiring more approach exposure may provide different data and document a difference in surgical time as previously described for other ultrasonic surgical blades [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…To circumvent some of the potential complications associated with these standard instruments, the harmonic scalpel was developed. An earlier model of the harmonic scalpel (Ultracision; Ethicon Endo-Surgery, Cincinnati, OH) was previously evaluated for its potential efficacy in posterior spinal instrumentation in humans [ 25 ]. In this study, use of the Ultracision led to significantly decreased surgical time and lower blood loss.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of harmonic blade versus traditional approach in canine patients undergoing spinal decompressive surgery for naturally occurring thoracolumbar disk extrusion

et al. 2017

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ObjectivesTo assess feasibility of the harmonic Osteovue blade (HOB) for use in the soft tissue approach for dogs undergoing hemilaminectomy and to compare outcomes between dogs undergoing HOB or traditional approach (TRAD).MethodsA prospective randomized clinical trial was performed using 20 client-owned dogs with thoracolumbar intervertebral disk extrusion requiring hemilaminectomy. Dogs were randomly assigned to HOB or TRAD. Neurologic function and pain scores were assessed pre-operatively. Intraoperative blood loss and surgical approach time as well as postoperative pain and wound healing scores were recorded. Additionally, neurologic recovery and owner perceived quality of life were recorded at day 10 and 30 postoperative.ResultsThere was no significant difference in sex distribution, weight, age, preoperative neurological grade and pain score, and perioperative outcome measures between groups. Intraoperative total blood loss was minimal for HOB and TRAD (median: 0 ml (range 0–9) and 2.2 ml (range 0–6.8), respectively; p = 0.165) and approach times were similar (median: 7 min (range 5–12) and 8 min (range 5–13), respectively; p = 0.315). While changes in wound healing scores were similar, changes in postoperative pain scores and neurological function were significantly improved in the HOB compared to the TRAD group. Postoperative complications in the HOB group consisted of automutilation of part of the incision and development of a small soft, non-painful subcutaneous swelling in 1 dog each.ConclusionsThe HOB is a safe and effective tool for the soft tissue approach for routine spinal surgery in dogs and is associated with decreased pain and increased neurological function post-surgery.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of harmonic blade versus traditional approach in canine patients undergoing spinal decompressive surgery for naturally occurring thoracolumbar disk extrusion

et al. 2017

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“…Early reports indicated that the ultrasonically vibrating knife produced less tissue injury resulting in faster cutaneous wound healing compared with electrosurgery [2], and since then numerous studies have confirmed the advantages of this surgical dissection method in various tissues. In comparison to electrosurgery, the Harmonic Blade provided better hemostasis and tissue strength in oral mucosal surgery [5], less bleeding in tonsillectomy [8,11], faster operative times and less bleeding in thyroidectomy [12], less blood loss in hip replacement [13,14] and spinal surgery [15], less postoperative pain, drainage volume and soft tissue injury in hip arthoplasty [16], and less bleeding, shorter operative times, and better wound healing in neck dissection [3].…”

Section: Introductionmentioning

confidence: 99%