How to Prevent Lateral Thermal Damage to Tissue Using the Harmonic Scalpel: Experimental Study on Pig Small Intestine and Abdominal Wall

Pogorelić, Zenon; Perko, Zdravko; Družijanić, Nikica; Tomić, Snježana; Mrklić, Ivana

doi:10.1159/000226219

Cited by 41 publications

(21 citation statements)

References 38 publications

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“…The short duration of peritoneal contact with a hook probably explains the more favorable outcome in our study than in the study of Kim et al [4]. Lateral thermal injury also was less in pig intestine and abdominal wall when energy was applied with pauses in contrast to the continuous activation of the Harmonic Scalpel [29]. …”

Section: Discussionmentioning

confidence: 40%

Electrocautery causes more ischemic peritoneal tissue damage than ultrasonic dissection

2010

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BackgroundMinimizing peritoneal tissue injury during abdominal surgery has the benefit of reducing postoperative inflammatory response, pain, and adhesion formation. Ultrasonic dissection seems to reduce tissue damage. This study aimed to compare electrocautery and ultrasonic dissection in terms of peritoneal tissue ischemia measured by microdialysis.MethodsIn this study, 18 Wistar rats underwent a median laparotomy and had a peritoneal microdialysis catheter implanted in the left lateral sidewall. The animals were randomly assigned to receive two standard peritoneal incisions parallel to the catheter by either ultrasonic dissection or electrocautery. After the operation, samples of microdialysis dialysate were taken every 2 h until 72 h postoperatively for measurements of pyruvate, lactate, glucose, and glycerol, and ratios were calculated.ResultsThe mean lactate–pyruvate ratio (LPR), lactate–glucose ratio (LGR), and glycerol concentration were significantly higher in the electrocautery group than in the ultrasonic dissection group until respectively 34, 48, and 48 h after surgery. The mean areas under the curve (AUC) of LPR, LGR, and glycerol concentration also were higher in the electrocautery group than in the ultrasonic dissection group (4,387 vs. 1,639, P = 0.011; 59 vs. 21, P = 0.008; 7,438 vs. 4,169, P = 0.008, respectively).ConclusionElectrosurgery causes more ischemic peritoneal tissue damage than ultrasonic dissection.

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Section: Discussionmentioning

confidence: 40%

Electrocautery causes more ischemic peritoneal tissue damage than ultrasonic dissection

2010

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“…In addition, European Surgical Research (2009) reported that coagulation necrosis is greater if the utilization is nonstop rather than separated or reconnected. Studies on porcine and rodent abdominal walls showed that the lateral thermal tissue damage is directly related to duration of application, being greater when a long continuous period is utilized irrespectively if the USADs are used in the standard output power and likewise when the USADs’ application is not followed by a short pause between applications 18. Moreover, the performance of currently laparoscopic USAID’s is different in terms of vessel sealing speed (mean time), vessel burst pressure (mmHg), visibility, operation time and degree of thermal damage (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic ultrasonic dissectors: technology update by a review of literature

Devassy¹,

Hanif²,

Krentel³

et al. 2018

MDER

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The evolution of minimally invasive surgery has brought forward the appearance of new advances in the course of the most recent couple of years and has introduced energy-based devices. The newest among them today are the ultrasonically activated devices, which are utilized with a great deal of components in-play, including ergonomics and financial aspects amid surgery. The methodology embraced was finding significant investigations through studies from PubMed, Medline and Google Scholar on current ultrasonic dissectors, which are Ethicon’s Harmonic Scalpel (ACE®), Covidien’s Sonicision™ (SNC), Conmed’s SonoSurg® (SS) and Olympus’s Thunderbeat®, to describe their efficacy in terms of vessel sealing speed, vessel burst pressure, visibility, operation time and thermal speed. We found postmarketing evidence to determine which device exhibits the better performance. Animal studies showed that emissivity values and maximum temperatures for coagulation are similar among devices but maximum cutting temperatures are significantly different: ACE = 191.1°C, SNC = 227.1°C, SS = 184.8°C (p < 0.001). Cooling times are significantly different among devices: 35.7 s for ACE, 38.7 s for SNC and 27.4 s for SS (p < 0.001). Cooling times of passive jaws to reach 60°C after activation were also significantly different: 25.4 s for ACE, 5.7 s for SNC, and 15.4 s for SS (p < 0.001). The perfect device would unify brilliant hemostatic outcomes with visual sharpness while permitting none or insignificant thermal damage at the place of use.

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“…The blade vibrates at 55.5 kHz; in this way, it generates less heat from tissue friction. Laser and electrosurgical energies create a temperature range between 100 and 400°C, at which tissue dehydration (100-150°C) and charring (>150°C) occur [19,20]. …”

Section: Discussionmentioning

confidence: 99%

“…Ultrasonic energy delivered by means of an HS has been shown to be safe and to produce minimal damage to the surrounding tissues, especially with an application time less than 5 s [19,20]. Minimal heat production with the HS leads to a minimal zone of thermal injury and better healing compared with electrosurgery and lasers [9].…”

Section: Discussionmentioning

confidence: 99%

New Harmonic Scalpel versus Conventional Hemostasis in Right Colon Surgery: A Prospective Randomized Controlled Clinical Trial

Sista¹,

Abruzzese²,

Schietroma³

et al. 2013

Dig Surg

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Background: The Harmonic Scalpel (HS) is a device that uses vibrations to coagulate and cut tissues simultaneously. Its advantages are represented by minimal lateral thermal tissue damage, less smoke formation, no neuromuscular stimulation and no transmission of electricity to the patient. Methods: A total of 211 consecutive patients (113 men, 98 women; mean age 64 years) undergoing hemicolectomy for cancer of the right colon were divided into two groups, namely those in whom the operation was performed using a new HS handpiece (NHS; 108 patients) and those assigned to conventional hemostasis (CH; 103 patients). The two surgical groups were compared regarding patients' age and sex, tumor size, location, histotype and local invasiveness assessed by American Joint Cancer Committee stage, operative time, fluid content in the suction balloon (drainage volume) during the first 1-3 days after surgery, hospital stay and complications. Results: Ultrasonic energy delivered through an HS has been shown to be safe and to produce minimal damage to the surrounding tissues because of its minimal heat production. Electrical devices allow hemostatic control in vessels up to 3 mm in diameter, while HS can coagulate vessels up to 5 mm in diameter; thus, HS allows not only better control of bleeding but also of lymphorrhea. In fact, the amount of fluid collected in the drainage was significantly lower in the NHS group compared to the CH group. Protein depletion influences the patient's regenerative capacity and thus also the occurrence of complications and recovery time. Conclusion: NHS is a useful device in colon surgery; it facilitates surgical maneuvers and reduces operative times and blood and lymphatic losses, allowing satisfactory maintenance of protein storage. This results in a lower incidence of complications and faster recovery by patients.

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How to Prevent Lateral Thermal Damage to Tissue Using the Harmonic Scalpel: Experimental Study on Pig Small Intestine and Abdominal Wall

Cited by 41 publications

References 38 publications

Electrocautery causes more ischemic peritoneal tissue damage than ultrasonic dissection

Electrocautery causes more ischemic peritoneal tissue damage than ultrasonic dissection

Laparoscopic ultrasonic dissectors: technology update by a review of literature

New Harmonic Scalpel versus Conventional Hemostasis in Right Colon Surgery: A Prospective Randomized Controlled Clinical Trial

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