Application Of Harmonic Scalpel Research Articles

Laparoscopic Harmonic Scalpel Use Causes Burn Injury

Skin burns are observed rarely after laparoscopic application of harmonic scalpel. We present 2 cases of port-site burn occurring after the application of harmonic scalpel during laparoscopic surgery. Laparoscopic staging surgery was performed in two women with endometrial carcinoma. Harmonic scalpel was introduced through the left paraumbilical port for dissection. The surgical procedure was uneventful. At day 1 or 2 postoperatively, skin burn was found around the left paraumbilical puncture. The burn healed after conservative treatment or full thickness debridement. Our experiences suggest that overheating of harmonic scalpel can occur and predispose abdominal wall to thermal injury. Surgeons should be aware of and avoid this rare but regrettable complication.

Which is better: stapler haemorrhoidopexy vs traditional excisional surgery?

Background: Haemorrhoids are tortuous dilated veins within the submucosa of anal canal. They are external, internal or internoexternal. External haemorrhoids cause pain. Internal haemorrhoids are characterised by painless bleeding or prolapse. Various treatment options are available- dietary modification, band ligation, sclerosant therapy, cryosurgery, traditional excisional surgery (Milligan/Ferguson), stapler haemorrhoidopexy, Doppler guided haemorrhoidal artery ligation (DGHAL), application of harmonicscalpel and ligasure.Methods: Adult patients (>18 yrs) with grade II, III & grade IV haemorrhoids are randomly allotted in equal numbers to receive either stapler haemorrhoidopexy or traditional excisional surgery from July 2017 to December 2018. Post-operative complications, pain (using visual analogue scale), recurrence rate and the need for further surgery with these procedures were analysed in this 1 and half year study period.Results: Patients who underwent stapler haemorrhoidopexy had better temporary quality of life, but patients who underwent traditional excisional surgery had lesser recurrence.Conclusions: Overall, traditional excisional surgery should be the choice when compared to stapler haemorrhoidopexy.

Potential application of Harmonic Scalpel in Laparoscopic Cholecystectomy as an alternative to Monopolar electrocautery

Potential application of Harmonic Scalpel in Laparoscopic Cholecystectomy as an alternative to Monopolar electrocautery

A new device for the liver parenchyma dissection

Introduction: Main tendency in the modern liver surgery is application of parenchyma sparing segmentectomies and mesohepatectomies instead of hemihepatectomies and extended hepatectomies. These procedures are technically demanded and require perfect equipment. Clamp-crashing is the fastest tool of the liver parenchyma dissection, but it is accompanied with the highest blood loss. On the other hand, application of energy devices (radio frequency, harmonic scalpel or bipolar electro cautery) associates with adhesion of the active electrode to the liver tissue and its tearing off leads to more damage of the liver tissue. Materials and methods: We created a new instrument for the liver parenchyma separation, which integrates three principles: clamp-crashing, radio frequency ablation and irrigation. Carrying out 44 liver resections in 42 patients, among them: segmentectomies (16), bisegmentectomies (5), mesohepatectomies (5), hemihepatectomies (10), extended hemihepatectomies (4) and atypical resections (4), we compered blood loss and duration of the surgery applying three devices bipolar electro cautery (n = 19), harmonic scalpel (n = 7) and our instrument (n = 18). Results: Mean blood loss applying our instrument came to 627,04 ± 161,89 ml, applying harmonic scalpel – 1652,29 ± 624,50 ml (p = 0.008) and bipolar electro cautery – 811.01 ± 225,08 ml. Mean duration of the procedure came to 301,67 ± 26,08 min, 386,14 ± 40.40 min and 360,15 ± 29,31 min (p = 0.104) respectfully. Conclusion: Integration of three principles: clamp-crashing, radio frequency ablation and irrigation in one instrument for the liver parenchyma dissection enables to reach less blood loss then application of harmonic scalpel.

HARMONIC SCALPEL POSSIBILITIES IN THE SURGICAL TREATMENT OF SECONDARY HYPERPARATHYROIDISM

The significant changes in coagulation status during chroniodialysis, performed in patients with secondary hyperparathyroidism require completion of meticulous surgical hemostasis in order to prevent active bleeding in the postoperative period. Aim: To present our experience with harmonic scalpel application in the surgical treatment of secondary hyperparathyroidism. Patients and Methods: 112 patients with secondary hyperparathyroidism (77 males and 35 females, aged from 23 to 60 years) have been operated on in our institution for 10 years period. All patients were on chroniodialysis. Hemostasis was achieved using conventional instruments and electrocautery in 46 patients and in 66 patients harmonic scalpel of Ethicon EndoSurgeryCare has been used. All patients had serum levels of parathormone above 2500ng/l. Ultrasonic examination revealed at least 2 parathyroid glands larger than 10mm in all cases. The amount of blood loss, necessity and type of drainages used, frequency of postoperative complications, postoperative hospital stay were comparatively evaluated. Results: In 12 patients parathyroidectomy with autotransplantation was carried out, in 62 patients subtotal parathyroidectomy was performed. In the rest 35 casesthree of the parathyroid glands were removed (because of the impossibility to identify the fourth parathyroid gland, using ultrasonic and intraoperative methods). All patients were proven to have a sharp decrease in parathormone and Calcium serum levels. In the group of patients, where conventional instruments and electrocautery for hemostasis have been used, corrugated and tube drainages were applied as a rule. For the patients, in whom hemostasis was performed using a harmonic scalpel, simple glove drainages were used. In all patients in the preoperative and post-operative period serial hemodialysis was done with LMW heparin administration. Significantly lower blood loss from the surgical wound was found in the group, where harmonic scission was used. Conclusions: We consider that the application of harmonic scalpel in the surgical treatment of patients with secondary hyperparathyroidism on chroniodialysis leads to safer hemostasis, lower postoperative complications rate and thus shortens the postoperative hospital stay.

Comparison between harmonic scalpel as major instrument and conventional operation for tonsillectomy

To investigate the feasibility of applying harmonic scalpel in tonsillectomy by comparing it with the conventional tonsillectomy. Thirty-five patients were treated by harmonic scalpel assisted tonsillectomy (harmonic scalpel group) and 35 patients were treated by conventional tonsillectomy (control group). The operating time and blood loss during operation and the degree of pain and post-tonsillectomy hemorrhage as well as the time of defining were observed. The data of the operating time and blood loss during operation and the degree of pain in harmonic scalpel group were lower than that in the conventional group, the harmonic scalpel group had less perioperative bleeding (median 1 ml), short operation time (median 20 min), postoperative pain during 5 days with visual analogue scale was lighter (median from 5 scores down to 1 score), there was statistical difference (P < 0.01). Neither primary hemorrhage nor secondary hemorrhage occurred in harmonic scalpel group, while one primary hemorrhage and one secondary hemorrhage occurred in conventional group. No difference was found in the beginning time of defining (P > 0.05). The application of harmonic scalpel in tonsillectomy was safe, efficient and feasible, which had a nice application prospect in the field of otolaryngology.