Ethicon Endo-Surgery Research Articles

Step-by-Step Atraumatic Technique of Harvesting of the Radial Artery using Harmonic Scalpel: A Video Presentation

We present here-in the technical details of harvesting the left radial artery in a 50-year- old man undergoing coronary artery bypass grafting. The radial artery has been harvested atraumatically using a Harmonic scalpel (Ethicon Endosurgery LLC, Johnson & Johnson Company, Guaynaba, Puerto Rico, USA) and two vessel loops by “No touch” technique, thereby preventing perioperative spasm. The postoperative recovery was uneventful.

Evaluation of a Clinical Outcome of Resistant Gastroesophageal Reflux Disease after Treatment with Full Thickness Endoscopic Device

Abstract Introduction The full-thickness Plicator® (Ethicon Endosurgery, Sommerville, NJ, USA) was developed for endoscopic treatment of gastroesophageal reflux disease (GERD). The goal is to restructure the antireflux barrier by delivering transmural pledgeted sutures through the gastric cardia. To date, studies using this device have involved the placement of a single suture to create the plication, Aim of the Work To evaluate clinical efficacy of endosural suturing using gastroscope for patients with resistant GERD, Patients and Methods This is A Prospective study, was carried out on 25 adult patients having resistant GERD or Hiatus hernia at Gastroenterology outpatient's clinic, endoscopic center, From September 2020 to March 2020, Result According to Endoscopy, there were 20 with Esophagitis in found GERD, and 1 case with Incompetent cardia in no GERD finding, Conclusion Endoscopic full-thickness plication using the GERDx™ device improves the distal acid exposure of the esophagus, typical reflux-related symptoms and QoL in well-selected patients. This procedure might constitute an option for patients with mild GERD. Long-term outcomes are required to expand our knowledge on the effects of this procedure,

Harmonic Scalpel-Assisted Endonasal Endoscopic Resection of the Vascular Tumors of the Anterior Skull Base

Vascular tumors represent a challenging pathologic subset for surgical treatment as they show a propensity for profuse bleedings. This is especially applicable to the skull base region, where surgical access is difficult due to its complex anatomy. To overcome this problem, the authors introduced the use of a harmonic scalpel in endoscopic skull base surgery for vascular tumors. Here, the authors report the outcomes of endoscopic harmonic scalpel-assisted surgery in 6 juvenile angiofibromas and 2 hemangiomas. All surgeries were performed using Ethicon Endo-Surgery HARMONIC ACE 5mm Diameter Shears. The median intraoperative blood loss was 400mL (range: 200-1500mL). The median length of hospital stay was 7 days (range: 5-10 days). Recurrence was recorded in 1 patient with juvenile angiofibroma, which was successfully resolved with revision surgery. In this institutional experience, ultrasonic technology showed precise cutting with minimal bleeding, resulting in reduced surgical morbidity compared with conventional endoscopic instruments.

Comparison of Medisonic with Harmonic HD 1000i and Sonicision ultrasonic energy device in laparoscopic gastrectomy: a pilot randomized clinical trial.

This study aimed to compare the clinical performance of Medisonic (Daiwha Corp.) to that of Harmonic HD 1000i (Ethicon Endo-Surgery Inc.) and Sonicision (Medtronic) in patients undergoing gastrectomy for gastric cancer. A total of 30 patients were enrolled in this prospective randomized study. The patients were randomly assigned to a Medisonic (M group, n = 10), Harmonic HD 1000i (H group, n = 10), or Sonicision (S group, n = 10) groups. Primary outcome was cutting speed and activation times during omentectomy. Other variables were visibility of surgical field, blade stickiness, and clinical outcomes, including operation-related complications. Clinicopathologic characteristics, including age, sex, body mass index, or stage were not different between the 3 groups. Operative outcomes, including operation time, estimated blood loss, and postoperative hospital stay were not different between the 3 groups. There was no significant difference in 30-day postoperative complications. The running time of omentectomy was 7.3, 9.2, and 8.7 minutes in the H, S, and M groups, respectively, with no statistical difference (P = 0.589). We also looked at the activation times during the omentectomy, and there was no statistical difference between the groups (52.6 times vs. 58.9 times vs. 56.2 times in the H, S, and M groups, respectively; P = 0.860). Medisonic is safe and efficient to perform laparoscopic radical gastrectomy and is not inferior to Harmonic HD 1000i or Sonicision in terms of clinical outcomes and cutting/sealing function.

Tissue sealing versus suture ligation in open canine ovariectomy: Surgical times, intraoperative nociceptive response and frequency of complications.

In this study, we compared two different techniques currently used for open canine ovariectomy: traditional method utilising absorbable suture and vessel sealing device (ENSEAL® Ethicon Endo-Surgery, Cincinnati, OH). The aim of this study was to compare the surgical times, intraoperative nociceptive response and the frequency of intraoperative complications in the canine ovariectomy procedure using these two techniques. Forty bitches were randomly divided into two groups. The Control Group (C) will use a classic open surgery approach using ligatures with absorbable suture and ovarian resection with a scalpel blade. In the Group E, resection of ovarian structures was performed with ENSEAL® tissue sealer device. For each dog the surgical times, the intraoperative nociceptive response (measuring heart rate, respiratory rate and non-invasive blood pressure) and the intraoperative complications were measured to compare the effectiveness of the two techniques. The results of this study showed that the procedures performed using ENSEAL® were faster than the traditional techniques using surgical suture. Instead, the results regarding the nociception and the safety of the two procedures are similar. The present study shows that the use of ENSEAL® significantly shortened the surgical time. Meanwhile, its use was found to be similarly safe and efficient in terms of intra-operative nociception, as the classical techniques with absorbable suture. Canine ovariectomy using ENSEAL® device is more practical and faster than the traditional technique; the routine use of this device is considered a useful alternative for the canine neutering.

Ruptured Corpus Luteum with Hemoperitoneum in Early Pregnancy

We present a 24-year-old woman with a positive β-human chorionic gonadotropin at 5 weeks and 4 days with acute postcoital lower abdominal pain. Imaging revealed acute intra-abdominal bleeding and no intrauterine or extrauterine fetal sac present. We considered both ruptured ectopic pregnancy and ovarian hemorrhage—recognizing that differentiation is difficult. At emergency laparoscopy (Fig. 1), the enlarged left ovary was actively bleeding, and luteal rupture with hemorrhage was diagnosed. Intraperitoneal lavage was performed, and hemostasis was achieved using bipolar coagulation and hemostatic agents (SURGICEL Powder Absorbable Hemostat; Ethicon Endo-Surgery, Cincinnati, OH).

251 Use of Harmonic Focus Shears in Plastic Surgery Literature Review and Future Recommendations

Abstract Introduction Harmonic Focus Shears (HFS) (Ethicon Endo-Surgery, USA) is an ultrasonic device specifically designed through its curved clips and hand activated trigger system to be precise and minimise the impact on tissues. Initially designed for head and neck dissection and proved to be effective without increasing risk of complications in thyroidectomy procedure it is surprisingly rarely mentioned in the field of plastic surgery. We performed a literature search to established current uses of ultrasonic devices in plastic surgery and determine its effectiveness, and future uses. Method Literature search was performed in accordance with guidelines for Preferred Reporting Items for Systemic Reviews and Metanalysis. Discussion Use of ultrasonic devices as harmonic prove to be a useful tool in precise large tissue dissection surgery including pedicled flap and free flap dissection. Described benefits embrace upgraded operative time, blood loss, tissue discharge and morbidity. Initially described to be superior to traditional electrocauthery in facelift procedure, ultrasonic devices then evolved to be advantageous when considering outcomes in breast reduction surgery, implant-based breast reconstruction and capsulectomy. HFS as a novel and improved ultrasonic device allows for focused forceps dissection, haemostasis and tissue coagulation without the need to swap instruments that is safe to the surrounding tissues. Learning curve is expected, and pitfalls include additional staff training, multiple wire device setup, single use and possible overheating. On balance however improved timings and therefore operative efficiency, low risks of complications and optimal patient outcomes make this method of tissue handling a favourable tool to introduce to common plastic surgical practice.

EP-87 Use of Harmonic Focus Shears in Plastic Surgery. Literature review and future recommendations

Abstract Introduction Harmonic Focus Shears (HFS) (Ethicon Endo-Surgery, USA) is an ultrasonic device specifically designed through its curved clips and hand activated trigger system to be precise and minimise the impact on tissues. Initially designed for head and neck dissection and proved to be effective without increasing risk of complications in thyroidectomy procedure it is surprisingly rarely mentioned in the field of plastic surgery. We performed a literature search to established current uses of ultrasonic devices in plastic surgery and determine its effectiveness, and future uses. Methods Literature search was performed in accordance to guidelines for Preferred Reporting Items for Systemic Reviews and Metanalysis. Discussion Use of ultrasonic devices as harmonic prove to be a useful tool in precise large tissue dissection surgery including pedicled flap and free flap dissection. Described benefits embrace upgraded operative time, blood loss, tissue discharge and morbidity. Initially described to be superior to traditional electrocauthery in facelift procedure, ultrasonic devices then evolved to be advantageous when considering outcomes in breast reduction surgery, implant based breast reconstruction and capsulectomy. HFS as a novel and improved ultrasonic device allows for focused forceps dissection, haemostasis and tissue coagulation without the need to swap instruments that is safe to the surrounding tissues. Learning curve is expected and pitfalls include additional staff training, multiple wire device setup, single use and possible overheating. On balance however improved timings and therefore operative efficiency, low risks of complications and optimal patient outcomes make this method of tissue handling a favourable tool to introduce to common plastic surgical practice.

ESHRE guideline: endometriosis.

ESHRE guideline: endometriosis.

1226-P: Three Year Outcomes after Metabolic Surgery or Medical/Lifestyle Intervention: The ARMMS-T2D Trial

There is limited Level-1 evidence from well-powered randomized controlled trials (RCTs) examining improved glycemic control after metabolic surgery in patients with type 2 diabetes (T2D) and obesity. ARMMS-T2D is a multi-center consortium conducting a follow-up study of 4 merged RCTs in 256 patients with baseline Class 1-3 obesity and T2D, randomly assigned to metabolic surgery (MS; Roux-en-Y gastric bypass, sleeve gastrectomy, or gastric banding) or intensive Medical/Lifestyle Intervention (MLI). Three years after randomization, T2D remission rates were higher after MS than MLI (37.5%, 60/160 vs. 2.6%, 2/76, respectively, P<0.001). Adjusting for treatment allocation, baseline HbA1c, and T2D duration, the probability of remission with MS was 41.6% (95% CI, 29.6-58.3%) compared to 1% (95% CI, 0.2-4.0%) with MLI (P<0.001). MS patients experienced greater reductions than MLI in HbA1c (-1.9±2.0 vs. -0.1±2.0%, P<0.001) and fasting plasma glucose ( -52 [-105, 5] vs. -12 [-48, 26] mg/dL, P<0.001). Compared to MLI, MS patients had greater reductions in BMI (-22.0±9.4 vs. -4.8±7.9 kg/m2, P<0.001) and waist circumference (-17.5 ±10.2 vs. -2.1±9.6 cm, P<0.001), greater increases in HDL-C (35.5± 27.6 vs. 9.1±24.1, P<0.001), greater reductions in triglycerides (-33[-52, -2] vs. -10 [-36, 14] P<0.001), and similar changes in LDL-C (9.5±41.5 vs. 4.2±31.6 mg/dL). MS and MLI rendered similar reductions in albumin/creatinine ratio (-2 [-13, 1] vs. 0 [-4, 4]) and eGFR (-3.1±16.7 vs. -4.6±19.5 mL/min/1.73 m2). Also, MS patients required fewer medications for diabetes, hypertension, and dyslipidemia compared to MLI (P<0.001). In summary, this 3-year follow-up of the largest cohort of patients randomized to metabolic surgery vs. non-surgical treatment demonstrates that surgery is more effective than intensive medical/lifestyle therapy in achieving extended diabetes remission, BMI reduction, and improved metabolic disease biomarkers while reducing medication requirements. Disclosure J. P. Kirwan: None. J. M. Jakicic: Advisory Panel; Self; Naturally Slim, Spark360, Weight Watchers International, Inc. M. Patti: Consultant; Self; Cello Health, Fractyl Laboratories, Inc., MBX, Poxel SA, WGBH, Other Relationship; Self; Xeris Pharmaceuticals, Inc., Research Support; Self; Dexcom, Inc. K. Wolski: None. P. Schauer: Advisory Panel; Self; GI Dynamics, Keyron, Mediflix, Persona, Consultant; Self; Ethicon, Inc., Medtronic, Research Support; Self; Ethicon, Inc., Medtronic, Pacira. A. Courcoulas: None. D. E. Cummings: Advisory Panel; Self; DyaMx, GI Dynamics. A. Goldfine: Employee; Self; Novartis AG. S. Kashyap: Advisory Panel; Self; Fractyl Laboratories, Inc., GI Dynamics. D. C. Simonson: Stock/Shareholder; Spouse/Partner; Phase V Technologies, Inc. D. Arterburn: None. W. F. Gourash: None. A. H. Vernon: None. Funding National Institutes of Health (DK114156); Ethicon Endo-Surgery; Covidien

Safety and effectiveness of REALIZE adjustable gastric band: 5-year prospective study.

BackgroundThe long-term safety results of the REALIZE (Ethicon Endo-Surgery, Inc., Cincinnati, OH) adjustable gastric band collected in this prospective, multicenter study in patients with morbid obesity are presented.ObjectivesTo determine the reoperation rate, including band revisions, replacements, and explants, resulting from a serious adverse device-related event through years 4 and 5. Various efficacy measures were also assessed as secondary objectives.SettingNine academic and/or private institutions.MethodsThe participating institutions enrolled 303 patients, who were then assessed on an annual basis, with 231 patients completing 5 years of follow-up. The study parameters included reoperation rates, changes in percentage of excess weight loss (%EWL), and changes in body mass index (BMI), as well as parameters of diabetes and dyslipidemia. Quality of life was assessed using the Short Form (SF)-36 and the Impact of Weight on Quality of Life-Lite questionnaires.ResultsThe reoperation rate due to a serious adverse event in this population at 5 years after implantation with the REALIZE gastric band was 8.9%. The most common serious adverse event was band slippage, which affected 6.9% of the study population. The mean %EWL was 35.6% ± 26.84%, and the decrease in mean BMI was −7.01 ± 5.45 kg/m2 at 5 years. Patients experienced improvements in mean glycated hemoglobin and serum lipid levels, in addition to improvements in the quality of life measures.ConclusionNo new safety concerns were identified during the 5 years of follow-up. Although the results of this study did not meet the predefined safety criteria of 8% or less, the safety profile and long-term effectiveness observed in this study are consistent with those in the current literature.

Nonvisualized palpable bowel endometriotic satellites.

STUDY QUESTIONWhat is the prevalence of laparoscopically nonvisualized palpable satellite bowel nodules at or near the planned stapler site in women undergoing segmental bowel resection for endometriosis?SUMMARY ANSWEROverall, 13 (25.5%) of 51 patients who underwent resection had nonvisualized palpable satellite lesions as small as 2 mm, including seven (14%) who had nonvisualized palpable lesions at or beyond the planned stapler site.WHAT IS KNOWN ALREADYBoth laparoscopy and laparotomy for bowel resection are standard of care in Europe and the USA. Reoperation rates after laparoscopic bowel procedures are 1–16%. Endometriotic lesions at the stapler margin of bowel resections are associated with increased repeat surgery. Nodules of 0.1 mm to 1 cm in size were not recognized during laparoscopic bowel surgery but were recognized on histological examination. Up to 20 nodules not visualized at laparoscopy have been recognized and excised at laparotomy. Tenderness is found at up to 27 mm from a recognized lesion. The size of a lesion does not always predict its symptoms or behavior.STUDY DESIGN, SIZE, DURATIONThis single-arm, observational study focused on the presence of nonvisualized palpable satellite lesions of the bowel. Fifty-one patients scheduled for laparoscopic-assisted bowel resection for deep infiltrating endometriosis with suprapubic incision for placement of the stapler’s anvil and removal of the specimen in the course of routine clinical care were included. There were no additional inclusion or exclusion criteria.PARTICIPANTS/MATERIALS, SETTING, METHODSLaparoscopic-assisted segmental bowel resection for endometriosis was performed in a private referral center on women aged 24–49 years.MAIN RESULTS AND THE ROLE OF CHANCEForty-nine (96.1%) of the 51 patients underwent segmental resection of the sigmoid or rectum, and 14 (27.5%) underwent segmental resection of the ileum for large nodule(s) recognized on MRI. Twelve patients underwent both procedures. Eleven (22.4%) of the 49 patients with recognized sigmoid or rectal lesions and 5 (35.7%) of the 14 patients with recognized ileal lesions had nonvisualized, palpable, satellite lesions. All the large lesions and none of the satellite lesions had been recognized preoperatively on MRI. Five (10%) of 49 patients with lesions of the large bowel and 4 (28.6%) of the 14 patients with lesions of the ileum had nonvisualized palpable satellite lesions at or beyond the planned stapler site. Lesions as small as 2 mm were palpable.LIMITATIONS, REASONS FOR CAUTIONThis is an observational study. It is not known if the small lesions of this study contributed to the symptoms or were progressive, stable or regressive. This study analyzed lesions in the bowel segment proximal to the primary large bowel lesion, but not in the distal segment as that would have required a change in standard of care surgical technique. This study protocol did not include shaving or disk resection or patients in whom no lesions were visualized. The use of additional techniques for recognition, such as hand-assisted laparoscopy or rectal probes, was not investigated.WIDER IMPLICATIONS OF THE FINDINGSThis study confirms that some nonvisualized satellite lesions as small as 2 mm are palpable and that an increased length of resection can be used to remove lesions recognized by palpation and to avoid lesions at and beyond the stapler site. This may decrease recurrent surgery in 1–16% of the women undergoing surgery for bowel endometriosis. Knowledge of the occurrence of these small lesions may also be particularly useful in plans for repeat surgery or for women with clinically significant bowel symptoms and no visible lesions at laparoscopy. Moreover, small lesions are considered to be important as there is no current technique to determine whether a large primary lesion, smaller lesions, an associated adjacent tissue reaction or a combination of those cause symptoms.STUDY FUNDING/COMPETING INTEREST(S)This CIRENDO cohort was supported by the G4 Group (the University Hospitals of Rouen, Lille, Amiens and Caen) and the ROUENDOMETRIOSE association. No specific funding was received for the study. H.R. reports receiving personal fees from Plasma Surgical Inc., Ethicon Endosurgery, Olympus and Nordic Pharma for presentations related to his experience with endometriosis surgery. D.C.M. reports being given access to Lumenis Surgical CO2 Lasers’ lab at a meeting. None of the other authors have conflicts of interest to disclose.TRIAL REGISTRATION NUMBERN/A

Risk of Infection Associated With Administration of Intravenous Iron: A Systematic Review and Meta-Analysis

Background: Intravenous iron is increasingly being used in clinical practice to treat iron deficiency and anaemia. However, its effect on important safety outcomes, such as infection, remains uncertain. We systematically reviewed the risk of infection associated with administration of intravenous iron when compared with oral iron or no iron. Methods: We searched for MEDLINE, EMBASE, CENTRAL and the Transfusion Evidence Library from 1966 to Jan 5, 2021 randomised controlled trials (RCTs) comparing intravenous iron with oral iron or no iron across all patient populations. Two reviewers independently extracted data, assessed risk of bias and graded the certainty of the evidence. A narrative synthesis was performed to characterize the reporting of infection. The primary outcome was risk of developing an infection. Data synthesis: A total of 154 RCTs (32,920 participants) were included in the main analysis. Intravenous iron was associated with an increased risk of infection (Risk Ratio [RR] 1·17, 95% CI 1·04-1.31, I2=37%, moderate certainty) when compared with oral iron or no iron. Intravenous iron was associated with higher haemoglobin concentrations (Mean Difference 0·57 g/dL, 95% CI 0·50-0·64, I2=94%,) and a reduction in the risk of requiring a red blood cell transfusion (RR 0·93, 95% CI 0·76-0·89, I2=15%) when compared with oral iron or no iron. There was no evidence of an effect on mortality or hospital length of stay. Conclusions: Intravenous iron administration is associated with an increased risk of infection. There was considerable variation in infection reporting between the included studies which may limit our understanding of the true nature and extent of this risk. Healthcare providers should recognise that the benefits of treating anaemia and reducing transfusion requirements may need to be balanced against the risk of developing infection. Well-designed studies, using standardized definitions of infection, are required. Registration Details: This study is registered with PROSPERO (CRD2018096023). Funding Information: NIHR Doctoral Research Fellowship (NIHR-DRF-2017-10-094). Declaration of Interests: AS (Shah) is currently supported by a National Institute for Health Research Doctoral Research Fellowship (NIHR-DRF-2017-10-094). Outside of this work, Prof Acheson’s research department has received grant support from Syner-Med (UK), Vifor Pharma (Switzerland) and Pharmacosmos A/S (Denmark). He has received honoraria and travel support for consulting or lecturing from Ethicon Endosurgery (UK), Johnson and Johnson Ltd (UK), Olympus (UK) and Vifor Pharma (Switzerland). All other authors have nothing to declare.

Knee osteoarthritis outcomes in patients with severe obesity following bariatric surgery or total knee arthroplasty: the swift trial

Purpose: High body mass index (BMI, kg/m2) is a modifiable risk factor that has been associated with the development and progression of osteoarthritis (OA) and knee pain. The gold standard for the treatment of end stage knee OA remains total knee arthroplasty (TKA), though patients with morbid obesity (BMI≥40 kg/m2) are increasingly required to lose weight prior to TKA due to increased surgical risk and a higher rate of complications. Conservative weight-loss approaches often fail to help patients lose the recommended weight prior to TKA, potentially making them ineligible for surgery. Recent studies have shown that patients who undergo bariatric surgery experience short-term improvements in knee functionality and decreased pain, either obviating the need for arthroplasty - or at least improving the success of subsequent total knee replacements. Here we present interim data from the trial entitled “Surgical Weight-loss to Improve Functional Status Trajectories following arthroplasty for painful knee osteoarthritis”. This current multi-center, prospective study compares pain and functional outcomes in patients receiving bariatric surgery prior to TKA versus obese patients who go straight to TKA. Methods: We recruited patients with BMI ≥40 kg/m2 and painful knee OA who met the indications for TKA from the bariatrics, orthopedics and rheumatology clinics at the four hospital centers. Patients with a BMI >35 kg/m2 were also recruited if they had a qualifying comorbid condition including obstructive sleep apnea, diabetes, hypertension or hyperlipidemia. Patients were assigned to the bariatric (BAR) or TKA (TKA) arms based on surgical choice (goal n=150 for each arm), with all bariatric patients having anatomy-altering sleeve gastrectomy or gastric bypass, and not laparoscopic gastric banding. At baseline and several time points after surgery (see figure), we documented height, weight, the Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog pain (VAS) scales, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and had patients perform functional assessments (Timed-Up and Go, 30-second Chair Stand and 40-meter fast paced walk test). We targeted minimum detectable change (MDC) in outcomes for the VAS for knee pain (33% reduction), Timed Up and Go (decrease by 2 seconds), 30-second Chair Stand (increase by 2 reps), 40-meter fast paced walk (increase by 0.16 m/s), WOMAC score (16% reduction), and the KOOS pain score (10-point improvement). Using a logistic regression to adjust for age and baseline BMI, we compared the percentage of patients in the two arms who achieve an MDC for the various outcomes. Results: For the current analysis, 20 bariatric surgery patients and 22 TKA patients completed their 6-month follow-up visits. Each subcohort had a similar sex distribution (15% vs 14%, p=0.999) but the bariatric group was younger (53 vs 61 years old, p=0.0045) and had a higher baseline BMI (47.1 vs 40.9, p=0.0009). Many bariatric patients achieved significant improvement in knee pain and function as evidenced by the MDC in the various tests, though the percent with MDC consistently tended to be higher in the TKA cohort. These MDC benchmarks included the 30-second Chair Stand (TKA 60% vs BAR 29%, p=0.085), KOOS pain score (TKA 89% vs BAR 65%, p=0.130), the Visual Analog Pain Scale (TKA 50% vs BAR 34%, p=0.390), Timed Up and Go (TKA 45% vs BAR 21%, p=0.205), the 40-meter fast paced walk (TKA 61% vs BAR 42%, p=0.319), and the WOMAC (TKA 81% vs BAR 59%, p=0.225). Many of the bariatric patients have had subsequent arthroplasty, but not enough time has passed to report levels of improvement. Conclusions: In morbidly obese patients who are eligible for TKA, bariatric surgery may result in modest improvements in knee pain and function when compared to TKA at 6 months post operatively. In addition to potentially altering the need for and timing of TKA, surgical weight loss may result in improved TKA outcomes. This study was supported by the Investigator Initiated Study Program of Ethicon-Endo Surgery, Inc. (Grant Number: 14-621).

Comparison of the short-term outcomes of using DST and PPH staplers in the treatment of grade III and IV hemorrhoids

Stapled hemorrhoidopexy has a few advantages such as less postoperative pain and faster recovery compared with conventional hemorrhoidectomy. There are two major devices used for stapled hemorrhoidopexy, PPH stapler (Ethicon EndoSurgery) and DST stapler (Covidien). This study was conducted to investigate the postoperative outcomes among patients with grade III and IV hemorrhoids who underwent hemorrhoidopexy with either of these two devices. A total of 242 consecutive patients underwent stapled hemorrhoidopexy with either PPH stapler (110 patients) or DST stapler (132 patients) at a single center in 2017. We performed a retrospective case–control study to compare the short-term postoperative outcomes and the complications between these two groups. After matching the cases in terms of age, gender, and the grade of hemorrhoids, there were 100 patients in each group (PPH versus DST). There were no significant differences in the postoperative visual analog scale (VAS) score and analgesic usage. Among complications, the incidence of anorectal stricture was significantly higher in the DST group (p = 0.02). Evaluation of the mucosal specimen showed that the total surface area, the muscle/mucosa ratio and the surface area of the muscle were also significantly higher in the DST group (p = 0.03). Further analysis of the DST group demonstrated that patients with anorectal stricture after surgery are younger than patients without anorectal stricture, and higher muscle/mucosa ratio (p = 0.03) and a higher surface area of the muscle (p = 0.03) also measured in the surgical specimen. The two devices provide similar outcomes of postoperative recovery. Patients who underwent DST stapled hemorrhoidopexy had a higher incidence rate of stricture, larger area of muscle excision, and higher muscle/mucosa ratio in the surgical specimen. Further investigation is warranted for a better understanding of the correlation between muscle excision and anorectal stricture.

O212 IVOR LEWIS ESOPHAGECTOMY AFTER SLEEVE GASTRECTOMY: THE USE OF GASTRIC CONDUIT IS STILL POSSIBLE

O212 IVOR LEWIS ESOPHAGECTOMY AFTER SLEEVE GASTRECTOMY: THE USE OF GASTRIC CONDUIT IS STILL POSSIBLE

Anesthesia-related Safety Profile of a High-energy Ultrasonic Scalpel in Oropharyngeal and Laryngeal Surgery: An Ex Vivo Model.

IntroductionThe aim of this study was to evaluate the fire risks associated with a harmonic scalpel, with an established avian model simulating oropharyngeal/laryngeal surgery. MethodsA standard polyvinyl-chloride (PVC) endotracheal tube (ETT) was inserted into a degutted, whole raw chicken through which 100% oxygen was piped at 10 L/min. The inflated cuff of the tube was grasped and sectioned with the jaws of a standard high-power ultrasonic dissection system Ultracision (Ethicon Endosurgery, Cincinnati, Ohio, USA). Then, the whole ETT was grasped and cut, leaving the device in contact with the ETT for two more minutes. In a second step under the same conditions, an electrosurgical device was placed into the chicken cavity and activated at the chicken tissue near the ETT at a setting of 20 W. All trials were repeated to ensure accuracy.ResultsNo ignition could be produced with the harmonic scalpel under any operation mode settings. In all cases, the ETT was cut through with some fumes and brown discoloration at the site of contact. The electrosurgical device easily caused flash ignition within seconds.ConclusionThe harmonic scalpel appears to be a safer tool than electrosurgical devices in the setting of open cavity surgery in oxygen-enriched environments with respect to the presence of flammable medical PVC devices as ETT or catheters.

Prosthetic Valve Removal Technique Using Ultrasonic Scalpel

Prosthetic valve removal for reoperative valve replacement is time consuming and has a risk of damage to the heart because of severe adhesions. Prosthetic valves can be removed quickly, easily, and safely by using an ultrasonic scalpel (Harmonic Scalpel, Ethicon Endo-Surgery, Cincinnati, OH). The space between the prosthesis and the native annulus was carefully dissected using Harmonic Synergy blades connected to an Ethicon Gen11 Generator at energy level 5. The average time for prosthetic valve removal using an ultrasonic scalpel was 6 minutes 11 seconds. No patient required new permanent pacemaker implantation.

Spinal dural closure without suture: Minimizing the risk of CSF leakage with a flat non-penetrating titanium U-clip

BackgroundThe classic surgical spinal dural closure technique in surgery on intradural lesions is performed with continuous suture or loose stitches using 4-0 to 6-0 polypropylene monofilament or nylon suture. Dural closure with suture causes irritant damage to the dural/arachnoid interface. The penetrating suture causes new dural holes. Even the needle of the suture can cause harm to the patient and the surgeon. For these reasons, other non-penetrating techniques for dural closure have been sought. ObjectiveThe purpose of this review was to show the efficacy of using the titanium clip (U-clip) (Ligaclip-MCA of Ethicon Endo-Surgery, LLC, Medical GmbH, Norderstedt, Germany) with a flat internal surface in spinal neurosurgical procedures, and to evaluate the effects of its use on post-operative magnetic resonance imaging (MRI). MethodsWe performed a retrospective analysis of a cohort of 50 consecutive patients who underwent intradural spinal surgeries for intradural spinal lesions in the neurosurgery department of our institution between 2013 and 2018. ResultsThe mean follow-up period was 27 months. No patient developed a post-operative cerebrospinal fluid (CSF) dural-cutaneous fistula. CSF leakage was not observed in the control MRIs at 6 weeks. ConclusionsWe describe, for the first time, the use of this type of U-clip with a flat inner side. The non-penetrating titanium U-clip facilitates effective and rapid dural closure at all spinal levels due to its flat internal face when closed. The U-clips did not cause significant artefacts or distortions on the magnetic resonance imaging.

Spinal dural closure without suture: Minimizing the risk of CSF leakage with a flat non-penetrating titanium U-clip.

The classic surgical spinal dural closure technique in surgery on intradural lesions is performed with continuous suture or loose stitches using 4-0 to 6-0 polypropylene monofilament or nylon suture. Dural closure with suture causes irritant damage to the dural/arachnoid interface. The penetrating suture causes new dural holes. Even the needle of the suture can cause harm to the patient and the surgeon. For these reasons, other non-penetrating techniques for dural closure have been sought. The purpose of this review was to show the efficacy of using the titanium clip (U-clip) (Ligaclip-MCA of Ethicon Endo-Surgery, LLC, Medical GmbH, Norderstedt, Germany) with a flat internal surface in spinal neurosurgical procedures, and to evaluate the effects of its use on post-operative magnetic resonance imaging (MRI). We performed a retrospective analysis of a cohort of 50 consecutive patients who underwent intradural spinal surgeries for intradural spinal lesions in the neurosurgery department of our institution between 2013 and 2018. The mean follow-up period was 27 months. No patient developed a post-operative cerebrospinal fluid (CSF) dural-cutaneous fistula. CSF leakage was not observed in the control MRIs at 6 weeks. We describe, for the first time, the use of this type of U-clip with a flat inner side. The non-penetrating titanium U-clip facilitates effective and rapid dural closure at all spinal levels due to its flat internal face when closed. The U-clips did not cause significant artefacts or distortions on the magnetic resonance imaging.