Hemostatic Tool Research Articles

Formulation and Evaluation of Haemocoagulase Gel for Dental Pulp- an In-vitro study.

This study aims to develop a novel hemostatic gel of hemocoagulase, a snake venom-derived serine protease enzyme, by incorporating it into the matrix of bioadhesive polymers to prevent damage due to hemorrhage. Haemocoagulase was combined with polymers Carbopol 940 and HPMC K 100, and these formulations were evaluated for physical properties, efficacy, safety and stability. Batches F3 and F6 were selected for further studies on animal models, which were found to be safe without any skin irritation effect and effective as hemostats with blood clotting times of 1.24 ± 0.007 min and 1.36 ± 0.014 min, respectively, in a rat liver incision model. From this study, it can be suggested that the combination of hemocoagulase with bioadhesive polymer can provide a novel hemostatic tool for controlling bleeding.

The Use of Bone Wax in Hemostatic Control for Total Knee and Hip Arthroplasties: A Systematic Review.

Background/Objectives: Blood loss can be a serious complication in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Various methods are used by surgeons to achieve hemostatic control in these patients. Complications are associated with perioperative blood loss. In this systematic review, we examined the efficacy of using bone wax to control bleeding in patients undergoing THA and TKA. Methods: The PRISMA model was used to systematically identify and aggregate articles for this study. The PubMed and EMBASE databases were used to search individual studies that examined the use of bone wax in THA or TKA. After applying the search term "bone wax", 2478 articles were initially identified. After inclusion and exclusion criteria were applied, three articles were aggregated for this systematic review. Results: The use of bone wax in THA and TKA decreased blood loss in patients undergoing these operations. Postoperative blood loss following surgery was lower in the bone wax groups compared to the control groups as well. Patients in the bone wax groups also required fewer blood transfusions than those who did not receive bone wax. Conclusions: Bone wax appears to be another modality that can be used by physicians to maintain hemostatic control in THA or TKA patients. Reduced blood loss and transfusion rates in surgery can increase patient outcomes. More studies are needed to examine the efficacy of bone wax in comparison with other hemostatic tools.

HARMONIC SCALPEL COMPARED TO BIPOLAR COAGULATION FOR THYROIDECTOMY

Introduction. The basic principles of high-efficient and safe thyroid surgery were established by 1920: identification and ligation of vessels, identification and preservation of laryngeal nerves, and parathyroid glands. Bleeding remains one of the major intraoperative complications of thyroid surgery.
 The aim of this study is to evaluate the benefits of the Harmonic when compared with bipolar coagulation for open thyroidectomy.
 Materials and methods: We enrolled 85 patients who underwent total thyroidectomy for multinodular disease from 2019 till 2022 years. Patients were randomly assigned to either the group 1 (43 patients in which the operation was performed entirely using the Harmonic scalpel (HS) and no other haemostatic tool) or the group 2 (42 patients in which the operation was performed using classic technique of resorbable ligature, bipolar coagulation). The inclusion criteria were scheduled total thyroidectomy for multinodular goiter.
 Results. There were no significant differences between two groups regarding age, gender, ASA distribution, so two groups are comparable. The mean operating time in the group 1 was 62.84±0.66 (M±m) minutes, and that in the group 2 was 75.19±0.42 (M±m) minutes for thyroidectomy, and there was 19.65% (i.e. 12.35 minutes) statistically significant reduction in the operating time using the Harmonic scalpel device (p<0.05). The 48 hours mean total amount of drainage was 69.05±0.88 (M±m) ml for group 1 and 81.40±0.64 (M±m) ml for group 2, which was statistically significant (p<0.05). The rate of postoperative complications was comparable among the two groups (pχ2>0,05).
 Conclusions. The use of Harmonic scalpel in thyroid surgery is safe and effective and is associated with a significant reduction in operative time without increasing complications rate, may also permit a better view of structures to preserve nerves, vessels of parathyroid glands and parathyroid glands when operating. Other benefits include significantly lower blood loss, efficient hemostasis and sectioning in a single instrument.

Clinical Benefits of LigaSure™ for Surgical Amputation Without Tourniquet Use in Patients With Musculoskeletal Tumor.

Amputation is still a viable option for musculoskeletal tumors that are multi-compartmental, adjacent to neurovascular structures, and involving pathological fractures. Complications such as poor surgical margins, local recurrence and infection after limb salvage surgery are also indications for secondary amputation. An effective hemostatic technique is vital for preventing complications of massive blood loss and prolonged operative time. The use of LigaSure™ in the field of musculoskeletal oncology has not been well documented. This retrospective study included 27 patients with musculoskeletal tumor who underwent amputation using either LigaSure™ system (n=12) or traditional hemostatic technique (n=15) from 1999 to 2020. The purpose of this study was to evaluate the effect of LigaSure™ in terms of intra-operative blood loss, blood transfusion rates, and duration of surgery. The use of LigaSure™ resulted in a significant decrease in intraoperative blood loss (p=0.027) and blood transfusion rates (p=0.020). There was no significant difference for the duration of surgery between the two groups (p=0.634). The LigaSure™ system can potentially improve clinical outcomes in patients with musculoskeletal tumor undergoing amputation surgeries. The LigaSure™ system is a safe and effective hemostatic tool for musculoskeletal tumor amputation surgeries.

S2515 Chicken Bone Causing Gastric Perforation With Liver Penetration: Successfully Managed With Endoscopic Removal and Clipping

Introduction: Perforation of gastric wall by a chicken bone has rarely been reported. Most foreign bodies (FB) pass through the gastrointestinal tract uneventfully within one week. However, we report a case of chicken bone-induced gastric perforation managed by endoscopic retrieval and closure with clips. Case Description/Methods: A 70-year-old-man presented with sharp epigastric abdominal pain with nausea and vomiting 4 hours after eating chicken wings. He was hemodynamically stable. The abdomen was soft and non-tender, with normoactive bowel sounds on examination. CT scan revealed a small pneumoperitoneum in the upper abdomen and a 3.4 cm linear radiopaque density within the lumen of the gastric antrum and partially outside directed posteriorly, abutting the left hepatic lobe. An EGD revealed a 3.5 cm long, narrow bone with a hollow center protruding through the antral wall along the lesser curvature. One endoclip was placed adjacent to the FB for easier identification of the location of the perforation. The FB was then extracted from the wall with rat tooth forceps. The gastric wall defect was then closed with 6 endoclips in a zipper-like fashion. Finally, the FB was retrieved with rat tooth forceps by allowing the sharp end to trail with the withdrawal of the gastroscope. Post-procedure, the patient was started on a clear liquid diet 48 hours later, which he tolerated well, and was discharged on post-procedure day 4 (Figure). Discussion: Accidental foreign body (FB) ingestion is common. Most ingested FB pass spontaneously, with only 10%-20% requiring non-operative intervention. Serious complications include impaction or perforation. A foreign body that perforates the bowel wall may have a wide spectrum of clinical manifestations, from acute generalized peritonitis to chronic abscess formation. Patients with foreign bodies in the stomach, duodenum, and large intestine rarely have perforation due to thick walls and may have delayed presentation. We report the second case of endoscopic retrieval of a chicken bone causing gastric perforation managed endoscopically. Endoclips are often used as a hemostatic tool or to close endoscopic mucosal resection sites. Endoscopic intervention is more likely to be successful in cases of FB ingestion in the absence of peritonitis. In this case, the endoscopic removal of FB resulted in successful non-surgical management of gastric perforation. Placement of initial endoclip prior to bone removal allowed successful closure despite loss of gas after FB removal.Figure 1.: A-Upper Endoscopy shows a sharp hollow chicken bone in gastric antrum. B-Upper Endoscopy showing removal of chicken bone followed by endoscopic clipping. C- CT Abdomen/Pelvis without contrast shows a foreign body perforating the gastric wall and penetrating the liver.

Efficacy and safety of prophylactic Bakri balloon tamponade after vaginal delivery in women with low-lying placenta: a retrospective cohort study.

BackgroundLow-lying placenta is a special form of placenta previa and a major cause of postpartum hemorrhage (PPH). As an important hemostatic tool, the Bakri balloon is widely used in the prevention and treatment of PPH caused by placenta previa. Few studies have paid attention to the effect of Bakri balloon after vaginal delivery in women with low-lying placenta. The aim of this study is to evaluate the efficacy and safety of prophylactic Bakri balloon tamponade (BBT) after vaginal delivery in women with low-lying placenta based on a retrospective cohort study.MethodsSingleton pregnant women with low-lying placenta who had vaginal deliveries at our hospital between January 2015 to December 2020 were enrolled. Women who received prophylactic balloon tamponade immediately after vaginal delivery were defined as the BBT group, while women who underwent routine procedures after vaginal delivery except immediate balloon tamponade were defined as the non-BBT group. The maternal clinical characteristics and outcomes of the two groups were collected and analyzed retrospectively.ResultsA total of 118 women with low-lying placenta were included in the study, with 47 in the BBT group and 71 in the non-BBT group. The postpartum bleeding amount was 339.19±102.94 mL at 2 hours and 418.11±90.73 mL at 24 hours in the BBT group, while in the non-BBT group the postpartum bleeding amount was 421.55±106.37 mL at 2 hours and 505.11±94.51 mL at 24 hours, with significant differences between the two groups (P<0.05). However, there were no significant differences in the postpartum length of hospital stay (P=0.085) and the incidence of puerperal infection (P=0.244) between the two groups.ConclusionsRoutine use of prophylactic BBT after vaginal delivery can significantly reduce the postpartum bleeding amount in women with low-lying placenta and does not increase the incidence of puerperal infection and the postpartum length of hospital stay.

COMPARISON BETWEEN POSTOPERATIVE DRAIN OUTPUT AFTER THYROIDECTOMY WITH AND WITHOUT USE OF HARMONIC SCALPEL DEVICE

Abstract:&#x0D; Introduction: Thyroid gland is one of the most important endocrine organs in human body performing multiple functions to maintain homeostasis. Thyroid nodular disease is a frequently encountering problem in surgical OPD that could be malignant or benign. It is more common in females than in males and is expecting that after a decade or so, it will be the 2nd most common malignancy in women. Ultrasound guided fine-needle aspiration (FNA) and core needle biopsy (CNB) are two modalities use to diagnose thyroid swelling preoperatively. Multiple techniques are used to manage thyroid swellings, depending on type and size of thyroid enlargement. Total thyroidectomy, radical and subtotal thyroidectomies are few examples. As thyroid has rich blood supply, ensuring early hemostasis is of vital importance as it directly affects duration of operation as well as visibility of surgical site and intra operative bleeding. Newer techniques include use of harmonic scalpel device that can seal and dissect blood vessels simultaneously by coagulating proteins present in blood vessels, decreasing duration of operation and better hemostasis.&#x0D; Objective: This study was done to evaluate the operative duration, post-operative complications and drain output after thyroidectomy with and without use of harmonic scalpel device. &#x0D; Material and Methods: Randomized controlled trial was conducted at Surgical Unit 3 of Lahore General Hospital between July 2018 and June 2019. Written informed consent was acquired from all of the patients. All participants underwent near total or total thyroidectomy and were euthyroid at the time of surgery. All participants were randomly allocated to one of the two study groups using lottery method. All the data was collected using preformed questionnaire and was evaluated through SPSS v 25.&#x0D; Inclusion criteria: Age group of 20–70 years and American Society of Anesthesiologists (ASA) physical status I–II.&#x0D; Exclusion criteria: Morbidities (e.g., coagulopathy, diabetes, hypertension, ischemic heart disease).&#x0D; Results: Out of 50 patients 35 patients were female with mean age group of 47±4.8 years. 25 participants were enrolled in group in which Harmonic Scalpel device was used while 25 patients underwent conventional method. Mean duration of thyroidectomy from skin incision to skin closure in group with use of harmonic scalpel was 104.19±13.67 minutes while in conventional group it was 128.62 ± 11.76 minutes. Mean output of fluid/blood in drain post operatively in group treated with harmonic scalpel was 48.82±16.56 while in conventional group, post-operative drain output was 89.45±23.21ml.&#x0D; Conclusion: Harmonic device is both useful and widely used hemostatic tool in thyroid gland surgery. This device is safe and more compelling than the conventional monopolar diathermy.

Transoral Robot-Assisted Surgery in Supraglottic and Oropharyngeal Squamous Cell Carcinoma: Laser Versus Monopolar Electrocautery.

Background: Monopolar electrocautery (EC) is the surgical cutting and haemostatic tool most commonly used for transoral robotic surgery (TORS). The aim of this study was to retrospectively compare EC efficacy in the treatment of patients affected by T1 or T2 oropharyngeal and supraglottic squamous cell carcinomas with the more recently introduced laser fibres. Methods: We considered all TORS patients admitted to our department from January 2010 to June 2019. The outcomes of patients treated with Thulium: yttrium aluminium garnet (YAG) laser (TY-TORS), CO2 laser (CO2-TORS) and EC (EC-TORS) were analysed in order to assess surgical performances, functional outcomes and postoperative complications. Results: Twenty patients satisfied the enrolling criteria, of which nine underwent laser-TORS, and the remaining 11 underwent EC-TORS. In all candidates, TORS procedures were completed without the need for microscopic/open conversion. Close or positive margins were significantly more frequent in EC-TORS (p = 0.028). A considerable difference was found in overall functional parameters: times of nasogastric tube and tracheostomy removal and time of hospital discharge were significantly shorter in laser-TORS (p = 0.04, p = 0.05, p = 0.04, respectively). Conclusions: Laser-TORS showed better results in comparison with EC-TORS in term of tumour resection margins and patient functional outcomes. Our findings can be justified with the greater tissue thermal damage caused by EC-TORS, despite prospective randomized trials and increased patient numbers being needed to confirm these preliminary conclusions.

Endoscopic Hemostasis for Non-Variceal Upper Gastrointestinal Bleeding: New Frontiers.

Non-variceal upper gastrointestinal bleeding (NVUGIB) refers to blood loss from the gastrointestinal tract proximal to the ligament of Treitz due to lesions that are non-variceal in origin. The distinction of the bleeding source as non-variceal is important in numerous aspects, but none more so than endoscopic approaches for successful hemostasis. When a patient presents with acute overt blood loss, NVUGIB is a medical emergency, which requires immediate intervention. There have been major strides in pharmacologic and endoscopic interventions for successful induction and remission of hemostasis in the last two decades. Despite achieving tangible improvements, the burden of the disease and the consequent mortality remain high. To address endoscopic outcomes better, several new technologies have emerged and have been subsequently incorporated to the armamentarium of hemostatic tools. This study aims to provide a succinct review on novel technologies for endoscopic hemostasis.

Blood loss mitigation and replacement in facial surgery: a review.

To provide a comprehensive overview of the predisposing factors that contribute to a risk of excess bleeding for surgical therapy in the head and neck regions, provide a thorough overview of techniques and tools for managing blood loss complications, and provide intervention algorithms to help guide clinical decision making. With the current landscape of medications and reversal agents, protocols for intervention in a variety of situations, and new tools for blood loss management all rapidly changing and being developed it is critical to stay up to date to provide patients the best care in the most critical of situations. With the risk of blood loss complications in head and neck surgery ranging from minimal to extreme surgeons require a comprehensive understanding risk factors, patient evaluation tools, and proper management algorithms. The first opportunity to prevent unnecessary blood loss and blood loss complications is the health history and physical appointment where a clinician can identify any medications, conditions, or other predisposing factors that would elevate a patient's risk of excess bleeding and the necessity for treatment augmentation. Although not all complications can be prevented because of the natural physiological variation that occurs from patient to patient, despite proper and proper diagnostics, a full working knowledge of most likely complications, hemostatic tools, and concise communication with team members can prevent a lot of blood loss and the complications associated.

Emergency Cholecystectomy for Patients on Antiplatelet Therapy

The use of antiplatelet therapy (APT) and/or anticoagulant therapy (ACT) continues to increase due to the aging population. Because the management of patients with acute cholecystitis receiving APT/ACT is still unclear, surgeons are sometimes faced with the difficult decision to delay surgery. We aimed to analyze characteristics and surgical risks of patients who underwent emergency cholecystectomy for acute cholecystitis without discontinuing APT. We conducted a retrospective review of 113 patients between 2006 and 2014. Treatment outcomes among 13 patients who underwent cholecystectomy without discontinuing APT (the cAPT group), 11 patients who discontinued APT and ACT (the D group), and 89 patients who did not receive preoperative APT and/or ACT (the No APT group) were compared. There were no significant differences in intraoperative blood loss, conversion to open surgery, and bleeding-related complications. However, the incidence of intraoperative blood transfusion was higher in the cAPT group (P = 0.04). They presented with severe local inflammation; thus, it was difficult to stop bleeding from the gallbladder bed. Hemostatic tools for liver surgery were used to control bleeding. Emergency cholecystectomy was tolerable for patients with acute cholecystitis while continuing APT. However, in case of severe local inflammation, there is a greater risk for massive hemorrhage.

Sutureless thyroidectomy for controlled toxic goiter: a single-institute experience

Background Total thyroidectomy for controlled toxic goiter is usually associated with more bleeding because of high vascularity of the toxic gland. Several new instruments were developed as hemostatic tools (harmonic scalpel; LigaSure) during total thyroidectomy as an alternative to conventional hemostatic methods. This study aimed to compare the use of Harmonic Focus Scalpel to conventional hemostatic technique (classic suture ligation with standard bipolar diathermy forceps) in patients with controlled toxic goiter undergoing total thyroidectomy regarding operative time, intraoperative complications, postoperative complications, postoperative hospital stay, and return to normal daily activities. Patients and methods The present study included 50 patients with a diagnosis of controlled toxic goiter who underwent total thyroidectomy at the Department of Surgery, Medical Research Institute Hospital, Alexandria University. Candidates were randomized into two groups: group A, in which patients underwent total thyroidectomy using Harmonic Focus Scalpel, and group B, in which patients underwent total thyroidectomy using classic suture ligation and standard reusable bipolar diathermy. Results There was no significant difference between both groups regarding preoperative data (age, sex, comorbidities, and type of thyrotoxicosis). The operative time was significantly shorter in group A patients compared with group B patients (P Conclusion Harmonic Focus Scalpel can be used safely and effectively as a hemostatic tool instead of conventional hemostatic techniques in total thyroidectomy for controlled toxic goiter.

EP25.01: Foley balloon versus uterine artery embolisation (UAE) as hemostatic tool in the treatment of Caesarean scar pregnancy (CSP)

EP25.01: Foley balloon versus uterine artery embolisation (<scp>UAE</scp>) as hemostatic tool in the treatment of Caesarean scar pregnancy (<scp>CSP</scp>)

Intravesical Hemostatic Clip Migration After Robotic Prostatectomy: Case Series and Review of the Literature

The Weck Hem-o-lok™ Ligating clip is a routinely used hemostatic tool in robotic and laparoscopic surgery. It has been the practice in our institution to use such clips for hemostasis of the vascular bundles during robotic prostatectomy. Migration of such clips has been reported in the literature as single case reports. In this study, we present a case series of intravesical Weck clip extrusions presenting as bladder calculi. Such events have led to a change in our practice, and more research is needed to assess the impact of this change. A retrospective chart review was conducted over the period 2006-2011. Patients included in the study required cystoscopic intervention for removal of encrusted or impacted Weck clips. Primary data points included type of intervention required, time to presentation, and number of presentations. Postoperative anastomotic leak, duration of postoperative hospital stay, and initial operative time were also investigated. Out of 570 total men undergoing robotic-assisted laparoscopic radical prostatectomy (RALRP), eight required return to the operating room for clip extraction (1.4%). Extraction methods included laser lithotripsy, blunt litholapaxy, and grasper extraction. Men experiencing clip migration were hospitalized for a longer period of time (7.6 days vs. 2.1 days, P < .01) and they required more blood transfusions (1.4 units vs. 0.05 units, P < .01) than men who did not experience clip migration. The most common site for clip intrusion was the bladder neck. Average time to presentation was 1.75 years. Weck clip migration is a recognized complication of robotic-assisted radical prostatectomy. Men with recurrent urinary tract infection, bothersome voiding symptoms, or hematuria following RALRP should be considered for cystoscopic evaluation. Increased length of hospital stays and the need for a larger volume blood transfusion following prostatectomy were significant predictors of clip migration. More research is needed to determine if implemented changes to our surgical technique have mitigated these risks.

A new approach to supracervical hysterectomy during laparoscopic sacral colpopexy for pelvic organ prolapse: A randomized clinical trial.

Laparoscopic sacral colpopexy (LSC) for pelvic prolapse is a complex procedure, characterized by long operative times and, when combined with supracervical hysterectomy, by a high risk of spreading of unsuspected cancerous tissue. The aim of the present study was to compare, in patients who underwent hysterectomy plus LSC for severe POP, different methods for cervical incision and uterine morcellation. This is a prospective single Institution randomized double-blinded clinical trial enrolling 124 patients with severe POP from June 2014 to May 2015. Patients underwent laparoscopic supracervical hysterectomy (LSH) plus LSC for pelvic organ prolapse and were randomized in Group 1 (monopolar hook and conventional mechanical morcellator) and Group 2 (bipolar laparoscopic loop and bipolar morcellator), for supracervical incision and uterine morcellation, respectively. Our primary endpoints were the operative times and the secondary endpoints the incidence of intra- or post-operative complications. A total of 50 patients for group completed the study. Baseline characteristics were similar between the groups. Cervical cutting time (32 vs. 3.10 sec; P <0.01), morcellation (4.10 vs. 2.13 min; P <0.01) and operative time (131 vs. 118 min; P <0.05) resulted significantly lower in Group 2. No differences were found in terms of intra- or post-operative complications. Laparoscopic bipolar loop and morcellator guaranteed a faster and hemostatic tool during supracervical incision and a controlled and rotation-free uterine extraction. The significant surgical time reduction linked to these devices should be considered even more helpful and effective to perform a complex procedure represented by LSH plus LSC. Neurourol. Urodynam. 36:798-802, 2017. © 2016 Wiley Periodicals, Inc.

New Haemostatic Agentand Application Tool forNeurosurgery

There are a variety of electrical, mechanical and chemical methods used to achieve haemostasis in Neurosurgery. Generally, chemical haemostatic agents are often preferable to bipolar cautery in spinal procedures. These haemostats have been used in neurosurgical spinal procedures for more than 65 years. This paper focuses on efficacy and technical aspects of the application of biodegradable gelatin haemostatic agents Pahacel Gelatin Powder® and a new application tool. Our experience for a new haemostatic tool in spine surgery has been presented in this study. The efficacy of it was tested on the patients who underwent surgery for lumbar disc hernia, lumbar spinal stenosis and lumbar trauma. Depending on the surgery effective hemostasis was achieved between 60 to 195 seconds following the initial application without any secondary effects. Preliminary results have shown that besides its advantages Pahacel Gelatin Powder® can also be a cost effective choice for the brain surgeries. However, extensive research is necessary for statistical results.

Endoscopic haemostasis: an overview of procedures and clinical scenarios.

Acute gastrointestinal bleeding is among the most urgent situations in daily gastroenterological practise. Endoscopy plays a key role in the diagnosis and treatment of such cases. Endoscopic haemostasis is probably the most important technical challenge that must be mastered by gastroenterologists. It is essential for both the management of acute gastrointestinal haemorrhage and the prevention of bleeding during high-risk endoscopic procedures. During the last decade, endoscopic haemostasis techniques and tools have grown in parallel with the number of devices available for endotherapy. Haemostatic powders, over-the-scope clips, haemostatic forceps, and other emerging technologies have changed daily practise and complement the standard available armamentarium (injectable, thermal, and mechanical therapy). Although there is a lack of strong evidence-based information on these procedures because of the difficulty in designing statistically powerful trials on this topic, physicians must be aware of all available devices to be able to choose the best haemostatic tool for the most effective procedure. We herein present an overview of procedures and clinical scenarios to optimise the management of gastrointestinal bleeding in daily practise.

Giant laterally spreading tumors of the duodenum: endoscopic resection outcomes, limitations, and caveats

Giant hemicircumferential and greater nonampullary duodenal adenomas or laterally spreading tumors (LSTs) may be amenable to safe endoscopic resection, but little data exists on outcomes or risk stratification. We interrogated a prospectively maintained database of all patients who underwent endoscopic resection between January 2008 and November 2010. The resection technique was standardized. Major complications were defined as perforation, bleeding requiring readmission with hemoglobin drop of more than 20 g/L, or other substantial deviations from the usual clinical course. Outcomes were analyzed in 2 groups: giant lesions (>30 mm) and conventional duodenal polyps (<30 mm in diameter). Statistical evaluation was performed by using a χ(2) test. A total of 50 nonampullary duodenal polyps and LSTs were resected from 46 patients (23 men, mean age 59.4 years, range 35-83 years). Nineteen were giant hemicircumferential and greater LSTs (mean size 40.5 mm, range 30-80 mm), and 31 were less than 30 mm in diameter (mean size 14.5 mm, range 5-25 mm). Intraprocedural bleeding occurred more frequently in giant lesions (57.8% vs 19.3%, P = .005) and was treated with a combination of soft coagulation and endoscopic clips with hemostasis achieved in all cases. Major complications, mostly bleeding related, occurred in 5 patients (26.3%) with giant lesions and 1 patient (3.2%) with a smaller lesion (P = .014). There were no deaths. Retrospective observational study in a tertiary center. Endoscopic resection of giant nonampullary duodenal LSTs is a successful treatment. However, it is hazardous and associated with significantly higher complication rates, primarily bleeding, when compared with conventional duodenal polypectomy. Safer and more effective hemostatic tools are required in this high-risk location.

Harmonic scalpel versus flexible CO2 laser for tongue resection: A histopathological analysis of thermal damage in human cadavers

BackgroundMonopolar cautery is the most commonly used surgical cutting and hemostatic tool for head and neck surgery. There are newer technologies that are being utilized with the goal of precise cutting, decreasing blood loss, reducing thermal damage, and allowing faster wound healing. Our study compares thermal damage caused by Harmonic scalpel and CO2 laser to cadaveric tongue.MethodsTwo fresh human cadaver heads were enrolled for the study. Oral tongue was exposed and incisions were made in the tongue akin to a tongue tumor resection using the harmonic scalpel and flexible C02 laser fiber at various settings recommended for surgery. The margins of resection were sampled, labeled, and sent for pathological analysis to assess depth of thermal damage calculated in millimeters. The pathologist was blinded to the surgical tool used. Control tongue tissue was also sent for comparison as a baseline for comparison.ResultsThree tongue samples were studied to assess depth of thermal damage by harmonic scalpel. The mean depth of thermal damage was 0.69 (range, 0.51 - 0.82). Five tongue samples were studied to assess depth of thermal damage by CO2 laser. The mean depth of thermal damage was 0.3 (range, 0.22 to 0.43). As expected, control samples showed 0 mm of thermal damage. There was a statistically significant difference between the depth of thermal injury to tongue resection margins by harmonic scalpel as compared to CO2 laser, (p = 0.003).ConclusionIn a cadaveric model, flexible CO2 laser fiber causes less depth of thermal damage when compared with harmonic scalpel at settings utilized in our study. However, the relevance of this information in terms of wound healing, hemostasis, safety, cost-effectiveness, and surgical outcomes needs to be further studied in clinical settings.

Bipolar forceps: A hemostatic tool for patients with electrocoagulation-induced dental pain

Bipolar forceps: A hemostatic tool for patients with electrocoagulation-induced dental pain