Harmonic ACE Research Articles

Evaluation of efficacy of an ultrasonic scalpel for pulmonary vascular ligation in an animal model

Dissection to accommodate bulky stapling devices may cause injury to pulmonary arteries in thoracoscopic lobectomies. The Harmonic Ace (Ethicon Endo-Surgery, Inc; Cincinnati, Ohio), a small ultrasonic scalpel used in systemic vessels, was tested on pulmonary vessels in pigs. Nine pigs were assigned 1- or 6-week survival. Lobectomies were performed using the device to divide and ligate pulmonary vessels. Vessel diameter was measured, and ligation outcome was recorded. Necropsies were then performed. Permanent ligation occurred in 76% of arteries and 92% of veins. At the highest power setting, the instrument showed no failure in arteries 5 mm or less and veins 7 mm or less. Necropsies revealed no evidence of postoperative bleeding. Histopathologic analysis revealed acute coagulation necrosis at 1 week. By 6 weeks, the vessel stumps displayed features consistent with normal wound healing. This device reliably divides pulmonary vessels 4 mm and smaller, typically encountered in pig lobectomies. Higher power settings and operator experience may increase effectiveness. Further testing is necessary to delineate the device's limitations before potential use in human pulmonary vasculature.

In vivo comparison of the coagulation capability of SonoSurg and Harmonic Ace on 4 mm and 5 mm arteries

Ultrasonic dissectors are useful to ligate arteries, but their effectiveness on larger arteries has not been thoroughly documented in vivo. The purpose of this study is to determine the bursting pressure of sealed arteries and the incidence of failure to adequately seal 4 mm and 5 mm arteries in a porcine model using two commercially available ultrasonic coagulators. The splenic, renal, superior mesenteric and carotid arteries of 60 kg swine were dissected and sealed alternating between SonoSurg (SS), 70% output (Olympus Surgical America) and Harmonic Ace (HA), level 3, (Ethicon Endosurgery). The burst pressures of each sealed segment was measured by subjecting them to infusion of water at 50 ml/hr until the seal burst. The mean burst pressure, incidence of burst pressure less than 360 mm Hg and incidence of not sealing were calculated and compared with the t and chi-square tests. Significance was assumed at p = 0.05. Each instrument was used to divide 44 arteries measuring between 4 and 5 mm (4.7 +/- 0.48 mm vs. 4.7 +/- 0.44 mm, p = NS, SS vs. HA, respectively) in diameter. The burst pressure (900.2 +/- 574.9 mmHg vs. 896.6 +/- 481.0 mmHg, p = NS) was not different comparing SS with. HA. Four vessels (9.1%) failed to seal with each instrument and resulted in immediate hemorrhage. Including the vessel that failed to seal initially, five vessels (11.4%) ligated with SS and six (13.6%) ligated with HA had burst pressure less than 360 mm Hg. This incidence of inadequate sealing was not significantly different between the two instruments when compared with chi-square analysis. SS and HA seal 4-5 mm arteries with similar burst pressures. There is no difference in the incidences of failure to initially seal the arteries or in bursting pressure <360 mmHg in 4-5 mm arteries in the porcine model.

961: Evaluation of Surgical Energy-Devices for Vessel Sealing and Peripheral Energy Spread in a Porcine Model: Harmonic ACE, Harmonic LCS-C5 Ligasure 5, and Trisector

961: Evaluation of Surgical Energy-Devices for Vessel Sealing and Peripheral Energy Spread in a Porcine Model: Harmonic ACE, Harmonic LCS-C5 Ligasure 5, and Trisector

960: Comparative Study of in VIVO Lymphatic Sealing Capability of the Porcine Thoracic Duct Using Ligasure V, Gyrus Trissector, Harmonic ACE Scalpel, Enseal, and Monopolar Scissors

960: Comparative Study of in VIVO Lymphatic Sealing Capability of the Porcine Thoracic Duct Using Ligasure V, Gyrus Trissector, Harmonic ACE Scalpel, Enseal, and Monopolar Scissors

Ausdehnung der Lymphknotendissektion nach minimalinvasiver Ösophagusresektion?

Esophageal resection is still today associated with a high morbidity and mortality. Minimally invasive procedures show a significantly lower rate of such complications and therefore might also be associated with a lower surgical risk. However, publications till date contain little or no data on the extent of lymph node dissection. The aim of our study was to evaluate the morbidity and mortality rate of minimally invasive esophageal resection. In the last two years, we carried out 25 minimally invasive esophageal resections on five women and 20 men with a median age of 63 years (range 41-74 years). All data were accrued prospectively. Nine patients were operated upon transhiatally and 12 combined laparocopic-thoracoscopic. On four patients, a thoracotomy was necessary. The average surgical time for the transhiatal approach was calculated at 164 minutes (range 150-180 min) and for the combined laparoscopic-thoracoscopic procedure 285 minutes (240-360 min). The thoracoscopic esophageal resection itself lasted 105 minutes on average; the last five resections each lasting 70 minutes. A median of 24,5 lymph nodes (19-26) was calculated in the laparoscopic-thoracoscopic technique. The transhiatal procedure revealed a median of 14 lymph nodes (12-17). Postoperatively, we had three cases of anastomotic and two cases of bronchial leakages, most probably associated with the use of monopolar current; complications no longer seen since usage of the HARMONIC ACE for surgical preparation. There was no 30 day letality. Our experience with 25 successful minimally invasive esophageal resections shows that with increasing experience and better surgical equipment, the extent of lymph node dissection does not differ from open procedure.

335: Laparoscopic Approach to Hysterectomy with the Harmonic Ace

335: Laparoscopic Approach to Hysterectomy with the Harmonic Ace