Use Of Scalpel Research Articles

Comparing the Outcomes of Scalpel and Diathermocoagulation Dissection in Abdominoplasty: A Systematic Review and Meta-Analysis.

Abdominoplasty, an emerging surgical procedure worldwide, associated with complications, as seroma, infection, and hematoma. This systematic review and meta-analysis compare the outcomes of abdominoplasty procedures performed using a scalpel versus a diathermocoagulation device (diathermy monopolar electrocautery), aiming to find a safer approach with fewer complications. We conducted a systematic search in November 2023 using PubMed, Ovid Medline, and Ovid Chocrane databases. The methodological index for nonrandomized studies and the Revised Cochrane Risk of Bias assessment tools were used to assess risk of bias for observational studies and randomized controlled trials, respectively. The data were analyzed using RevMan software. Six articles (1135 patients) were included, 521 patients were operated using a scalpel and 614 using electrocautery. Our analysis suggests that both seroma and drain output were seen more among the electrocautery group, with an odds ratio (OR) of 0.62 (95% CI [0.39, 0.97], p = 0.04) and - 103.63 (95% CI [- 205.67, - 1.59], p = 0.05), respectively. It is important to note the high heterogeneity seen among the studies discussing the total drain output. Additionally, we did not find any statistical significance between both techniques in terms of the rate of hematoma, wound infection, operation time, and hospital stay length. When comparing the use of scalpel and electrocautery dissection in abdominoplasty, higher rates of seroma and total drain output are significantly associated with electrocautery dissection. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of postoperative complications using Harmonic scalpel and LigaSure in thyroid surgery

Background: Thyroid surgery is the most common operation in the field of endocrine surgery. The aim of this study was to compare the use of LigaSure vessel (LS) and Harmonic scalpel (HS) in 1599 total thyroid surgeries between January 2008 and December of 2022, with regards of analysis of surgical complications, duration of hospital stay and operative surgical time.
 Methods: In this retrospective study patients have been categorized into two groups: Group A included 718 patients from January 2008 to May 2013 when LigaSure vessel was used, and the Group B included 881 patients from June 2013 to December 2022 when Harmonic scalpel was used. A summary of the total number of postoperative complications cases, surgical time and the duration of hospital stay between the two groups is presented.
 Results: There was no significant difference in the sex, age, and mean operating time between the two groups (P>0.05). Either major bleeding or wound infection occurred in 4 (0.6%) or 14 (1.9%) of the patients undergoing thyroidectomy when LS was used compared to 4 (0.5%) or 15 (1.7%) of the patients undergoing thyroid surgery when HS was used (P> 0.05 and P> 0.05, respectively). In addition, either hypoparathyroidism or temporary recurrent laryngeal nerve palsy was observed in 91 (12.7%) or 39 (5.4%) of the Group A patients compared with 98 (11.1%) or 44 (5%) of the Group B patients (P> 0.05 and P> 0.05, respectively).
 Conclusion: The current study demonstrates that thyroidectomy can be safely performed with both devices without increasing the risk of complications.

Comparing Surgical Outcomes with Scalpel vs N110A Microneedles in Oral and Maxillofacial Surgeries - RCT

Background Incisions on skin with scalpel have been linked to adverse effects such as excessive blood flow inadequate visibility caused by blood in the operating field and use of a large amount of vasoconstrictor to reduce haemorrhage from skin incision. The use of electrocautery scalpel to open skin was questioned in past for fear of delayed wound healing wound dehiscence due to thermal and tissue damage or infection. The newer finer-tipped electrocautery devices like the Colorado microdissection needle CN enable the use of smaller energy amounts thereby reducing peri-incision tissue damage compared to traditional broad-tipped devices.Methodology The current study compared CN vs. traditional scalpel incisions in various intraoral and extraoral surgical procedures. A total of 40 patients were included in this study conducted to understand the efficacy of CN in terms of speed of incision visibility bleeding effect on wound healing and scar assessment.Results The findings suggest that utilizing the CN offers several advantages. Firstly it can potentially reduce blood loss BL thereby lowering the risk of complications. Secondly it may cause minimal tissue damage leading to improved scar outcomes and quicker recovery time. Thirdly it could enhance visibility and precision for the surgeon resulting in superior surgical outcomes. Additionally the speed of incision is higher with CN.Conclusion CN offers significant benefits compared to traditional scalpels in maxillofacial surgeries. Specifically it reduces BL and enhances visibility at the surgical site. Given the critical role of BL and surgical duration in determining surgical outcomes these improvements are noteworthy.

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.

The Outcomes of Using Scalpel and Electrosurgery Methods for Anterior Abdominal Wall Incision During Cesarean Section

Background: There are different ways to make a surgical incision. The most widely used ones are the use of scalpel and electrosurgery. Each of these methods has advantages and disadvantages that affect its use. Objectives: This study aimed to compare scalpel and electrosurgery methods in cutting the anterior abdominal wall during Cesarean section. Methods: This double-blind clinical trial manner was conducted by permuted block randomization. The participants were placed in two groups. In the scalpel group, incisions were made with a scalpel, and in the electrosurgery group, incisions were made with an electrosurgical pencil. This clinical trial was conducted on 86 pregnant women who were candidates for Cesarean section with spinal anesthesia. The inclusion criteria were an age range of 18 - 45 years, gestational age of 37 - 41 weeks, Pfannenstiel skin incision, and willingness to participate. The exclusion criteria were emergency Cesarean section, vertical skin incisions, incomplete medical files, chronic skin diseases, allergy to antibiotics, consuming anticoagulants, cardiovascular and pulmonary problems, and underlying diseases. Results: There was no significant difference between the two groups in terms of intraoperative bleeding, newborn Apgar score, postoperative pain, and wound complications. However, the duration of surgery (P = 0.012), incision time (P = 0.049), and hemodynamic status showed a significant difference (P < 0.05). Conclusions: The use of electrosurgery to make a surgical incision does not pose a risk to the patient if safety points are followed.

Comparison of the harmonic scalpel and electrocautery during breast surgery

Background. As one of the most frequent procedures, breast surgery puts high healthcare costs. The significance of surgical quality and complications before and after breast surgery entailed using methods with the highest outcomes and the least complications. Methods. Throughout this research, postoperative complications and factors affecting the quality of surgery were evaluated in the Kowsar hospital between the 2019 and 2020.Patients undergoing breast surgeries were randomly categorized into two groups: electrocautery (A) and harmonic scalpel (B). Results. Out of the 56 people, 28 patients were in group A, and the remaining 28 patients were in group B. After matching the patients, intraoperative bleeding, drainage rate, a period of drainage, duration of hospitalization in group B were significantly lower (P<0/05). Further, the extent of pain in both groups was different (P<0/001), so that there was less postoperative pain in women who experienced harmonic breast surgery. Patients throughout Group A reported more complications than in Group B, such that 7 (25%) of patients underwent limb anesthesia and 3 (10/7%) of patients experienced seroma, however, the difference between the two groups was not significant. Conclusion. Harmonic scalpel usage in breast surgery has fewer complications, better operation quality and shorter hospital stay than other older methods, so it is suggested that the use of harmonic scalpel may substitute different surgical strategies. Practical Implications. According to the results of this study, the use of harmonic has fewer complications for patients, and suffering of patients are reduced and they pay less.

The Use of Ultrasonic Bone Scalpel (UBS) in Unilateral Biportal Endoscopic Spine Surgery (UBESS): Technical Notes and Outcomes.

Case Series and Technical Note, Objective: UBS has been extensively used in open surgery. However, the use of UBS during UBESS has not been reported in the literature. The aim of this study was to describe a new spinal surgical technique using an ultrasonic bone scalpel (UBS) during unilateral biportal endoscopic spine surgery (UBESS) and to report the preliminary results of this technique. We enrolled patients diagnosed with lumbar spinal stenosis who underwent single-level UBESS. All patients were followed up for more than 12 months. A unilateral laminotomy was performed after bilateral decompression under endoscopy. We used the UBS system after direct visualization of the target for a bone cut. We evaluated the demographic characteristics, diagnosis, operative time, and estimated blood loss of the patients. Clinical outcomes included the visual analog scale (VAS), the Oswestry Disability Index (ODI), the modified MacNab criteria, and postoperative complications. A total of twenty patients (five males and fifteen females) were enrolled in this study. The mean follow-up period was 13.2 months (range 12-17 months). The VAS score, ODI, and modified MacNab criteria classification improved after the surgery. A minimal mean blood loss of 22.1 mL was noted during the operation. Only one patient experienced neuropraxia, which resolved within 2 weeks. There was no durotomy, iatrogenic pars fracture, or infection. In conclusion, our study represents the first report of the use of UBS during UBESS. Our findings demonstrate that this technique is safe and efficient, with improved clinical outcomes and minimal complications. These preliminary results warrant further investigation through larger clinical studies with longer follow-up periods to confirm the effectiveness of this technique in the treatment of lumbar spinal stenosis.

Comparison of postoperative bleeding using harmonic scalpel and LigaSure in thyroid surgery: a 15-year single-centre retrospective study.

Aim Thyroidectomy is the most common operation in the field of endocrine surgery. The aim of this study was to compare the use of LigaSure vessel (LS) and harmonic scalpel (HS) in 1653 total thyroidectomies between January 2008 and March of 2023, with regards to analysis of surgical bleeding complications duration the hospital stay and operative surgical time. Methods It is a retrospective analysis of a prospectively maintained database. Patients have been categorized into two groups: Group A included 718 patients from January 2008 to May 2013 when LS was used, and the Group B included 935 patients from June 2013 to March 2023 when HS was used. Results From the total of 14 postoperative bleeding cases that occurred in patients of Group A, only in 4 of them it was necessary to have a reoperation. The other 10 cases involved minor haemorrhages, while from the total of 6 postoperative bleeding cases that happened to patients of Group B, there were 4 cases that needed a reoperation (p-value >0.05) and 2 patients with minor haemorrhages. The postoperative evaluation of minor bleedings revealed statistically significant differences between the two groups (p-value < 0.05). The average hospital stay was similar in the two groups. Conclusion Both devices exhibit identical safety profiles in thyroidectomies specifically regarding major bleeding complications that require reoperation. Additionally, HS was found to be more effective at achieving haemostasis, especially in the subgroup of patients with thyroid carcinoma. The results of the present study may be useful for high-volume centres performing numerous thyroidectomies every day.

A Systematic Review and Meta-Analysis of Harmonic Scalpel Versus Conventional Techniques of Appendiceal Stump Closure in Laparoscopic Appendicectomy.

Acute appendicitis is one of the most commonly encountered surgical emergencies worldwide. The laparoscopic approach for managing acute appendicitis is gaining popularity over open appendicectomy in the current surgical practice. The advantages of laparoscopic appendectomy are early recovery, fewer wound complications, less pain and better cosmesis. One of the most critical steps in laparoscopic appendicectomy is a secure appendicular stump closure. Life-threatening postoperative complications are often encountered following the breakdown of appendicular stump closure. There are several methods to achieve appendicular stump closure such as intra-corporeal knotting, endoloops, external corporeal knotting and pushing knot inside, endoscopic linear cutting stapler (endo GIA), and endoclips. A meta-analysis on the technique of appendicular stump closure in laparoscopic appendicectomy failed to demonstrate the superiority of one method over the other. In the last few years, many authors have evaluated the outcome of sutureless appendicectomy performed using devices like a harmonic scalpel. This systematic review and meta-analysis is aimed to summarise the current evidence regarding the utility and safety of harmonic scalpel in sutureless appendicectomy.This systematic review and meta-analysis was conducted as per the preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines. A systematic, detailed search was carried out by the authors in the electronic database, including Medline, Embase, CENTRAL, Scopus, Google scholar and clinical trial registry. Studies were selected and compared based on outcomes such as operative time, hospital stay, postoperative paralytic ileus, wound infection, and total complications. Statistical analysis was performed using the random effect model, fixed-effect model, pooled risk ratio, pooled mean difference and I2 heterogeneity.Four comparative studies with a total of 642 patients (376 male and 266 females) were included in the analysis. There were 359 patients in the conventional technique of appendicular stump closure group and 283 patients in the harmonic scalpel for appendicular stump closure group. Pooled analysis of the outcome measure of total complications showed that the use of harmonic scalpel for closure of appendiceal stump does not result in an increased incidence of complications as compared to the conventional technology of appendiceal stump closure. Pooled analysis of the outcome measure of mean operative time revealed a statistically significant reduction in the operative time in the patients where harmonic scalpel has been used for the management of appendiceal stump as compared to conventional methods (pooled mean difference of -12.96 with 95% CI -15.42, -10.50). Appendiceal stump closure during laparoscopic appendectomy by harmonic scalpel (HS) is comparable with the conventional techniques in terms of hospital stay, wound infection, postoperative paralytic ileus, and total complications. The use of a harmonic scalpel for closure of appendicular stump is associated with a reduction of the mean operative time of laparoscopic appendicectomy.

Laparoscopic Management of Partial Molar Caesarean Scar Ectopic Pregnancy

To demonstrate laparoscopic management of a molar scar ectopic pregnancy. Stepwise demonstration of the technique with narrated video footage. Cesarean scar ectopic pregnancy and molar pregnancy are 2 separate extremely rare pathologies with an incidence range from 1/1800 to 1/2500 of all pregnancies for the former [1,2]. The concurrence of both cesarean scar ectopic and molar pregnancy is furthermore exceptionally rare, and there are only 8 reported cases of cesarean scar molar pregnancy in literature till date [3]. There is a high risk of uterine rupture, uncontrolled hemorrhage, hysterectomy, and significant maternal morbidity owing to thin myometrium and fibrous scar after cesarean section [4,5]. Knowledge and awareness about this clinical condition aid in early diagnosis and reduced morbidity. Here, we present a rare case of cesarean scar ectopic pregnancy that was operated for failed medical management and diagnosed to be molar scar ectopic pregnancy intraoperatively. Total laparoscopic approach to molar scar ectopic pregnancy excision involved the following steps, strategies to minimize blood loss, and complete enucleation of tissue: (1) Hysteroscopy to localize the scar ectopic and its type and size (2) Bladder dissection to expose scar (3) Intramyometrial injection of vasopressin (4) Use of harmonic scalpel to delineate the gestational sac (5) Complete evacuation of products of conception (6) Excision of scar tissue (7) Uterine repair in 2 layers CONCLUSION: There are only 8 reported cases of cesarean scar molar pregnancy in literature till date, and all patients had at least 2 previous uterine curettages with abnormally increased β-hCG levels. The clinical manifestations were varied, the most common symptom being vaginal bleeding for a period >1 month, including our case [3]. Considering the limitations of ultrasound, magnetic resonance imaging, and serum hCG levels in the differential diagnosis of molar cesarean scar pregnancy from normal cesarean scar pregnancy, postoperative specimen should be sent for histologic examination [6]. As seen in our case, the possibility of molar pregnancy at cesarean scar ectopic site should be kept in mind in cases with rising β-hCG levels despite continuous medical interventions, which was being medically managed for 3 months. Our case is the first to be successfully managed with laparoscopic surgery as the previously reported cases were managed with suction evacuation, chemotherapy, laparotomy, or hysterectomy [3].

SPLENECTOMY IN PATIENTS WITH PATHOLOGY OF THE BLOOD SYSTEM

Abstract. Splenectomy (SE) in hematologic patients is accompanied by an increased risk due to the presence of a hemostasis violation in most cases. All this determines the search for more favorable methods of surgical intervention in patients with diseases of the blood system. The purpose of the study is to improve the results of surgical treatment of patients with blood system diseases by planning the method of splenectomy.&#x0D; Materials and methods: the work was performed on the basis of a comprehensive clinical-laboratory and instrumental examination of 112 patients with various diseases of the blood system that needed surgical treatment. In addition to laboratory diagnosis, special attention was given to the anamnesis: duration of the disease, hormonal therapy; instrumental research methods: ultrasound of the abdominal cavity and CT, as well as nosologies. A harmonic scalpel was used to mobilize the spleen. The EndoGIA-30 stapler (AutoSuture) was used to treat the vascular pedicle.&#x0D; Results and discussion: analysis of the results of SE in patients with hematological profile showed that the choice of surgical access depends on many factors which can be set before operation by dint of ultrasound and CT. There were no conversion cases, which could be explained by the possibility of objective preoperative planning, as a result of which in cases of laparoscopic adverse events, a decision was made to perform open type of SE. The absence of complications and fatal cases at SE in hematologic patients shows the efficacy of the use of harmonic scalpel and EndoGIA-30 (AutoSuture) staplers to mobilize the spleen.&#x0D; Conclusions: the use of ultrasound and CT plays an important role in planning the method of spleenectomy, which avoids cases of conversion. Simultaneous use of harmonic scalpel and Autosuture staplers for performing SE helps to avoid complications.

A retrospective observational study of patients on maintenance hemodialysis receiving parathyroidectomy by ultrasonic scalpel

BackgroundSecondary hyperparathyroidism (SHPT) remains a common complication in many patients on maintenance hemodialysis. Kidney Disease Improve Global Outcomes (KDIGO) 2017 guidelines suggest that parathyroidectomy (PTX) should be performed in severe SHPT patients with chronic kidney disease stage 3a-stage 5D. In the present study, we observed the efficacy of ultrasonic scalpel for PTX in SHPT patients on maintenance hemodialysis.MethodsA total of 74 patients on maintenance hemodialysis who underwent PTX (34 with traditional electrocautery and 40 with an ultrasonic scalpel) were observed between August 2020 and August 2021 at Xiangyang Central Hospital (Hubei University of Arts and Science). Baseline demographic and clinic characteristics were collected pre- and post-PTX. Moreover, the postoperative complications and operation time were assessed between the two groups.ResultsThe univariate analysis showed that there was no statistical significance in weight, dialysis duration, serum potassium, serum calcium, serum magnesium, alkaline phosphate, triglyceride, and intact parathyroid hormone (iPTH) before and after PTX between the two groups (P > 0.05). The operation time in the ultrasonic scalpel group was significantly decreased compared with the traditional electrocautery group (P < 0.05). Compared with the traditional electrocautery group, the drainage amount was significantly reduced in the ultrasonic scalpel group, and the number of days with drain and postoperative hospital stay were also remarkably decreased (P < 0.05).ConclusionsThe use of ultrasonic scalpel significantly reduced the operation time and postoperative hospital stay in patients on maintenance hemodialysis undergoing PTX.

Comparative Study of Use of Diathermy Vs Scalpel for Incision Making in Midline Laparotomy With Respect to Blood Loss

Background: Scalpels are used by surgeons for making incisions. Modern cautery units are used nowadays for making incisions. Aim: To evaluate and compare use of diathermy and scalpel for incision making in midline laparotomy with respect to incision time and blood loss. Method: This prospective randomized study was conducted at Surgical Unit1 Fatima Memorial Hospital from January 2017 to December 2018. Patients were categorized into diathermy and scalpel groups and evaluated for incision time and blood loss. Results: A total of 50 patients were included in the study with 25 (50%) patients in both diathermy and scalpel groups. For incision time, there was no difference found to be statistically significant in the diathermy and scalpel groups but pertaining to blood loss, less blood loss was calculated in diathermy group than in scalpel group. Conclusion: Diathermy is a primary choice for making incision to minimize blood loss in patients than scalpel. However, considering these options for incision time, none is superior to other. Keywords: diathermy, scalpel, laparotomy, skin incision, blood loss

Comparison of Conventional Bipolar Electrocautery and Ultrasonic Harmonic Scalpel in Colorectal Cancer Surgeries.

Background and objectiveColorectal cancer (CRC) is the third most common malignancy and the second most deadly cancer worldwide. Powered equipment has transformed modern surgery, revolutionizing the delicacy, precision, and accuracy of many surgeries. The safety and efficacy of tissue dissection and artery sealing in colorectal surgery remain highly debatable. With the increased use of minimally invasive procedures in colon and rectal surgery, energy devices for tissue dissection and vascular sealing have become widely used. In light of this, we aimed at comparing the use of bipolar electrocautery and harmonic scalpel in CRC surgeries.MethodsOur study was a hospital-based comparative study conducted at our tertiary care hospital. Fifty patients were divided equally into two groups by block randomization, and bipolar electrocautery was used in one group, and harmonic scalpel was used in the second group during surgery. The mean operative time, blood loss, and hospital stay were calculated in both groups. The comparison between bipolar electrocautery and harmonic scalpel was evaluated using independent t-tests.ResultsThe mean operative time, blood loss, and hospital stay were significantly lower in the harmonic scalpel group than in the electrocautery group. The results were statistically significant (p < 0.001).ConclusionBased on our findings, the harmonic scalpel is a better energy source when compared to bipolar electrocautery in CRC surgeries.

Systematic Review of Comparison of use of Ultrasonic Scalpel Versus Conventional Haemostatic Techniques in Performing Thyroid Surgery.

Haemostasis during any surgical procedure is fundamental for attaining a positive patient outcome. Safe thyroid surgery requires meticulous attention for careful control of bleeding and safe guarding important structures like recurrent laryngeal nerve. Many methods such as ligation and suturing, electro ligation sealing, coagulation, and ultrasonic coagulation have been put to use for achieving haemostasis. The objective of this systemic review was to compare and review the surgical outcomes between harmonic (ultrasonic) scalpel and conventional ligature techniques in performing thyroid surgery. The systematic review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and checklist with a total of 11 studies selected for qualitative analysis. The statistical software Review Manager 5.4.1 provided by the Cochrane Collaboration was used for performing the analysis on the two groups. It was concluded that the use of harmonic scalpel for thyroid surgery is useful for reducing operative time, postoperative pain, drainage volume and transient hypocalcemia, hence can be a reliable and a safe tool compared to conventional techniques often used for surgery.

Efficacy of diathermy on healing power of cesarean section scar: A randomized control trail

Abstract Background Over several decades, has come to a dramatic increase In the number of cesarean sections performed across the world, especially in developed country The use of diathermy in the opening of anterior abdominal wall during CS decreases blood loss and operative time. The current study will investigate if diathermy cutting from skin through anterior abdominal is better or the same in cosmoses and post-operative pain Objective To compare the effects of electro-surgery on healing power of CS scar as a primary outcome (from skin to the peritoneum. A randomized controlled trial Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2019. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion Our study showed that with the use of diathermy for incising skin during CS is not inferior to the use of scalpel regarding healing power of the scar but also adds benefits of decreasing post-operative pain. Therefore the use of diathermy can be safely recommended for the opening of the skin during cesarean sections as it decrease post-operative pain and blood loss.

V09-09 UPDATED TIPS AND TRICKS FOR ROBOTIC ASSISTED LAPAROSCOPIC URETEROCALICOSTOMY

You have accessJournal of UrologyUpper Tract Reconstruction (V09)1 Sep 2021V09-09 UPDATED TIPS AND TRICKS FOR ROBOTIC ASSISTED LAPAROSCOPIC URETEROCALICOSTOMY John Richgels, Hernan Lescay, Brittany Adamic, and Mohan Gundeti John RichgelsJohn Richgels More articles by this author , Hernan LescayHernan Lescay More articles by this author , Brittany AdamicBrittany Adamic More articles by this author , and Mohan GundetiMohan Gundeti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002052.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureterocalicostomy is an option for renal salvage in cases where conventional reconstructions have failed or as a primary option in anatomic situations such as intrarenal pelvis, malrotated, or horseshoe kidney. The primary principle of this procedure is to allow for dependent drainage. Ureterocalicostomy is often difficult due to extensive scar tissue and may be complicated by bleeding in the setting of a normal functioning lower pole cortex.. Identification of a dependent calyx and hemostasis can be difficult when there is a normal cortical thickness. We suggest some simple tips to avoid this step and optimize surgical results. We present our experience and updated technical tips with robotic-assisted laparoscopic ureterocalicostomy and provide a step-by-step video. METHODS: Five patients underwent robotic-assisted laparoscopic ureterocalicostomy between the years 2012 and 2021 by a single surgeon. Perioperative outcomes measured included operative time, hospital stay, pain relief, degree of hydronephrosis on postoperative ultrasound at 3 months, and renal scintigraphy as needed. We describe the operative procedure and provide tips on identifying a dependent lower pole calyx, the use of harmonic scalpel for incision of the lower pole cortex, and anastomosis by pre-placement of interrupted sutures as the urothelium of the renal calyces is thin and friable. RESULTS: Four of five patients had one prior pyeloplasty, and one patient had two prior pyeloplasties. Mean operative time (incision to closure) was 208 minutes. No Clavien-Dindo 30-day complications were encountered and no patients required blood transfusion. Long term follow up was available for four out of five patients. Anatomic success was reported those four patients with a mean follow-up of 4.46 years; however, one out of the four patients with long term follow up ultimately required nephrectomy despite patent anastomosis, which would not drain due to a capacious pelvis. CONCLUSIONS: Robotic-assisted laparoscopic ureterocalicostomy is feasible in re-operative cases with extensive scaring and in patients with abnormal renal anatomy. We offer tips to allow for safe and proficient performance of this procedure. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e690-e690 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Richgels More articles by this author Hernan Lescay More articles by this author Brittany Adamic More articles by this author Mohan Gundeti More articles by this author Expand All Advertisement Loading ...

Comparison of Ultrasonic Dissection and Suture Ligation for Mesoappendix in Laparoscopic Appendectomy.

ObjectiveTo compare the use of ultrasonic dissector and suture ligation for mesoappendix in laparoscopic appendectomy in terms of mean operative time and per-operative bleed.MethodologyThis was a randomized controlled trial conducted at Surgical Unit II, Holy Family Hospital over a period of six months. All patients with the diagnosis of acute appendicitis who presented in the emergency department of Holy Family Hospital on the call days of Surgical Unit II undergoing laparoscopic appendectomy were included in the study. After taking informed consent about the respective procedure, patients were allocated to two groups using computer-generated random numbers. Group A was operated using harmonic scalpel and in Group B suture ligation was done. Total time required to ligate the mesoappendix or to cauterize it using the harmonic scalpel was measured in minutes. Data was entered and analyzed in SPSS version 21.0 (IBM Corp., Armonk, NY).ResultsA total of 110 patients were enrolled in the study according to the inclusion criteria of the study. Patients were randomly divided into two equal groups. Patients in Group A were operated using harmonic scalpel whereas patients in Group B were operated by suture ligation for dealing the mesoappendix in laparoscopic appendectomy. Mean operative time to ligate the mesoappendix for Group A patients was 1.56 (SD = 0.68) minutes while that of Group B was 21.07 (SD = 2.84) minutes. There was no per-operative bleeding in case of Group A while its incidence was 24% of patients in Group B. Results were statistically significant.ConclusionThe conclusion of the study is that the use of harmonic scalpel was better than suture ligation for ligating the mesoappendix in laparoscopic appendectomy in terms of mean operative time and per operative bleed, hence it's preferable over the later in laparoscopic appendectomy.

Harmonic scalpel thyroidectomy versus conventional haemostasis thyroidectomy

Background: As there is paucity of data on harmonic scalpel thyroidectomy from Jammu and Kashmir belt. So, we conducted this study to bridge this gap and also to create awareness about the use of harmonic scalpel. Thyroidectomy has become one of the most common and frequent surgery. Hemostasis in thyroid surgery is of utmost importance for a successful surgery. Our aim was to compare operative factors, postoperative outcomes of thyroidectomy using the Harmonic Scalpel (HS) and Conventional Haemostasis (CH).Methods: In this randomized control trial study, 100 patients who underwent thyroidectomy were enrolled and randomly divided in two groups- HS group and CH group. The inclusion criteria were age&gt;18years, acceptance to participate in the study (signed informed consent form) and scheduled total thyroidectomy. The groups were compared with regards to age, gender, operative time, post-operative drainage volume, postoperative pain, and hospital stay.Results: The mean age in years was 39.8 years for HS group and 43.8 years for CH group with female preponderance. There was a significant difference with regards to operative time, post-operative drainage volume, postoperative pain, and hospital stay (p&lt;0.001). Harmonic Scalpel shortens the operative time. And there was less post-operative drainage volume and postoperative pain in HS group. Hospital stay was also less as compared to CH group.Conclusions: HS is superior then CH thyroidectomy and is considered as a safe and better tool in thyroidectomy.

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.