Standard Scalpel Research Articles

Incision Precision of a Novel Wire-Guided Scalpel During Central Venous Catheter Placement: A Randomized Observational Trial

To determine whether the wire-guided scalpel (GuideBlade) improves incision precision, reduces the need to revise dermatotomy incision, improves the first-time success rate of a central venous catheter (CVC) placement, and decreases CVC-related complications. A randomized 2-arm observational trial. At University of California Irvine Medical Center. Patients (n=63) undergoing surgery requiring placement of a CVC as part of the standard of care recruited from August 1, 2021, to December 31, 2021. After randomization, either the GuideBlade (intervention) or the standard #11 scalpel (control) was used during CVC placement before surgery. The number of dermatotomy attempts was higher using the GuideBlade (1.6 ± 1.0) compared to the standard #11 scalpel (1.4 ± 0.6); however, the difference did not reach statistical significance (p=0.19). Similarly, the number of dilation attempts demonstrated no significant difference between the GuideBlade (1.2 ± 0.4) and the standard scalpel (1.1 ± 0.4; p=0.65). No CVC-related infections or complications were documented. No superiority was observed with using the GuideBlade compared to the standard scalpel during central line insertion by novice users. User unfamiliarity and inadequate training may have contributed to this finding, highlighting the importance of proper technique and user experience.

A comparative evaluation of management of hyperpigmented gingiva using surgical stripping technique and diode laser: A clinical study

BackgroundTo compare the treatment outcome of laser and its effectiveness in the management of gingival hyperpigmentation over scalpel surgical method. MethodsThe patients were selected and were divided into two groups by the split-mouth design. Group A: Right half upper and lower central incisors to premolars were treated using the laser technique. GROUP B: Left half upper and lower central incisors to premolars were treated by Scalpel technique. This study was a comparative, split-mouth analytical study, and the results were observed for a period of 9 months. ResultsDiode laser technique gave better results in this perio-esthetics procedure as compared to scalpel technique. However, recurrence of pigmentation has been reported even after this duration. Diode laser was superior over the scalpel technique in the aspect of operator convenience, reduced postoperative bleeding, and reducing the incidence of repigmentation in terms of intensity and extent of pigmentation. Patient comfort was more in scalpel technique. ConclusionLaser can be used for better periodontal esthetic procedure over the standard scalpel technique, although repigmentation was reported in both groups. But delayed healing occurred on the laser side due to the thermal effect of the laser on the adjacent tissues. Provision of such advanced instruments to dental surgery can give better satisfaction to patient clientele in terms of good esthetic results.

Wearable AR and 3D Ultrasound: Towards a Novel Way to Guide Surgical Dissections

Nowadays, ultrasound (US) is increasingly being chosen as imaging modality for both diagnostic and interventional applications, owing to its positive characteristics in terms of safety, low footprint, and low cost. The combination of this imaging modality with wearable augmented reality (AR) systems, such as the head-mounted displays (HMD), comes forward as a breakthrough technological solution, as it allows for hands-free interaction with the augmented scene, which is an essential requirement for the execution of high-precision manual tasks, such as in surgery. What we propose in this study is the integration of an AR navigation system (HMD plus dedicated platform) with a 3D US imaging system to guide a dissection task that requires maintaining safety margins with respect to unexposed anatomical or pathological structures. For this purpose, a standard scalpel was sensorized to provide real-time feedback on the position of the instrument during the execution of the task. The accuracy of the system was quantitatively assessed with two different experimental studies: a targeting experiment, which revealed a median error of 2.53 mm in estimating the scalpel to target distance, and a preliminary user study simulating a dissection task that requires reaching a predefined distance to an occult lesion. The second experiment results showed that the system can be used to guide a dissection task with a mean accuracy of 0.65 mm, with a mean angular error between the ideal and actual cutting plane of 2.07°. The results encourage further studies to fully exploit the potential of wearable AR and intraoperative US imaging to accurately guide deep surgical tasks, such as to guide the excision of non-palpable breast tumors ensuring optimal margin clearance.

Who needs a stapling device for haemorrhoidectomy, if one has the radiofrequency device?

Abstract Background Multiple operations exist to treat haemorrhoids. Although comparisons of conventional excision and other techniques have been performed, there are less comparative outcome data available for stapled haemorrhoidopexy (SH) and radiofrequency haemorrhoidectomy (RFH). Use of a radiofrequency energy device for haemorrhoidectomy is an alternative to standard diathermy, scissors or scalpel. It provides vessel sealing between the jaws of the instrument and aims to minimise wider tissue damage. Objective To systematically review the literature comparing SH and RFH, assessing complications, outcomes, patient experience and costs. Methods A tailored search of medical databases identified literature containing relevant primary and secondary data comparing SH and RFH. Papers were screened for relevance and completeness of published data. Those missing methodological information, outcome data or statistical analysis were subsequently excluded. A narrative review was then performed. Results The primary data in this review originate from six randomised control trials (RCTs) and five meta-analyses. Evidence was conflicting, with a trend towards more early postoperative pain in the RFH vs. the SH group (three RCTs reported increased early pain scores in the RFH group). Significantly higher rates of residual and recurrent haemorrhoids and prolapse in the SH group were observed in two RCTs and four meta-analyses. Bleeding, urinary retention, incontinence and anal stenosis did not significantly differ. No detailed contemporary cost analysis was found. Conclusion The trials are small, with significant heterogeneity in the techniques used and outcome data recorded. However, despite the limited available evidence, RFH appears superior to SH due to significantly lower rates of residual and recurrent haemorrhoids and prolapse.

On Demand Additive Manufacturing of a Basic Surgical Kit

On Demand Additive Manufacturing of a Basic Surgical Kit

Comparative study of safety and efficacy of electrocautery blade with cold scalpel blade for skin opening during fixation of fracture of forearm bone with plate and screws

Introduction: The art of performing surgeries have improved in recent years with the development of various electrosurgical devices assisting surgeons in performing safer surgeries with better outcomes. Skin incision has traditionally been made with a standard scalpel blade with good primary healing end results of the wound. The electrocautery has been used safely in performing deeper dissections. Use of electrocautery in skin incision has been discouraged in the past for the fear of cutaneous scarring, wound dehiscence, and infections particularly in orthopedic surgeries using internal implants. A review of the literature shows not many studies have been conducted to evaluate the safety and efficacy of electrocautery in skin incisions during orthopedic surgeries using internal implants. Aim: A prospective study was conducted in a tertiary care hospital with the aim to determine whether an electrocautery blade can be used safely for skin incisions. Materials and Methods: Sixty-two patients with single-bone fracture of the forearm undergoing open reduction and internal fixation received one-half of the incision with a standard scalpel blade and another half with electrocautery in pure cutting mode randomly. Analysis: Wounds were compared on operating day for any physical changes and on days 3, 5, and 12, and again on 3 rd and 6 weeks follow-up to know any difference in skin healing between the incised wounds of the two halves. Results: No evidence of any difference in healing of the two halves of skin incision was noted. There was also no increased risk of wound scarring, dehiscence, or infection with electrocautery incision when compared with standard scalpel incision. The time taken for skin incision with electrocautery was significantly less when compared with cold scalpel incision. Conclusion: We propose that electrocautery can be safely used for performing skin incision, with comparable results to that of a standard scalpel skin incision.

Preventing seroma formation after axillary dissection for breast cancer: a randomized clinical trial

BackgroundSeroma formation after axillary dissection remains the most common early sequel to breast cancer surgery. Different surgical approaches have been performed to reduce seroma collection. Therefore, we aimed to assess the outcome of patients operated on using an ultrasound scalpel according to a standardized operative technique before accepting it as a routine procedure. MethodsA randomized controlled trial was designed to compare the outcome of patients undergoing breast surgery and axillary dissection using either standard scalpel blades, scissors, ligations, and electrocautery or the ultrasound scalpel only. Each arm of the trial consisted of 30 patients. ResultsA statistically significant benefit in terms of axillary and chest wall drainage volume, the number of axilla seromas, intraoperative bleeding, and hospitalization stay was recorded in the harmonic scalpel group. No significant differences were found between the 2 groups in terms of operative time. Finally, no postoperative hematoma, wound infections, and chest wall seroma were observed. ConclusionsThe use of the harmonic scalpel was shown to reduce the magnitude of seromas in axilla and hospitalization stay. The harmonic scalpel can be used alone in axillary dissection with a safe and effective hemostasis. Our results must be confirmed by larger series.

Discussion: Comparative Healing of Human Cutaneous Surgical Incisions Created by the PEAK PlasmaBlade, Conventional Electrosurgery, and a Standard Scalpel

Discussion: Comparative Healing of Human Cutaneous Surgical Incisions Created by the PEAK PlasmaBlade, Conventional Electrosurgery, and a Standard Scalpel

Comparative Healing of Human Cutaneous Surgical Incisions Created by the PEAK PlasmaBlade, Conventional Electrosurgery, and a Standard Scalpel

The authors investigated thermal injury depth, inflammation, and scarring in human abdominal skin by comparing the histology of incisions made with a standard "cold" scalpel blade, conventional electrosurgery, and the PEAK PlasmaBlade, a novel, low-thermal-injury electrosurgical instrument. Approximately 6 and 3 weeks before abdominoplasty, full-thickness incisions were created in the abdominal pannus skin of 20 women, using a scalpel (scalpel), the PlasmaBlade, and a conventional electrosurgical instrument. Fresh (0-week) incisions were made immediately before surgery. After abdominoplasty, harvested incisions were analyzed for scar width, thermal injury depth, burst strength, and inflammatory response. Acute thermal injury depth was reduced 74 percent in PlasmaBlade incisions compared with conventional electrosurgical instrument (p < 0.001). Significant differences in inflammatory response were observed at 3 weeks, with mean CD3 response (T-lymphocytes) 40 percent (p = 0.01) and 21 percent (p ≈ 0.12) higher for the conventional electrosurgical instrument and PlasmaBlade, respectively, compared with the scalpel. CD68 response (monocytes/macrophages) was 52 percent (p = 0.05) and 16 percent (p ≈ 0.35) greater for a conventional electrosurgical instrument and the PlasmaBlade, respectively. PlasmaBlade incisions demonstrated 65 percent (p < 0.001) and 42 percent (p < 0.001) stronger burst strength than a conventional electrosurgical instrument, with equivalence to the scalpel at the 3- and 6-week time points, respectively. Scar width was equivalent for the PlasmaBlade and the scalpel at both time points, and 25 percent (p = 0.01) and 12 percent (p = 0.15) less than for electrosurgery, respectively. PlasmaBlade incisions demonstrated reduced thermal injury depth, inflammatory response, and scar width in healing skin compared with electrosurgery. These results suggest that the PlasmaBlade may provide clinically meaningful advantages over conventional electrosurgery during human cutaneous wound healing. Therapeutic, II.(Figure is included in full-text article.).

Comparative Healing of Rat Fascia Following Incision with Three Surgical Instruments

Incisional hernia and fascial dehiscence are associated with significant postoperative morbidity. Electrosurgical devices using pulsed radiofrequency energy and a novel electrode design markedly reduce thermal injury during cutting and coagulation while maintaining equal surgical performance. In this study, we examine fascial healing dynamics in a rat model following incision with a pulsed radiofrequency energy device (PRE), a conventional electrosurgical device, and a standard "cold" scalpel. We hypothesize that incisions made with the pulsed radiofrequency energy device will result in a superior fascial healing profile compared with conventional electrosurgery. Full thickness surgical incisions were created in rat fascia using a commercially available PRE device, conventional electrosurgery, and a scalpel. Harvested fascial specimens were analyzed for burst strength testing and healing-associated histologic characteristics at d 7, 14, 21, and 42. PRE incisions were fully healed by 6 wk with normal tissue architecture. By all measures, wounds created by the PRE device were comparable to those made with the standard scalpel. Compared with PRE, conventional electrosurgery incisions exhibited a larger zone of tissue injury (68% greater in Coag mode, P < 0.0001; 46% greater in Cut mode, P < 0.001), an increased inflammatory response and a less favorable wound architecture. In the immediate postoperative period (1 wk), burst strength testing demonstrated that PRE fascial wounds were significantly stronger than those made by electrosurgery in Coag mode (318%, P = 0.001). The favorable fascial healing profile of the PRE device suggests that it is a promising new surgical technology. The early improved strength of wounds made with this device is of particular interest, as wound dehiscence is of greatest concern early in the healing process.

Bipolar scissors circumcision is a safe, fast, and bloodless procedure in children

Purpose The aim of this study is to evaluate bipolar scissors circumcision by comparing it with standard freehand scalpel procedure. Patients and Methods Data were analyzed from a prospective, randomized study, comparing 2 different surgical techniques for pediatric circumcision: the bipolar diathermy scissors circumcision technique with those of a conventional scalpel technique. A total of 230 pediatric patients younger than 16 years (115 in each arm of the trial) who were undergoing circumcision were reviewed prospectively. Operative time, surgical bleeding, complications, and postoperative morbidity were analyzed. Differences between bipolar scissors circumcision and conventional surgery were compared. Results Median blood loss for bipolar circumcision was 0.2 mL (range, 0-0.8 mL) compared with 2.1 mL in the standard group (range, 0.9-4.2 mL) ( P < .001). Operative time in the bipolar diathermy treated group was significantly decreased compared with conventionally treated patients (10.8 ± 1.2 vs 19.1 ± 2.6 minutes; P < .01). Early and late postoperative morbidity were significantly decreased in circumcised patients who underwent the bipolar circumcision technique as compared with those who underwent the conventional approach regardless of the postoperative edema (22 vs 10; P = .02). Conclusions Bipolar scissors circumcision approach is an effective and safe procedure alternative to the standard scalpel technique in pediatric circumcision with no significant morbidity.

Comparative healing of surgical incisions created by a standard bovie, PEAK electrosurgical cutting tool, and standard scalpel blade

Comparative healing of surgical incisions created by a standard bovie, PEAK electrosurgical cutting tool, and standard scalpel blade

Randomized Clinical Trial Comparing Two Mastectomy Techniques

The unit was considering the routine use of diathermy scissors for standard mastectomy surgery. We therefore aimed to assess scientifically the outcome of patients following the use of this instrument in their operation before accepting it as a routine procedure. A single blind randomized control trial compared the outcome of patients undergoing simple mastectomy using either the standard scalpel blade technique or the bipolar cutting scissors technique. Each arm of the trial contained 30 patients. The two primary outcome measures were blood loss intraoperatively and the operating time. There was a significant difference between the two groups, with a statistically significant benefit in the scissors group in terms of the secondary outcome measures of chest wall clearance and skin flap development as assessments of surgical completeness of mastectomy. There is no evidence of any other secondary outcome measures differing between the treatment groups. There is strong evidence that using electric scissors reduces intraoperative blood loss and operating time. There is some evidence that the scissors may provide better surgical completeness of mastectomy.

An alternate approach for harvesting Mohs specimens with a flexible scalpel.

Mohs micrographic surgery is a highly successful technique for removing skin cancers while conserving normal tissue. However, conservation of the deep margins can often be difficult to achieve when using a standard scalpel. An inability to conserve normal tissue at the deep margins can greatly impact the complexity of repair, duration of surgery, aesthetic result, and patient morbidity. To find an alternative method of obtaining Mohs specimens that offers greater control of the depth of incision when compared to the standard scalpel. We utilized a flexible scalpel to obtain Mohs levels on patients with superficial cutaneous malignancies in anatomic locations where careful conservation of the deep margins would allow for less extensive repair. For those patients who had tumor-free margins after one level of Mohs surgery, the shallower defects achieved with the flexible scalpel allowed for excellent cosmetic outcomes and decreased patient operative time and morbidity. The flexible scalpel is both effective and efficient in obtaining thin Mohs specimens when conservation of the deep margin is of utmost importance.

Nd: YAG laser scalpel compared with conventional techniques in head and neck cancer surgery

Many theoretical advantages over conventional surgical techniques have been attributed to the Nd:YAG contact laser. Clinically significant differences in perioperative results between the Nd:YAG contact laser and standard surgery, however, are not well defined. The present study was undertaken to evaluate the Nd:YAG contact laser compared with standard scalpel and/or electrocautery in curative operations for head and neck cancer. Clinical records of 36 patients undergoing head and neck cancer surgery were reviewed retrospectively. Patients were studied in three groups: 9 previously irradiated patients operated upon using the Nd:YAG laser (Nd:YAG); 9 previously irradiated patients operated upon using conventional techniques (conventional/RT); 18 nonirradiated patients operated upon using conventional techniques (conventional/no RT). These groups underwent 14, 14, and 25 procedures, respectively. Differences between the Nd:YAG, conventional/RT, and conventional/no RT groups regarding cancer staging, age, procedures performed, operative time, intraoperative blood loss, and hospital and ICU stay were not statistically significant. Preoperative radiotherapy dosages in the Nd:YAG and conventional/RT groups were similar (5,127 +/- 842 vs. 604 +/- 2,373 cGy). Postoperative morbidity in Nd:YAG patients (11%) was similar to that of the conventional/no RT group (17%) and was significantly reduced compared to conventional/RT (11% vs. 56%, P < 0.05). Clinical outcome, including operative time, blood loss, and hospital and ICU stay using the Nd:YAG contact laser in curative operations on previously irradiated patients with head and neck cancer, is equal to that of conventional surgical techniques, with or without preoperative radiotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Burn Excision with Contact Neodymium:YAG Laser

The newest laser modality, the contact Neodymium: YAG laser, was compared with the standard steel scalpel in excisions of full-thickness burns. Six patients with deep burns of variable sizes were included in this pilot study. The area to be operated on in each patient was divided into two areas resembling each other as much as possible in size, tissue type, and depth of injury. The results suggest that bleeding was diminished by 44% in contact laser surgery compared with the steel scalpel. Still the difference was not significant. There was no impairment of graft take after laser surgery compared with the steel scalpel. However, the laser method caused a significant increase (p less than 0.02) in operating time. The contact Nd: YAG laser can be recommended for excision of relatively small deep burn injuries, especially in areas in which bleeding is a problem with other methods.

Development and Evaluation of a New Instrument for Safe Heelstick Sampling of Neonates

A new semiautomatic device for performing heelpunctures (TenderfootTM) on newborn infants was tested on 62 neonates and compared to the performance of a standard scalpel blade and a semiautomated lancet. The device makes an incision that is 1-mm deep and2.5-mm wide, allowing the free-flowing collection of up to 3 mL of blood. When compared to the other techniques, this device caused less hemolysis of sample, required fewer punctures to obtain a desired sample, and produced less physical trauma to the infant's heel. The blade of this device automatically retracts following skin incision, thereby insuring that the blood collector and infant are not subject to accidental puncture. Because of its greater performance and increased safety, this device is recommended for routine heel punctures.

New technique for producing uniform partial lacerations of tendons.

Previous experimental studies of partial flexor tendon lacerations have used tendons cut by hand with magnification and a scalpel. When we biomechanically tested chicken flexor tendons lacerated by hand through 75% of their cross-sectional area, the tensile strength of the residual tendons varied substantially among specimens from different chickens as well as between digit matched pairs of tendons from the same animal. A device was designed that uses standard scalpel blades to create a uniform tendon laceration by leaving a constant area of tendon intact regardless of original tendon size or shape. With the instrument we have called the "tenotome," a second group of chicken flexor tendons were lacerated through 75% of their cross-sectional area. Biomechanical testing of the tendons cut with the tenotome showed significantly less variation when compared with the tendons cut by hand. Use of the tenotome permits the establishment of a more uniform model for partial flexor tendon injuries, and potentially decreases the number of specimens needed to demonstrate statistical significance.

AP-S turnstile

As many AP-S inventors can readily testify, the transition from a laboratory prototype to a commercially viable product can be an agonizingly slow process. Leonard Taylor (University of Maryland) patented the microwave scalpel in 1979. The device integrates a 2.45 GHz loop antenna with a standard scalpel blade. During surgery on highly vascular organs, such as -the liver or the spleen, the localized microwave field produced by Taylor's scalpel thermally cauterizes blood vessels. In 1985, an option to manufacture and market the device wasold by the University of Maryland to Advanced Medical Imaging Corp. (Great Neck, NY). Now, a decade after the patent was issued to Taylor, the scalpel is undergoing human clinical trials under FDA supervision. Apparently between 75 and 100 documented surgical cases will be needed before the FDA will consider clearing the device for general use. (Microwaves & R F , March 1989)

The use of the bone curet in debridement of the burn wound and graft recipient sites.

We describe the use of the simple bone curet for the purpose of scraping and debriding partial-thickness burn wounds and other chronic wounds encountered by the burn surgeon before autograft placement. In our experience the instrument allows more efficient and safer operating room debridement than does the standard scalpel blade.