Ultrasonically Activated Shears Research Articles

Evaluation of the safety of using harmonic scalpel during laparoscopic cholecystectomy in children: A preliminary report.

Background and objectiveIn spite of being one of the most common surgical procedures performed in adults, laparoscopic cholecystectomy (LC) is relatively uncommon in the pediatric age group. Most surgeons prefer to dissect the cystic duct using a monopolar electrosurgical hook and occlude it with simple metal clips. Although the safety of using the ultrasonically-activated shears, e.g., harmonic scalpel for dissection of the gallbladder is confirmed in many studies, its efficacy in the closure of the cystic artery and duct in adults is still debatable. Furthermore, very few reports studied its safety in children during LC. The aim of our work is to study the safety and efficacy of ultrasonic shears in controlling the cystic duct and artery during LC in children.Materials and methodsA prospective study was conducted from May 2017 to April 2020, where all children having symptomatic gallbladder stone disease were included in the study. HS was used as a sole instrument in gallbladder dissection as well as in controlling cystic duct and artery. No metal clips or sutures were used throughout the procedure.ResultsA total of forty-two children having symptomatic gallstone disease were included in the study. The main indication for LC was hemolytic anemia. Their age ranged from 3 to 13 years with a mean of 8.4 ± 3.25 years. All operations were completed laparoscopically, i.e., no conversion to open surgery was needed. The mean operative time was 40 ± 10.42 min. There were no intraoperative complications apart from gall bladder perforation in two cases during dissection from the liver bed while the postoperative recovery was smooth in all patients. Patients started oral feeding after 11.30 ± 3.01 h. The mean time for discharge was 25.47 ± 7.49 h, ranging from 14 to 48 h. Postoperative ultrasound for all cases showed no evidence of minor or major bile leaks or CBD injuries.ConclusionThis is the first report to evaluate the use of HS as a sole instrument during LC in the pediatric age group. HS is a safe and efficient instrument that can be used alone in gallbladder dissection as well as in controlling cystic duct and artery during LC in children.

Oncological safety of use of ultrasonic activated shears in gastric cancer surgery: Long-term results of randomized controlled trial.

ObjectiveUltrasonically activated shears (UAS) have been applied in open gastric surgeries with no or little evidence. It was previously reported about the surgical outcome and effectiveness of UAS based on a randomized controlled trial of 256 patients with gastric cancer. We aimed to clarify the long-term oncological safety of the use of UAS in the aspect of overall survival and recurrence.MethodsGastric cancer patients who underwent gastrectomy with D2 lymph node dissection were enrolled and randomly assigned to either the conventional surgery group (n=125) or the UAS group (n=128). Survival, recurrence and long-term postoperative complications were compared between the two groups. The median follow-up period was 56 months.ResultsGastric cancer-related death was higher in patients of the UAS group compared with the conventional group (P=0.019). Overall survival rates stratified by stage were not significantly different between the two groups (P=0.170). Disease-free survival rates stratified by stage and recurrence-free survival rates of gastric cancer were similar between the conventional group and the UAS group (P=0.313 and 0.199, respectively). The postoperative complication rate was not significantly different between the groups (P=1.000).ConclusionsIt is suggested that the use of UAS in gastrectomy for gastric cancer showed oncologically acceptable safety compared with conventional electric instruments even in long-term period.

Ultrasonically Activated Shears Reduce Blood Loss without Increasing Inflammatory Reactions in Open Distal Gastrectomy for Cancer: A Randomized Controlled Study.

Previous studies regarding ultrasonically activated shears (UAS) were performed without controlled surgical procedures or consideration of potential thermal injury due to high temperature of active blade of UAS. The purpose of this study was to evaluate the efficacy and safety of UAS through a comparison with conventional monopolar electrocautery (CME) in open distal gastrectomy for gastric cancer. From October 2011 to November 2012, 56 gastric cancer patients eligible for open distal gastrectomy were randomized into UAS or CME groups. Primary endpoints were estimated blood loss (EBL) during surgery and amount of drainage through the fifth postoperative day. Secondary endpoints were operation time, length of hospital stay, postoperative morbidity, changes in cytokine levels in serum, peritoneal irrigation saline, and peritoneal drainage, and inflammatory markers of serum. (Registration-number of ClinicalTrials.gov: NCT01971775). EBL was lower in the UAS group than that in the CME group (339.8±201.2 vs. 428.6±165.8mL, p=0.021). However, the amount of postoperative drainage was not significantly different between the two groups. Although the complication rate was not different between the two groups, there were three cases of intra-abdominal bleeding requiring transfusion only in the CME group. Inflammatory markers from the cytokine assays and serum laboratory tests showed no significant differences between the two groups. UAS reduced EBL without increasing inflammatory reactions.

Measure of pancreas transection and postoperative pancreatic fistula

BackgroundIn pancreaticoduodenectomy (PD), a standard protocol for pancreas transection has not been established although the method of pancreas transection might be involved in the occurrence of postoperative pancreatic fistula (POPF). This study aimed to compare whether pancreas transection by ultrasonically activated shears (UAS) or that by scalpel contributed more to POPF development. MethodsA prospective database of 171 patients who underwent PD for periampullary tumor at National Cancer Center Hospital East between January 2010 and June 2013 was reviewed. Among the 171 patients, 93 patients with soft pancreas were specifically included in this study. Surgical results and background were compared between patients with pancreas transection by UAS and scalpel to evaluate the effectiveness of UAS on reducing POPF. ResultsBody mass index, main pancreatic duct diameter, or other clinicopathologic factors that have been reported as predictive factors for POPF were not significantly different between the two groups. The incidence of all grades of POPF and that of grade B were significantly lower in the scalpel group (52%, 4%) than in the UAS group (74%, 42%). Postoperative complications ≥ grade III were also significantly fewer in the scalpel group. ConclusionsScalpel transection was less associated with POPF than UAS transection in patients who underwent PD for soft pancreas. The method of pancreas transection plays an important role in the prevention of clinical POPF.

Comparison of Ultrasonic Shears and Traditional Suture Ligature for Vaginal Hysterectomy: Randomized Controlled Trial

Study ObjectiveTo compare operating time, intraoperative blood loss, postoperative analgesia, and length of hospital stay using ultrasonic shears vs traditional suture ligature in vaginal hysterectomy. DesignRandomized controlled trial (Canadian Task Force classification I). SettingGynecology units within a single health network, university hospital. PatientsForty women requiring vaginal hysterectomy because of benign disease. InterventionsVaginal hysterectomy performed using either ultrasonically activated shears (USS) or traditional suture ligatures. Measurements and Main ResultsTwenty-one patients were randomized to the USS arm, and 19 patients to the traditional suture ligature arm. Patient characteristics were comparable. Mean (SD) hysterectomy time and was similar in both the USS and traditional arms, 28.66 (4.0) minutes vs 32.37 (3.18) minutes (p = .47), as was total operating time, 97.38 (8.9) minutes vs 91.63 (7.69) minutes (p = .63). Operative blood loss was significantly decreased in the USS group: 62.63 (12.46) mL vs 136.05 (21.54) mL (p = .006). There was, however, no significant change in hemoglobin concentration between the 2 groups: 19.53 (1.79) g/L vs −16.72 (2.5) g/L. There was no significant difference in mean oxycodone use: 9.29 (2.66) mg vs 8.06 (3.19) mg (p = .77). Length of hospital stay was similar in both groups: 58.98 (3.27) hours vs 60.05 (6.48) hours (p = .88). There was no significant difference in overall complication rates between the groups. ConclusionAlthough the Harmonic scalpel system, compared with the traditional suture ligation method, seems to be a safe alternative for securing the pedicles in vaginal hysterectomy, it offers no benefit insofar as operative time, reduction in clinically significant blood loss, and analgesic requirements.

Ultrasonically activated shears versus electrocautery in open gastrectomy for gastric cancer: a randomized controlled trial

Use of ultrasonically activated shears (UAS) is gaining popularity in open surgery but without concrete evidence. We conducted a prospectively randomized study to assess the efficacy of ultrasonic dissection in open gastrectomy for gastric cancer. Patients with gastric cancer who were to undergo gastrectomy with D2 lymph node dissection were enrolled and assigned to either the conventional surgery group (n=125) or the UAS group (n=128). The mean operating time was significantly reduced in the UAS group (89.3±15.6min) when compared to the conventional group (97.8±17.2min; p<0.001). However, we did not find any significant difference in operative blood loss, the amount of postoperative abdominal drainage, or the rate of postoperative complications between the groups. A multivariate analysis for operating time revealed that the use of UAS, female gender and BMI less than 25 were significantly associated with reduced operating time. The operating time was significantly longer in the conventional group than in the UAS group (B 7.786; 95% CI 4.103-11.468; p<0.001). In the subgroup analysis, the use of UAS significantly reduced the operating time, especially in male patients, regardless of the BMI status. The use of UAS in gastrectomy for gastric cancer was a safe and efficient method, especially in terms of reducing operating time for male patients.

Ultrasonically Activated Shears in Gastrectomy for Large Gastric Cancers

High-frequency ultrasound energy was introduced in gastrointestinal surgery to improve dissection and coagulation. We assessed the safety and efficacy of ultrasonic dissection compared with standard electrosurgery in gastrectomy for large gastric cancers, which is associated with high morbidity. The subjects of this retrospective study were 52 patients who underwent gastrectomy for gastric cancers, > or =7 cm in diameter. Gastrectomy was performed with ultrasonically activated shears (UAS) between January 2005 and June 2006 (UAS group, n = 26) and with standard electrosurgery between July 2003 and December 2004 (control group, n = 26). We compared morbidity, operating time, and intraoperative blood loss between the two groups. The mean operating time and intraoperative blood loss were significantly lower in the UAS group than in the control group. Morbidity in the UAS group was also lower, but the difference was not significant. Our findings showed that UAS gastrectomy was safe, with significantly shorter operating times and less intraoperative blood loss than standard electrosurgery.

Efficacy and safety of ultrasonically activated shears in thyroid surgery

The purpose of this prospective study is to evaluate the efficacy of ultrasonically activated shears (UAS) in hemostasis as well as its safety in regard to complications in thyroid surgery. Three hundred patients who had undergone surgery on the thyroid gland were divided into 2 groups of 150 patients each. Hemostasis as well as division of blood vessels and thyroid tissue were performed with the use of UAS in the first group and by conventional ligations in the second group. The use of UAS resulted in as much as a 39.7% reduction in the operative time of the total thyroidectomy and a 30.8% reduction of the lobectomy (p < .001). However, there was no important difference in the postoperative blood loss in either the temporary hypoparathyroidism or the paresis of recurrent laryngeal nerves. The use of UAS in thyroid surgery is a safe method for hemostasis, as well as for the division of blood vessels and thyroid tissue. It leads to the reduction of the total operative time without serious complications.

Experimental Evaluation of Bursting Pressure in Lymphatic Vessels with Ultrasonically Activated Shears

To evaluate the ability of ultrasonically activated shears (USAS) to occlude lymphatic vessels, we investigated the bursting pressure of lymphatic vessels occluded with USAS and compared with pressures in an artery and a vein. The inguinal lymphatic vessels, testicular arteries, and testicular veins were removed from male pigs. The vessels were occluded by USAS at power level 2. The bursting pressures of the harvested vessels were measured ex vivo. The bursting pressure of the artery (average, 1154 mmHg; range, 1000-1341 mmHg) was significantly greater than that in the vein (average, 747 mmHg; range, 560-973 mmHg; p = 0.0024) or the lymphatic vessel (average, 610 mmHg; range, 491-996 mmHg; p = 0.0003). There was no significant difference of bursting pressure between the vein and lymphatic vessel (p = 0.2226). Although the bursting pressures of the vein and lymphatic vessel were significantly lower than that of the artery, they were much higher than that found in physiologic conditions. USAS is considered to be a powerful tool for lymph node dissection for malignant diseases in open surgery as well as laparoscopic surgery.

Two-Port Laparoscopically Assisted Appendectomy in a Child with Use of the Ultrasonically Activated Endo-shear

Laparoscopic appendectomy (LA) is a safe alternative to open appendectomy for treating appendicitis in children. Different methods of LA have been used in children. Single-port laparoscopically assisted appendectomy (LAA) has been performed in children with simple appendicitis. However, this is sometimes not possible when the mesoappendix is short and the position of the appendix is retrocecal. The problem can be overcome with the use of two-port LAA and the new 5-mm ultrasonically activated shears (UAS) (AutoSonix™; Auto Suture, US Surgical Corporation, Norwalk, Connecticut). We describe the new technique with the UAS in a 5-year-old child with acute appendicitis.

Use of Ultrasonically Activated Shears Improves the Safety of Pancreaticojejunostomy After Pancreaticoduodenectomy

To study whether the use of ultrasonically activated shears (UAS) would improve the safety of pancreatojejunal anastomosis after pancreaticoduodenectomy. Retrospective analysis. University teaching hospital. Seventy patients underwent pancreaticoduodenectomy between April 1997 and May 2001. Leakage of pancreatojejunal anastomosis as judged from the contents of the drain within 7 days after operation, and defined as a high amylase level of discharge that was 3 times higher than that of serum. Leakage of pancreatojejunal anastomosis was observed in 1 (1.4%) of the 70 cases. Other complications were stomal ulcer, bile leakage, renal failure, and intra-abdominal abscess in one case each. Use of UAS to perform pancreatectomy eliminates bleeding and pancreatic juice leakage from the branches of the pancreatic duct. Therefore, the cut surface of the pancreas is kept dry, simplifying anastomosis. Use of UAS improves the safety of pancreatojejunal anastomosis after pancreaticoduodenectomy.

Ultrasonically Activated Shears in Thyroid Surgery

Background: Ultrasonically activated shears (UAS) have been documented to be both safe and fast devices in laparoscopic surgery. We studied whether the use of UAS would have some advantage in thyroid surgery. Methods: Thyroidectomies, performed by one senior endocrine surgeon between December 1996 and February 1997, were retrospectively matched, with patients operated on by the same surgeon using the conventional method. Results: Six pairs of total thyroidectomies and one pair of lobectomies could be matched. Mean operating time was 100 minutes for the patients operated on with the UAS and 154 minutes for the patients operated on with the conventional method. The mean operating time with the UAS was thus on average 64.6% of the operation time with the conventional method, with a 95% confidence interval from 50.1% to 83.5% ( t = 4.00, 6 df, P = 0.007). Conclusions: In this material the use of UAS reduced significantly operating time in thyroidectomies.