Ultrasound Scalpel Research Articles

Comparative analysis of hemorrhoid treatment by submucosal laser hemorrhoidoplasty with Doppler controlled dezarterization and mucopexy and hemorrhoidectomy with ultrasound scalpel

Comparative analysis of hemorrhoid treatment by submucosal laser hemorrhoidoplasty with Doppler controlled dezarterization and mucopexy and hemorrhoidectomy with ultrasound scalpel

Piezo-osteotomy in orthognathic surgery: A comparative clinical study.

Background:After the clinical introduction of ultrasound scalpel in recent years, piezosurgery has become competitive with conventional instruments in orthognathic procedures to reduce the operative and postoperative complications reported to occur in association with these surgeries.Aims:The aim of this prospective clinical study was to compare intraoperative and postoperative outcomes of both piezoelectric device and the traditional bur technique in orthognathic surgery. Intraoperative bleeding time, operative time, postoperative swelling, and neurological impairment were evaluated.Materials and Methods:In this study, a split-mouth technique was applied on ten patients requiring orthognathic surgery. To make the osteotomy cuts, on the one side, piezo-osteotome was used, and on the other side, conventional osteotomy bur was used.Results:Duration of osteotomy was found to be greater with piezo osteotomy compared to bur osteotomy. Mild bleeding was observed with piezosurgery. Postoperative swelling was greater on the side of piezosurgery compared to the bur side. Altered neurosensory activity was found to be equal on the 1st day postoperatively, but the piezo side recovered faster compared to the bur side in the 1st month after surgery.Conclusion:Piezoelectric device offers better advantages over the conventional bur in orthognathic surgery and hence can be considered an alternative to the bur in some orthognathic procedures.

Broadband Three-Dimensional Focusing for an Ultrasound Scalpel at Megahertz Frequencies

Ultrasound focusing, with strong penetrability and superior biocompatibility, has attracted substantial interest in biomedical science. Conventional focusing techniques generally rely on an active transducer array or curved lens, and acoustic metamaterials have recently emerged as an alternative approach. However, the low operating frequency of an ultrasound focusing metasurface below 1 MHz and the narrow bandwidth hinder its broad applications in practice. Here, we experimentally realize broadband ultrasound focusing at megahertz frequencies based on a compact and passive metasurface. Three-dimensional spot focusing, ranging from 0.5 to 1.4 MHz, with high spatial resolution (Full width at half maximum of 0.63\ensuremath{\lambda} and full length at half maximum of 2.75\ensuremath{\lambda} at 1 MHz) and tunable focal length (18.5--71 mm), is demonstrated. The focusing pattern is further enriched by realizing a broadband ultrasound scalpel, which effectively converges sound energy within a sharp ``needle'' area. Additionally, accompanied by an enhancement of ultrasound intensity, a prominent temperature rise appears in the focal region, the dependence of which on the ultrasound frequency is investigated and the optimized operating frequency is revealed. Broadband and subwavelength ultrasound spot focusing and a scalpel at megahertz frequencies would promote applications in particle manipulation, nondestructive detection, diagnostic sonography, and ultrasound therapy.

Modified Delta-shaped Anastomosis via the Overlap Method Using Linear Staplers for Colon Cancer

Here, we describe the modified delta-shaped anastomosis (DSA) via the overlap method and how it was a beneficial intracorporeal anastomotic technique for four patients who underwent laparoscopic colectomy. After resecting the colon on both sides of the lesion, proximal and distal colon were laid in an overlap fashion and fixed using sutures. The entry hole was created using an ultrasound scalpel at a point 3 cm proximal to right colic stump and 7 cm distal to left colic stump on the anti-mesenteric side. Then, two arms of the linear stapler were inserted inside each lumen and fired. Finally, using the linear stapler, the common entry hole was closed in a delta-shaped manner. The mean duration of surgery was determined to be 218.4 (196-369) minutes, and amount of blood loss was measured to be 11 (5-25) mL. No intraoperative and postoperative complications were observed. Median postoperative hospital stay was 12 days. Thus, modified DSA via overlap method can be considered as a safe and simple IA technique.

Intraoperative anatomical observation of mesentery morphology of colonic splenic flexure

Objective: At present, surgeons do not know enough about the mesenteric morphology of the colonic splenic flexure, resulting in many problems in the complete mesenteric resection of cancer around the splenic flexure. In this study, the morphology of the mesentery during the mobilization of the colonic splenic flexure was continuously observed in vivo, and from the embryological point of view, the unique mesenteric morphology of the colonic splenic flexure was reconstructed in three dimensions to help surgeons further understand the mesangial structure of the region. Methods: A total of 9 patients with left colon cancer who underwent laparoscopic radical resection with splenic flexure mobilization by the same group of surgeons in Union Hospital of Fujian Medical University from January 2018 to June 2019 were enrolled. The splenic flexure was mobilized using a "three-way approach" strategy based on a middle-lateral approach. During the process of splenic flexure mobilization, the morphology of the transverse mesocolon and descending mesocolon were observed and reconstructed from the embryological point of view. The lower margin of the pancreas was set as the axis, and 4 pictures for each patient (section 1-section 4) were taken during middle-lateral mobilization. Results: The median operation time of the splenic flexure mobilization procedure was 31 (12-55) minutes, and the median bleeding volume was 5 (2-30) ml. One patient suffered from lower splenic vessel injury during the operation and the bleeding was stopped successfully after hemostasis with an ultrasound scalpel. The transverse mesocolon root was observed in all 9 (100%) patients, locating under pancreas, whose inner side was more obvious and tough, and the structure gradually disappeared in the tail of the pancreatic body, replaced by smooth inter-transitional mesocolon and dorsal lobes of the descending colon. The mesenteric morphology of the splenic flexure was reconstructed by intraoperative observation. The transverse mesocolon was continuous with a fan-shaped descending mesocolon. During the embryonic stage, the medial part (section 1-section 2) of the transverse mesocolon and the descending mesocolon were pulled and folded by the superior mesenteric artery (SMA). Then, the transverse mesocolon root was formed by compression of the pancreas on the folding area of the transverse mesocolon and the descending mesocolon. The lateral side of the transverse mesocolon root (section 3-section 4) was distant from the mechanical traction of the SMA, and the corresponding folding area was not compressed by the tail of the pancreas. The posterior mesangial lobe of the transverse mesocolon and the descending mesocolon were continuous with each other, forming a smooth lobe. This smooth lobe laid flat on the corresponding membrane bed composed of the tail of pancreas, Gerota's fascia and inferior pole of the spleen. Conclusions: From an embryological point of view, this study reconstructs the mesenteric morphology of the splenic flexure and proposes a transverse mesocolon root structure that can be observed consistently intraopertively. Cutting the transverse mesocolon root at the level of Gerota's fascia can ensure the complete resection of the mesentery of the transverse colon.

Non-drug technologies in early rehabilitation of patients after hemorrhoidectomy

To study effectiveness of comprehensive postoperative rehabilitation program including ozone therapy, laser therapy, recto-tibial myostimulation and biofeedback therapy in patients after hemorrhoidectomy. The study included 90 patients 20-65 years of age (mean age 41.4±2.1years) with chronic stage III hemorrhoids with prominent external nodules (ICD-10 code: K64.2). All patients underwent Milligan-Morgan hemorrhoidectomy using an ultrasound scalpel by the same coloproctologist to exclude the influence of personality factors. The patients were assigned into two groups by random sampling. The main group consisted of 45 patients who received standard of care and the rehabilitation program, including intravenous ozone therapy, rectal laser therapy, recto-tibial myostimulation, and biofeedback therapy starting from the second day after the surgery. The control group consisted of 45 patients who received the same standard of care in the early postoperative period, including analgesics, local antibacterial ointments (Levomekol, etc.), and rectal suppositories (Relief Pro, etc.). In the early postoperative period, in the patients who received non-drug rehabilitation program, the pain was significantly less intensive, and it relieved faster after surgery, which indicated a strong analgesic effect of the rehabilitation program. Patients in the control group received analgesics (including narcotic drugs) for pain control in 68.9% of cases. Duration of postoperative incapacity for work in the main group patients was 12.9±2.4 days vs. 24.1±2.3 days in the control group patients (p<0.001). The analysis of the quality of life in the early and the late postoperative period by SF-36 scale showed a significant difference between the groups according to the physical health component and psychological component both in the early and in the late postoperative period (after six months), which indicates the higher quality of life in the main group patients. Assessment of the late period quality of life using the I. Yu. Alimzhanova and Yu.M. Sheptunov questionnaire showed good results in 43 (95.6%) patients of the main group. Only in 2 (4.4%) main group patients, anal stenosis was observed. Good results were shown in 38 (84.58%) control group patients. Seven patients had complications: cicatricial anal stenosis (5 [11.1%] patients) and pararectal fistulas (2 [4.4%] patients); in 3 (42.9%) of these 7 patients a persistent pain syndrome was developed. Introduction of the rehabilitation program in the early postoperative period after hemorrhoidectomy contributes to faster relief of pain and other signs and symptoms, a significant decrease of average postoperative wound healing time due to acceleration of adequate scar formation (according to ultrasound sonoelastography), improvement of life quality, reduction of hospital stay, a decrease of incapacity for work duration, and prevention of postoperative complications.

Impact on lower limb lymphedema of pelvic lymphadenectomy with external iliac lymph nodes left-opened distal lymphatics technique.

The aim of this study was to investigate the effect of maintaining opened distal lymphatic vessels of external iliac lymph nodes on lymphedema and lymphocyst formation of lower limbs after pelvic lymphadenectomy. Prospective single center observational study was carried out in 83 patients with gynecological malignancies who underwent pelvic lymphadenectomy. During the operation, the distal lymphatic vessels of the external iliac lymph nodes were cut off by an ultrasound scalpel or scissors, and the proximal end was closed by bipolar coagulation. The patients were re-examined by a physical examination, ultrasound examination and inquiry of the symptoms within 2 years after the operation to check whether they had lower limb lymphedema and to analyze the presence of lymphedema and lymphocyst of lower limbs and the risk. The incidence of lower limb lymphedema (LLL) was 21.6% (18/83). Among the patients with LLL, 5.5% (1/18) was diagnosed with stage 0 according to the criteria of International Society of Lymphology, 83.3% (15/18) with stage 1, and 11.1% (2/18) with stage 2. Presently, there was no lymphedema diagnosed at stage 3. The incidence of lymphocyst was 7.2% (6/83). Among the patients with lymphocyst, 3.6% (3/83) occurred 1 month after operation, 2.4% (2/83) occurred 3 months after operation and 1.2% (1/83) occurred 6 months after operation. Patients with radiotherapy and abdominal infection were more likely to suffer from LLL (P<0.05). Maintaining opened distal lymphatic vessels of external iliac lymph nodes during pelvic lymphadenectomy is feasible, safe and with a 21.6% and 7.2% of potential lymphedema and lymphocists, respectively.

Technological innovation and patent transformation in rectal cancer surgery

Surgery for rectal cancer has obtained quick improvement in techniques and concepts in recent years but still has challenging areas. Colorectal surgeons always seek to make operations clearer and easier, so that surgery can be safer and less time-consuming while guaranteeing surgical goals. With this purpose, our team have explored to make innovations in operations for rectal cancer and translate relevant patents from 2009. We summarize our achievements in this article as follows: (1) Reverse Miles operation (perineal operation first then laparoscopic abdominal operation) with two relevant patents-specialized instruments bag for laparoscopic operations (patent number ZL201520442331.0) and accessory spotlight for ultrasound scalpel (patent number ZL20102 0137689.X). (2) Laparoscopic sphincter-saving surgery for low rectal cancer through marker meeting approach with two patents-vacuum rectal drainage tube with functions of irrigation and ventilation (patent number ZL201520374385.8) and sterile sleeve cover of ultrasound scalpel handle (patent number ZL201920648102.2). (3) Laparoscopic radical resection of colorectal cancer and natural orifice specimen extraction. Different methods were designed according to the location of the tumor that classified as 20-40 cm, 10-20 cm and 5-10 cm to anus. Two relevant patents were specialized instruments for natural orifice specimen extraction (patent application number ZL2017101480141) and plastic film sleeve for natural orifice specimen extraction (patent application number ZL 201921169857.0). Reformation of surgical technique and innovation of surgical instruments should be conducted by surgeons with innovative thinking who always seek the way to translate ideas to patents and then real products to promote surgical treatment.

Study on Influencing Factors and Control Strategies of Surgical Smoke Concentration Distribution

Paroxysmal fumes during surgical operations endanger the health of medical staff. Special measures for removing surgical smoke are lacking. Article Real-time monitoring of particulate matter concentrations in surgical smoke at different locations under different surgical conditions were explored, and a particulate matter purification control strategy was proposed. The PM2.5 and PM10 concentrations in the operating and respiratory zones near the operating table were about 3.0 times more than the specified value, but both surgical procedures met the requirements of PM concentration in the public zone. Therefore, a clean operating room is not clean for medical staff. The smoke produced by the three scalpels resulted in particle sizes of 0.30 - 2.50 μm in the respiratory zone, and calculate apparent density of powders to be 1.21g cm-3. The surgical smoke produced by the ultrasound scalpel resulted in the highest median PM10 concentration in the operating area. The results show that the smoke produced by different surgical conditions is mainly ultra-fine particles, which are more likely to harm the health of medical staff. A small surgical smoke circulation purification and dust removal system was designed, which could effectively suppress the spread of surgical smoke and reduce the occupational hazards of medical staff. The optimized control plan could significantly reduce the PM2.5 concentration value at measurement point a when the electric knife was turned on by approximately 200.0 %. The PM2.5 concentration of breathing zone was close to 75.0 μg m-3, which basically met the occupational health requirements. The decrease in the PM2.5 concentration of operating zone was about 50.0 %, but it still exceeded the limit. It had a reference value for the occupational health protection of the first-line medical staff of existing epidemics.

Laparoscopic resection of hemangiomas in the right posterior hepatic section without any blood flow occlusion: a study on 28 patients

Objective To study the safety and efficacy of laparoscopic resection of hemangioma in the right posterior hepatic section without any blood flow occlusion. Methods Patients with hemangiomas in the right posterior section of liver operated from January 2016 to June 2018 in the Affiliated Hospital of Youjiang Medical College for Nationalities were studied retrospectively. There were 19 females and 9 males. The average age was (37.9±6.1). The operation methods, perioperative factors, hospitalization cost and follow-up outcomes were recorded and analyzed. Results 28 patients with hemangiomas were treated with laparoscopic resection of right posterior hepatic section without any blood flow occlusion. An ultrasound scalpel was applied to split the liver in 27 patients, and ultrasound scalpel combined with Ligasure to split the liver in 1 patient. The mean diameter of the hepatic hemangiomas was (6.7±1.3) cm. The intraoperative blood loss was (330.4±139.0) ml and the operation time was (87.4±27.9) min. One patient required conversion to open surgery due to rupture and bleeding of the hemangioma. The conversion rate was 3.6% (1/28). The postoperative drainage time was (45.4±18.9) h. The postoperative hospitalization time was (7.5±1.3) d, and the hospitalization cost was (3.1±0.5) ten thousand yuan. No death or serious complications occurred. No reoperation was needed. The follow-up period ranged from 1 to 30 months, and all the patients were well on follow-up. Conclusions Laparoscopic resection of hemangioma in the right posterior hepatic section without any blood flow occlusion was safe and efficacious. This method can be used for hemangiomas in the right posterior section of liver. Key words: Hemangioma; Liver; Laparoscopes; Non-blood control methods

The first experience of the simultaneous application of ultrasound scalpel and laser in the treatment of hemorrhoids.

In recent decades in Ukraine, there has been a steady increase in the incidence of hemorrhoids among the working p eople , which makes it an important socio-economic problem. Due to the exacerbation of hemorrhoids, the quality of life is significantly reduced. The choice of tactics for the treatment of chronic hemorrhoids is still not a complete solution to the problem. T he article describes a comparative analysis of the technique of performing hemorrhoidectomy using the ultrasound Harmonic scalpel, as well as the combination of the laser « Lika surgeon » with the ultrasound Harmonic scalpel.

Повышение эффективности спленэктомии в хирургической гематологии

Цель. Повышение качества хирургического лечения гематологических больных.&#x0D; Материалы и методы. Проведено комплексное обследование 102 больных с заболеваниями системы крови, которым была показана спленэктомия (СЭ). Особое внимание уделяли всестороннему дооперационному обследованию для выбора доступа к селезенке. Изменили тактику доступа при лапароскопической спленэктомии (ЛСЭ), во время СЭ использовали ультразвуковой скальпель (УЗС) и прошивающий аппа­рат.&#x0D; Результаты. Анализ полученных результатов СЭ у гематологических больных показал, что выбор доступа зависит от многих причин, которые можно установить до операции. Планирование способа СЭ по совокупным данным ультразвукового исследования (УЗИ) и компьютерной томографии (КТ), изменение тактики доступа при ЛСЭ, использование УЗС и прошивающего аппарата во время операции позволяют улучшить качество хирургического лечения гематологических пациентов.&#x0D; Выводы. УЗИ и КТ играют важную роль при планировании способа СЭ, позволяя избежать случаев конверсии. Изменение тактики доступа при ЛСЭ, а также сочетанное применение УЗС и прошивающего аппарата для выполнения СЭ предупреждают развитие осложнений.

Rectal shaving for deep endometriosis infiltrating the rectum: a 5-year continuous retrospective series

To report postoperative outcomes after rectal shaving for deep endometriosis infiltrating the rectum. Retrospective study using data prospectively recorded in the CIRENDO database. University tertiary referral center. One hundred and twenty-two consecutive patients whose follow-up observation ranged from 1 to 6years. Rectal shaving performed using ultrasound scalpel or scissors and plasma energy in 68 and 54 women, respectively. Postoperative digestive function assessed using standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index (GIQLI) and the Knowles-Eccersley-Scott-Symptom Questionnaire (KESS). Nodules were between 1 and 3cm, <1cm, and >3cm in diameter, in 73.7%, 11.5%, and 14.8% of cases, respectively. They were located on the middle (49.2%) and upper rectum (50.8%). Clavien-Dindo 3a, 3b, 4a, and 4b complications occurred in 0.8%, 5.7%, 1.6%, and 0.8% of cases, respectively. Excepting two rectal fistulas (1.6%), the majority of complications were not related to rectal shaving itself. Gastrointestinal scores revealed statistically significant improvement in digestive function and pelvic pain at 1 and 3years after rectal shaving, but not constipation. Rectal recurrences occurred in 4% of patients, 2.4% of whom had segmental resection, 0.8% shaving, and 0.8% disc excision. Three years postoperatively, the pregnancy rate was 65.4% among patients with pregnancy intention, 59% of whom conceived spontaneously. Our data suggest that rectal shaving is a valuable treatment for deep endometriosis infiltrating the rectum, providing a low rate of postoperative complications, good improvement in digestive function, and satisfactory fertility outcomes.

Clinical study of the impact on ovarian reserve by different hemostasis methods in laparoscopic cystectomy for ovarian endometrioma

ObjectiveTo evaluate the impact of different hemostasis methods on ovarian reserve in laparoscopic cystectomy in treatment of ovarian endometrioma for the long-term. Materials and MethodsA total of 207 patients with ovarian endometrioma, aged from 18 years to 45 years, were randomized into three groups: Group A (69 patients) treated by bipolar electrocoagulation hemostasis in laparoscopic cystectomy for ovarian endometrioma; Group B (69 patients) with ultrasound scalpel hemostasis; and Group C (69 patients) with suture technique hemostasis. The follicle-stimulating hormone (FSH), anti-Mullerian hormone (AMH), antral follicle count (AFC), and peak systolic velocity (PSV) were observed and compared at the 3rd day of the 1st, 3rd, 6th, and 12th menstrual cycle after surgery. Results(1) A total of 13 out of 207 patients failed; four in Group A, five in Group B, and four in Group C. There was no statistically significant difference between groups (p > 0.05). The failure rate was the highest during the 3rd month in the follow up (10 cases). (2) FSH: at the 1st month, 3rd month, 6th month, and 12th month follow up, FSH was higher in Group A and Group B than in Group C (p < 0.05). (3) AMH: AMH was significantly lower in Group A and Group B than in Group C (p < 0.05) during the same period. (4) AFC: no difference of AFC was observed at the 1st month and 3rd month (p > 0.05), whereas at the 6th month and 12th month, AFC in Group C was obviously higher than that in Group A and Group B (p < 0.05). (5) PSV: at the 1st month, 3rd month, 6th month, and 12th month follow up, PSV was significantly lower in Group A and in Group B than in Group C (p < 0.05). ConclusionUltrasonic scalpel or bipolar electrocoagulation hemostasis applied to laparoscopic cystectomy is associated with a significant reduction of ovarian reserve. Electrocoagulation of hemostasis should be used with caution.

Pure laparoscopic right hemihepatectomy via anterior approach

In open hepatectomy ear, right hemihepatectomy via anterior approach has been accepted as one of the standard methods in some specialized centers. However, pure laparoscopic right hemihepatectomy by anterior approach is technically demanding [1-5]. Here, we described the technique of pure laparoscopic right hemihepatectomy via anterior approach. We performed three pure laparoscopic right hemihepatectomies via anterior approach between 2013 and 2014. This video illustrated this procedure steps in a 32years old male with hepatocellular carcinoma. Right hemihepatectomy was performed after hemihepatic vascular inflow occlusion using the lowering of the hilar plate approach [6]. The hepatic parenchyma transection via anterior approach was performed with Ligasure, ultrasound scalpel and bipolar electrocoagulation. The right hepatic vein was divided with an endoscopic vascular stapler. Thereafter, mobilization of the right liver was performed. The operation time was 240min, and the blood loss was 150ml. The recovery was uneventful and the patient discharged on postoperative day 8. The pathology was hepatocellular carcinoma with vascular invasion and also satellites foci adjacent to the main tumor. The resection margin was negative. Pure laparoscopic right hemihepatectomy via anterior approach was safe and feasible.

Minimally invasive video-assisted submandibular sialadenectomy: surgical technique and results from two institutions.

Submandibular gland excision is traditionally performed using a transcervical approach. However, innovative surgical trials have recently been conducted to investigate techniques that can prevent or reduce visible scarring and nerve injury. The aim of the present study was to evaluate the feasibility of a new approach to submandibular gland excision that is based on the use of a minimally invasive video-assisted technique and an ultrasound scalpel in an endoscopic neck surgery program with a low annual flow of procedures. We retrospectively studied 15 patients with submandibular gland disease who underwent minimally invasive video-assisted submandibular sialadenectomy performed by two surgeons at two institutions. Eight patients had proximally located salivary calculi, three had chronic sialadenitis, and four had benign neoplasms. All dissections were carried out by a single-port gasless approach, using the Miccoli technique, involving endoscope magnification and an ultrasonic scalpel. All 15 submandibular gland resections were performed successfully, with no conversions to conventional open resection. The operative time ranged from 45 to 125min (median 84min). A total of 67% of patients were discharged the day after surgery, and the maximum length of stay was 3days. One patient experienced postoperative bleeding, and one experienced postoperative infection. There was no neural injury. The incision scar healed well in all cases, and all patients reported excellent cosmetic results. Endoscopic submandibular gland resection using a minimally invasive video-assisted technique, endoscopic magnification, and ultrasonic scalpel was feasible and resulted in excellent surgical outcomes.

Current Status and Deficiency of Hemostasis in Surgery: A Systematic Literature Review, Including Chinese Literature.

PHP91 Current StatuS and defiCienCy of HemoStaSiS in Surgery: a SyStematiC Literature review, inCLuding CHineSe Literature Tsao J.1, Chen X.J.2, Yue N.2 1Johnson & Johnson Medical Asia-Pacific, Singapore, 2Johnson & Johnson Medical China, Beijing, China Objectives: Perioperative bleeding sometimes results in severe consequence. An understanding of hemostasis approaches is crucial in managing the operations. This review aims to show the development of hemostasis in surgery around the world including China. MethOds: Literature in PUBMED was searched between 2009 and 2014; search terms included hemostasis and surgery; filters included human, English and clinical trials. A similar search was done in Chinese CNKI database. Searching results were carefully reviewed and studies compatible with our inclusion criteria were then selected. Results: From an initial search which yielded 99 references in PUBMED and 50 references in CNKI, 54 articles in PUBMED and 16 articles in CNKI were included in the review. Operations in 11 subjects were involved in these articles. We found that conventional hemostasis (classic technique of tying and knots, resorbable ligature) was gradually replaced by novel techniques such as bipolar tissue sealant device, ultrasound scalpel, hempclips, blue-violet light emitting diode irradiation, Ankaferd Blood Stopper, etc. Fibrin sealant, collagen hemostat and chitosan gel had important roles to be supplement. Certain drugs (tranexamic acid, Fibrinogen concentrate, hemocoagulase, etc) used perioperatively could be efficient too. On the other hand, some new techniques (vascular clips) failed to show significant benefits in some subjects (thyroid surgery). Furthermore, some techniques (bipolar coagulation) might affect the postoperative function of certain organs (ovary). While some techniques (harmonic scalpel) could save the whole cost in hospital, most could not. Information in China was similar with the world. cOnclusiOns: Some of the novel hemostasis approaches in surgery could decrease blood loss perioperatively as well as reduce operative time, hospital stay, the rate of complications and the whole cost. However, some shortcomings still exist and more correlative researches should be performed in the future.

Does the ultrasound dissector improve parathyroid gland preservation during surgery?

BackgroundThe most common complication of thyroid surgery is hypoparathyroidism, usually temporary. Ischemic injury or parathyroid avulsion are the causes of surgical hypoparathyroidism. We assessed the value of an ultrasound scalpel, the Harmonic Focus® (HF), could prevent surgical-related hypoparathyroidism. MethodsPatients consecutively undergoing total thyroidectomy using the HF from November 2009 to February 2011 were recruited and their clinical characteristics, type of operation, histology, and postoperative calcium levels (normal range: 2.10–2.55 mMol/l) were recorded. The prevalence of transient and permanent hypocalcemia was calculated for benign vs. malignant diseases and compared with a control group of 147 patients treated surgically in 2005 using manual technique. Results139 patients treated by the same surgeon with a total thyroidectomy (41.7% for a malignant disease) were considered. Prevalence of transient hypoparathyroidism (THP) was 45.2% and of definitive hypoparathyroidism (DHP) 1.4%. None of the patients with malignancies were hypocalcemic at 1-year follow-up. In the control group THP was found in 51.7% of cases and DHP in 5.4% (p < 0.001). ConclusionsUse of the ultrasound scalpel improved the likelihood of the parathyroid glands preservation during thyroid surgery. Paradoxically, the HF appears to be more effective in treating malignant disease, i.e. when central node dissection is required.

Video-assisted thoracoscopic lobectomy for non-small cell lung cancer: a morbidity limiting approach in a patient on chronic hemodialysis and double agent antiplatelet therapy

Patients with end-stage renal disease on hemodialysis undergoing surgery for lung cancer represent a high-risk group because of electrolyte imbalance, anemia, hemodynamic instability, bleeding tendency, and immunocompromised state. We describe a patient on hemodialysis with three lung adenocarcinoma of the right lower lobe as an incidental finding during the clinical course of a myocardial infarction treated with drug-eluting stent implantation and double-agent antiplatelet therapy. Considering patient comorbidities, we decided to perform a right lower lobectomy and complete lymph node dissection by a minimally invasive technique. In our experience, the thoracoscopic approach allowed us to perform lobectomy with complete lymph nodes dissection without morbidity. The use of ultrasound scalpel permits a complete lymph node dissection minimizing bleeding even in a double antiplatelet therapy patient.

Prospective Randomized Study of Radiofrequency Versus Ultrasound Scalpels on Functional Outcomes of Laparoscopic Radical Prostatectomy

Surgical treatment of patients with prostate cancer currently involves laparoscopic radical prostatectomy (LRP) or robot-assisted LRP. Continence and nerve-sparing procedures in these techniques are supported by dissection and hemostatic surgical devices powered by different types of energy. The aim of this study was to assess recovery of continence and erectile function after laparoscopic extraperitoneal radical prostatectomy comparing two surgical devices for dissection and hemostasis-radiofrequency (RF) and ultrasound (US) scalpels. A total of 132 men with localized prostate cancer were prospectively enrolled and scheduled for extraperitoneal LRP. Patients were randomly assigned to the RF group (LigaSure; n=66) or the US group (UltraCision; n=66). Outcomes were measured by the self-administered questionnaires (International Consultation on Incontinence Questionnaire-Urinary Incontinence [ICIQ-UI] and International Index of Erectile Function 5 [IIEF 5]) 15 days before surgery, 90 and 180 days after prostatectomy to assess recovery of urinary continence and erectile function. No significant difference was found between the two groups regarding operative time, intra- and perioperative complications, or time of hospital stay. At 180 days after surgery, patients in the RF-treated group showed better recovery in terms of continence and erectile function compared with patients in the US group (ICIQ-UI: p=0.0016; IIEF 5: p=0.0352). The use of the RF scalpel provided better functional outcomes compared with the US scalpel in patients undergoing extraperitoneal LRP. This might be attributed to the low contiguous damage of those tissues, which are not directly involved in dissection and hemostasis, achieved using the RF device.