Use Of Cavitron Ultrasonic Surgical Aspirator Research Articles

Reduction of Blood Loss by Means of the Cavitron Ultrasonic Surgical Aspirator for Thoracoscopic Salvage Anatomic Lung Resections.

In centrally located lung tumors, salvage pulmonary resections pose challenges due to adhesions between the pulmonary parenchyma, chest wall, and hilum. This study aimed to investigate the surgical outcomes associated with Cavitron Ultrasonic Surgical Aspirator (CUSA) usage in thoracoscopic salvage pulmonary resections. Patients with centrally located advanced-stage lung tumors who underwent salvage anatomic resections following systemic or radiotherapy were included. They were categorized into CUSA and non-CUSA groups, and perioperative parameters and surgical outcomes were analyzed. Results: The study included 7 patients in the CUSA group and 15 in the non-CUSA group. Despite a longer median surgical time in the CUSA group (3.8 h vs. 6.0 h, p = 0.021), there was a significant reduction in blood loss (100 mL vs. 250 mL, p = 0.014). Multivariate analyses revealed that the use of CUSA and radiotherapy had opposing effects on blood loss (β: -296.7, 95% CI: -24.8 to -568.6, p = 0.034 and β: 282.9, 95% CI: 19.7 to 546.3, p = 0.037, respectively). In conclusion, while using CUSA in the salvage anatomic resection of centrally located lung cancer may result in a longer surgical time, it is crucial in minimizing blood loss during the procedure.

Overview of the Use of CUSA as a Novel Technique to Aid in Annular Decalcification

Mitral annular calcification (MAC) is a major complicating factor in cardiac valve surgery, leading to increased difficulty and complexity in valve replacement. Utilisation of the Cavitron Ultrasonic Surgical Aspirator (CUSA) for annular decalcification has facilitated successful surgical intervention in the setting of severe calcific valve disease in patients who may have otherwise been deemed inoperable or had unsatisfactory surgical outcomes.

Incorporating the Laparoscopic Cusa into Robotic Hepatectomy

Introduction: Robotic technology has many advantages over laparoscopy including improved optics and instrument dexterity. However robotic hepatectomy has been slow to gain acceptance and one reason is the perceived inability to use the Cavitron Ultrasonic Surgical Aspirator (CUSA) during parenchymal transection. We provide a technical description for the successful incorporation of the laparoscopic CUSA during robotic hepatectomy.Methods: Surgical technique: Robotic ports are placed across the upper abdomen. The camera is placed in line with the liver hilum. An additional 12mm assist port is placed between the camera port and the most lateral right sided port for use of the CUSA during parenchymal transection. The liver is divided with the use of the laparoscopic CUSA. Intraparenchymal vascular and biliary structures are divided with a combination of the robotic vessel sealer and hem-o-lok clips. Larger hepatic veins are stapled with the robotic stapler. Results: Robotic hepatectomy was performed on 54 patients from September 2018 to December 2020 at our institution with the use of the laparoscopic CUSA. Major hepatectomy (>= 3 segments) was performed in 21 (39%) cases. Median EBL was 285mL (15-2200) and 5 (9%) of patients required blood transfusion. Major morbidity (grade III) occurred in 2 (4%) cases including 1 biloma and 1 pneumothorax. The median LOS was 2 days (1-9) and 30-day readmission was 7%. The 90-day mortality was 0%. Conclusions: Liver transection with the CUSA improves the visualization of intrahepatic vascular and biliary structures, reducing hemorrhage and biliary morbidity during robotic hepatectomy

Transection of the Liver Parenchyma With an Ultrasound Dissector or a Stapler Device: Results of a Randomized Clinical Study

Perioperative hemorrhage and postoperative bile leakage are severe complications of liver surgery. They may be related to the techniques used to divide the tissue. We designed a randomized clinical trial to compare the cavitron ultrasonic surgical aspirator (CUSA) and an endoscopic stapler device applied in routine clinical hepatic surgical practice. All consecutive patients admitted for elective hepatic resective surgery--at least bisegmentectomy of the liver--were assessed for enrollment in the study. A total of 100 patients were subsequently randomized. There was a good balance between the study groups concerning issues that may be of relevance for the perioperative and postoperative courses. The primary objective of the study was to achieve an approximately 25 % reduction in perioperative blood loss and postoperative bile leakage. Secondary outcome variables were operating time, general postoperative morbidity, length of hospital stay, and direct medical costs. The amount of perioperative or postoperative blood loss did not differ significantly between the two groups. We observed a trend toward shorter transection and operating time for patients in whom staplers were used, but the difference did not reach statistical significance. The postoperative courses were close to identical in the respective study arms with no difference in bile leakage rates or in the total morbidity profiles. The direct medical costs were nonsignificantly lower in the group where staplers were used for liver transection. The results show that the use of endoscopic vascular staplers in liver surgery is feasible and safe. It offers an attractive alternative for division of the liver parenchyma during routine hepatic surgery, being comparable to the use of CUSA without adding extra costs.

TRANSIENT INHIBITION OF MOTOR FUNCTION INDUCED BY THE CAVITRON ULTRASONIC SURGICAL ASPIRATOR DURING BRAIN MAPPING

We report, for the first time, the occurrence of interference between a Cavitron ultrasonic surgical aspirator (CUSA) and intraoperative brain mapping performed by direct electrical stimulation (DES). Intraoperative polygraphic recordings (electrocorticogram and electromyogram) were gathered from a 44-year-old patient harboring a recurrent Grade II oligoastrocytoma operated on with the aid of a CUSA and DES. Simultaneous use of CUSA and DES at the subcortical level in proximity to the corticospinal tract brought about the abolition of previously evident motor responses. This abolition was fully reversible after the CUSA was turned off. An analogous pattern of motor response inhibition was evident when the DES was applied cortically and the CUSA was used subcortically close to motor pathways. Interestingly, the authors had already observed a similar phenomenon in many patients when the CUSA was used for resection of lesions located within or in proximity to subcortical language pathways. In this setting, the CUSA induced transient speech disturbances that were confirmed afterwards by the DES. This interference with language and motor mapping might be interpreted as a transitory inhibition of axonal conduction. The clinical significance of this interference is relevant when the CUSA and DES are used simultaneously for motor mapping because the CUSA can decrease the sensitivity of the brain mapping technique. Further studies will be required to determine the neurophysiological mechanism underlying this interference.

TRANSIENT INHIBITION OF MOTOR FUNCTION INDUCED BY THE CAVITRON ULTRASONIC SURGICAL ASPIRATOR DURING BRAIN MAPPING

OBJECTIVE We report, for the first time, the occurrence of interference between a Cavitron ultrasonic surgical aspirator (CUSA) and intraoperative brain mapping performed by direct electrical stimulation (DES). METHODS Intraoperative polygraphic recordings (electrocorticogram and electromyogram) were gathered from a 44-year-old patient harboring a recurrent Grade II oligoastrocytoma operated on with the aid of a CUSA and DES. RESULTS Simultaneous use of CUSA and DES at the subcortical level in proximity to the corticospinal tract brought about the abolition of previously evident motor responses. This abolition was fully reversible after the CUSA was turned off. An analogous pattern of motor response inhibition was evident when the DES was applied cortically and the CUSA was used subcortically close to motor pathways. Interestingly, the authors had already observed a similar phenomenon in many patients when the CUSA was used for resection of lesions located within or in proximity to subcortical language pathways. In this setting, the CUSA induced transient speech disturbances that were confirmed afterwards by the DES. This interference with language and motor mapping might be interpreted as a transitory inhibition of axonal conduction. CONCLUSION The clinical significance of this interference is relevant when the CUSA and DES are used simultaneously for motor mapping because the CUSA can decrease the sensitivity of the brain mapping technique. Further studies will be required to determine the neurophysiological mechanism underlying this interference.

Postoperative vesicourethral function after ultrasonic surgical aspirator-assisted surgery of gynecologic malignancies

Objective: The most concerned complication of radical hysterectomy includes the vesicourethral dysfunction. The use of Cavitron ultrasonic surgical aspirator (CUSA) may preserve the blood supply to the urinary tract even during the surgical procedure, prompting us to evaluate the advantage of using the CUSA with the complication. Study Design: We analyzed medical profiles of a total of 275 patients with pelvic lymphnode dissection (137 subjects with radical hysterectomy and 138 with modified radical hysterectomy). Results: The use of CUSA in radical (formal or extended) hysterectomy reduced the period for the residual urine to become <50 ml in cases of advanced stages equal and over Ib of uterine cervical cancers. Conclusion: The CUSA may be more effective in the prevention of radical hysterectomy for its major complication, vesicourethral dysfunction. The CUSA-assisted surgery may be applicable, primarily, for advanced uterine cancer.