Background and Objectives:The ultrasonically activated scalpel is a surgical instrument that is used in minimally invasive surgery to safely cut and seal vessels. This study reported the experimental observations of the use of a laparoscopic ultrasonic scalpel, including its safety and feasibility. in sealing vessels of different diameters in an in vivo animal model during both physiological and supraphysiological blood pressure (BP) conditions.Methods:One healthy female swine was used. We performed resections of the omentum, biopsies in different regions of the liver, and a hysterectomy. Vessels with diameters ranging from 2 to 10 mm were sealed with the ultrasonic scalpel under regular hemodynamic conditions and during pharmacologically induced arterial hypertension (BP challenge).Results:For 10 random cuts made in the omentum and during the hysterectomy, the ultrasonic scalpel was effective and fast, with no immediate or delayed bleeding. Bipolar energy, sutures, and hemoclips were not required to control bleeding. No bleeding was observed in sealed vessels up to 8 mm, even during BP challenges sustained for longer than 5 minutes. When testing vessels of 10 mm, bleeding occurred in 1 common iliac vein before 10 minutes of waiting (the point of bleeding was easily identified) and bleeding occurred in 1 of the common iliac arteries during the BP challenge.Conclusion:Our findings corroborate that the ultrasonic scalpel can safely seal arteries up to 8 mm in diameter to prevent or control bleeding during laparoscopic procedures, even when BP exceeds normal levels.
Funding: This study was supported by DMC Importação e Exportação de Equipamentos Ltda which provided advanced medical devices and equipment for surgical procedures through its product development centers and manufacturing facilities in São Carlos-SP, Brazil, and by Instituto Crispi de Cirurgias Minimamente Invasivas (Rio de and measures that can help to minimize animal suffering and avoid problems during such experiments.
Trichoblastoma is characterized as a benign cutaneous neoplasm that originates in the trichoblastic epithelium of the hair bulb. The present report describes the case of a 4-year-old cross breed neutered male cat that had a history of a slow, freely movable, ulcerated, slow growing, solitary cutaneous nodule located on the left scapular region. Histopathological evaluation showed neoplastic cells arranged in cohesive nests or palisades with eosinophilic and scant cytoplasm. Based on the microscopic findings, a diagnosis of trabecular trichoblastoma was made. The treatment of choice consisted of total surgical excision of the mass with safe surgical margins. Tumor recurrence was not observed.
38Infertility has been a common postoperative problem caused by peritoneal adhesions. Since several 39 prophylactic agents have recently shown promising preliminary results, more complete studies comparing 40 their real efficacy and safety are needed urgently. The aim of this study was to investigate and describe 41 practical considerations of a porcine model that can be used to assess such prophylactic agents. First, 10 42 healthy 5½ months old female pigs (24.3 -31.3 Kg) underwent a standardized laparoscopy to provoke 43 peritubal adhesion formation without prophylactic agents. After 30 days, a second-look laparoscopy was 44 performed to evaluate adhesions and perform adnexectomy for histopathological evaluation. Adhesions 45 at different sites were classified by grade, for which the scores range from 0 (no adhesion) to 3 (very 46 strong vascularized adhesions), and also by area, with scores ranging from 0 (no adhesion) to 4 (>75% of 47 the injured area). The histopathological evaluation of the distal uterine horns, oviducts and ovaries were 48 compared withthose from a control group of six healthy pigs with no previous surgery. Biological samples 49 were collected to assess vitality, inflammation and renal, hepatic and hematopoietic systems. There were 50 small (but significant) changes in serum albumin (P=0.07), globulin (P=0.07), C-reactive protein 51 (P=0.011), fibrinogen (P=0.023) and bilirubin (P<0.01) after 30 days, but all values were within the normal 52 range. No inflammation or abscess formation was observed, but different degrees of adhesion were 53 identified. The estimated occurrence of adhesion (scores >0) and of strong / very strong adhesion (scores 54 >1) was 75% (95% CI: 55 -94.9) and 65% (95% CI: 45 -85), respectively. The porcine model represents 55 a useful animal platform that can be used to test the efficacy and safety of candidate prophylactic agents 56 intended to prevent postoperative peritubal adhesions formation. We present several practical 57 considerations and measures that can help to minimize animal suffering and avoid problems during such 58 experiments. 59 60 61 62 63 3 64 128 Suprema; Protocol Number 004/2017). Besides the health certificate issued by a veterinarian provided by 129 the supplier (Fazenda Penalva, Juiz de Fora, MG), the veterinarian responsible for the study (F.L.F.M.) 130 clinically evaluated all the animals before and during this study. 132In order to optimize the sample size, we considered as realistic an experimental model in which 133 adhesion formation would occur in 90% rather than all of the animals [10,18,19,20]. Assuming a 20%
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