The findings lead to the conclusion that tissue lateral thermal damage after Harmonic Scalpel application at standard output power is greater when a longer sustained period of application is used. Lateral thermal damage also is greater if the Harmonic Scalpel application time is continuous rather than of the same total duration with a brief midpoint interruption.

Background: New hemostatic technologies are often employed in open and laparoscopic surgery to reduce duration of surgery and complications. Monopolar diathermy, Harmonic scalpel and LigaSure are routinely used in open and laparoscopic surgery for tissue cutting and hemostasis. We compared lateral thermal damage following in vivo application of 3 commonly used instruments. Methods:We used monopolar diathermy, Harmonic scalpel and LigaSure to coagulate and divide the peritoneum of patients who underwent median laparotomy. After anesthesia, median supraumbilical laparotomy was performed, and the peritoneum of each patient was coagulated using different devices. Using light microscopy and morphometric imaging analysis, the width of tissue lateral thermal damage was measured from the point of the peritoneal incision. Results:We included 100 patients in our study. After a peritoneal incision, the mean lateral thermal damage of monopolar diathermy, Harmonic scalpel (output power 3), Harmonic scalpel (output power 5) and LigaSure were 215.79 μm, 90.42 µm, 127.48 µm and 144.18 μm, respectively. Conclusion:The degree of lateral thermal spread varied by instrument type, power setting and application time. LigaSure and Harmonic scalpel were the safest and most efficient methods of tissue coagulation. Monopolar diathermy resulted in the greatest degree of thermal damage in tissues. Contexte :On utilise souvent les nouvelles technologies hémostatiques lors de chirurgies ouvertes et laparoscopiques afin d'abréger l'intervention et de prévenir les complications. La diathermie monopolaire, le scalpel Harmonic et le système LigaSure servent couramment lors des chirurgies ouvertes et laparoscopiques pour inciser et cautériser les tissus. Nous avons comparé les lésions thermiques latérales consécutives à l'application in vivo de ces 3 instruments d'usage courant.Méthodes : Nous avons utilisé la diathermie monopolaire, le scalpel Harmonic et le système LigaSure pour cautériser et séparer le péritoine de patients soumis à une laparotomie médiane. Une fois les patients anesthésiés, la laparotomie supraombilicale médiane a été effectuée et le péritoine de chaque patient a été cautérisé à l'aide de différents instruments. Par microscopie optique et analyse morphométrique, nous avons mesuré la largeur des lésions thermiques latérales des tissus à partir du point d'incision du péritoine. Résultats :Nous avons inclus 100 patients dans notre étude. Après l'incision du péri-toine, les atteintes thermiques latérales moyennes associées à la diathermie monopolaire, au scalpel Harmonic (puissance 3), au scalpel Harmonic (puissance 5) et au système Liga Sure ont été respectivement de 215,79 μm; 90,42 μm; 127,48 μm; et 144,18 The Harmonic scalpel incorporates piezoelectric transducers that induce a vibration frequency at the functional tip and transduces a lower amount of energy to the tissue than high-frequency current or laser techniques, resulting in reduced lateral thermal damage and penetration depth owing to lower temperatures. 4,5 Ultras...

HBO therapy reduced the frequency of wound complications in patients with Gustilo type III wounds and shortened the time to granulation formation. HBO therapy was more effective in non-NATO than in NATO treated patients for the prevention of deep soft-tissue infection but not flap necrosis.

There is no clinical evidence supporting the routine use of endoscopic staplers. The appendiceal stump can be secured safely with the use of endoloops in the majority of patients. Surgeons have to be more selective when choosing how to perform closure, and an endostapler should be used only in cases where it is clinically indicated.