The specialty of laparoscopy has evolved with the advent of new technologies over the last few years. Energy-based devices and Ultrasonic dissectors are used with a lot of factors in play-including ergonomics and economics during surgery. Here an attempt is based to review the surgical efficacy and safety of these dissectors with importance to plume production and lateral thermal damage. The factors contributing to adversities to the dissectors are also to be noted. The strategy adopted was aimed at finding relevant studies from PubMed from 1995 to 2014. The basic principle of plume production and thermal damage are studied in this review. Factors contributing to the same that can lead to adversities during laparoscopic surgeries are identified. Summarizing key points that increase lateral thermal damage and plume production amongst different ultrasonic shears and suggesting a technique to identify the right balance between the existing dissectors was possible. The RF Device and USS are both useful and widely used and are more safer than monopolar devices. RF Device is considerably slower than USS, as it cannot achieve coagulation and cutting at the same time. Although USS definitely improvises dissection and has less thermal injury than RF Device, the clinical implications in balancing dissection efficacy with hemostasis need to be investigated further. The ideal haemostatic energy-based shear device would be one with excellent hemostatic results and visual acuity while allowing none or minimal thermal energy escape at the point of application. In our current setting, a combined use of both RF and USS device usage as applied in the particular situations has potential.

The evolution of minimally invasive surgery has brought forward the appearance of new advances in the course of the most recent couple of years and has introduced energy-based devices. The newest among them today are the ultrasonically activated devices, which are utilized with a great deal of components in-play, including ergonomics and financial aspects amid surgery. The methodology embraced was finding significant investigations through studies from PubMed, Medline and Google Scholar on current ultrasonic dissectors, which are Ethicon’s Harmonic Scalpel (ACE®), Covidien’s Sonicision™ (SNC), Conmed’s SonoSurg® (SS) and Olympus’s Thunderbeat®, to describe their efficacy in terms of vessel sealing speed, vessel burst pressure, visibility, operation time and thermal speed. We found postmarketing evidence to determine which device exhibits the better performance. Animal studies showed that emissivity values and maximum temperatures for coagulation are similar among devices but maximum cutting temperatures are significantly different: ACE = 191.1°C, SNC = 227.1°C, SS = 184.8°C (p < 0.001). Cooling times are significantly different among devices: 35.7 s for ACE, 38.7 s for SNC and 27.4 s for SS (p < 0.001). Cooling times of passive jaws to reach 60°C after activation were also significantly different: 25.4 s for ACE, 5.7 s for SNC, and 15.4 s for SS (p < 0.001). The perfect device would unify brilliant hemostatic outcomes with visual sharpness while permitting none or insignificant thermal damage at the place of use.

No abstract

Minimally invasive interventions for myomata treatment have gained acceptance due to the possibility of preserving fertility with reduced trauma induced by laparotomy as way of entrance. There are insufficient data regarding outcomes of high intensity focused ultrasound (HIFU) in non-Asiatic women. Therefore, we revised the available evidence to present an expert opinion that could support physicians, patients and policy-makers for considering this approach in other populations. We revisited systematic reviews, randomized controlled trials and cohort studies from January 2018 to August 2021 using PubMed and Google scholar, regarding short and long term outcomes after ablation with focused ultrasound waves. In total, 33 studies, including 114,810 adult patients showed that outcomes of this approach depend on several parameters directly related with resistance to thermal ablation, especially fibroid size and vascularization. Two studies report satisfactory outcomes in Afro-American women. In accordance to the technique used, fibroid volume reduction showed to be higher in fibroids <300 cm3 after ultrasound guided HIFU than after MRI guided. Compared to myomectomy and uterine artery embolization, HIFU seems to have shorter hospital stay, higher pregnancy rates and similar adverse events rates, with skin burn being the most reported. Symptoms and quality of life improvement is similar to myomectomy but lower than embolization, however reintervention rate is higher after HIFU. Lacks evidence about long-term sarcoma risk after ablation. Available evidence shows that HIFU can be considered as a uterine sparing treatment for women of different ethnicities suffering of uterine myomatosis, especially for those wishing to preserve their fertility.

No abstract

Postoperative adhesions represent a frequent complication of abdominal surgery. Adhesions can result from infection, ischemia, and foreign body reaction, but commonly develop after any surgical procedure. The morbidity caused by adhesions affects quality of life and, therefore, it is paramount to continue to raise awareness and scientific recognition of the burden of adhesions in healthcare and clinical research. This 2021 Global Expert Consensus Group worked together to produce consented statements to guide future clinical research trials and advise regulatory authorities. It is critical to harmonize the expectations of research, to both develop and bring to market improved anti-adhesion therapies, with the ultimate, shared goal of improved patient outcomes.

No abstract

Uterine fibroids or uterine myomas are one of the most common benign diseases of the uterus. Symptoms associated with myomas can make surgical removal of myomas necessary. Besides the traditional abdominal route, laparoscopic myomectomy (LM) has gained more acceptances over the last few decades, and it is anticipated that laparoscopy is associated with lower adhesion development. Therefore, we conducted this review to analyze the evidence on adhesions after LM. The PubMed database was searched using the search terms “myomectomy” alone and in combination with “adhesions,” “infertility OR fertility outcome,” and “laparoscopy” among articles published in English and German. Although the well-known advantages of laparoscopy, for example, less pain, less blood loss, or shorter hospital stay, myomectomy belongs to high-risk operations concerning adhesion formation, with at least every fifth patient developing postsurgical adhesions. In laparoscopic surgery, surgeons´ experience as well tissue trauma, due to desiccation and hypoxia, are the underlying mechanisms leading to adhesion formation. Incisions of the posterior uterus may be associated with a higher rate of adhesions compared to anterior or fundal incisions. Adhesions can be associated with severe complications such as small bowel obstruction, chronic pelvic pain, complications in further operations, or impaired fertility. Tissue trauma and the experience of the surgeon in laparoscopic surgery are most of the influencing factors for adhesion formation after myomectomy. Therefore, every surgeon should adopt strategies to reduce adhesion development in daily routine, especially when it conducted to preserve or restore fertility.