Comparison of experimental nerve injury caused by ultrasonically activated scalpel and electrosurgery

Carlander, Johan; Johansson, K.-A.; Lindström, Sivert; Velin, Å. K.; Jiang, Chonghe; Nordborg, Claes

doi:10.1002/bjs.4948

Cited by 64 publications

(49 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Carlander et al reported nerve dysfunction induced by the local energy effect from US instruments in a rat model. This study also considered that the degree of nerve damage depended on the duration of heat exposure (23). It has also been revealed that higher rates of transient recurrent laryngeal nerve palsy occur subsequent to the use of US instruments compared with conventional techniques (24).…”

Section: Discussionmentioning

confidence: 99%

Horner's syndrome subsequent to minimally invasive video-assisted thyroidectomy in two patients

Meng¹,

Tian²,

Lv³

et al. 2015

Oncology Letters

View full text Add to dashboard Cite

Abstract. Horner's syndrome (HS), characterized by a combination of ptosis and miosis, is an uncommon complication of thyroid surgery, particularly in minimally invasive thyroid surgery. Two cases of HS were observed secondary to minimally invasive video-assisted thyroidectomy in the Department of Thyroid Breast Surgery of Zhejiang Provincial People's Hospital between August 2012 and July 2014. The two patients developed miosis and ptosis following total thyroidectomy; all symptoms had resolved at 1 and 11 months subsequent to surgery, respectively. HS has currently been reported secondary to numerous types of minimally invasive thyroid procedures. The literature was reviewed to identify cases of this iatrogenic complication secondary to each type of thyroidectomy and the possible injury mechanisms underlying the syndrome were summarized in the present study. In addition, factors that were associated with minimally invasive thyroidectomy, such as the limited endoscopic vision during the procedure, the retraction effect and the occurrence of thermal damage from the use of the harmonic scalpel, were emphasized. The present study concluded that close attention is required during minimally invasive thyroid surgery in order to avoid HS as a complication of the procedure.

show abstract

Section: Discussionmentioning

confidence: 99%

Horner's syndrome subsequent to minimally invasive video-assisted thyroidectomy in two patients

Meng¹,

Tian²,

Lv³

et al. 2015

Oncology Letters

View full text Add to dashboard Cite

show abstract

“…3 Furthermore, the UAS have been found to be safer when used at nerve proximity. 5 In thyroidectomy, because the blood supply of the gland is rich, low-power levels are preferred and blood vessel division is achieved by an increase of pressure at the tip of the instrument after hemostasis is complete. The UAS have been used for several years in laparoscopic surgery, [6][7][8][9] but also in general and gynecological surgery.…”

Section: Discussionmentioning

confidence: 99%

“…5 Only Voutilainen et al 23 reported higher percentage of postoperative recurrent laryngeal nerve paresis and concluded that the instrument should not be used close to the nerve. The UAS can be safely used in dividing the thyroid tissue in lobectomies.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of ultrasonically activated shears in thyroid surgery

et al. 2006

View full text Add to dashboard Cite

show abstract

“…These findings are also consistent with a large body of research that shows that Harmonic devices are similar to scissors in terms of tissue injury when used more than 2 mm from a nerve and activated continuously for less than 15 seconds. [21][22][23][24][25] The decreased thermal damage induced by Focus+ does not appear to come at the expense of seal strength. Using vessels of sizes that are commonly sealed in thyroid surgery, there was no statistical difference in mean burst pressures between Focus+ and Small Jaw, and both devices created seals with burst pressures that were more than seven times higher than normal physiological pressures.…”

Section: Discussionmentioning

confidence: 99%

Ex vivo and in vivo evaluation of an ultrasonic device for precise dissection, coagulation, and transection

Bertke¹,

Scoggins²,

Welling³

et al. 2014

OAS

View full text Add to dashboard Cite

Background:A new ultrasonic device, Harmonic Focus ® +, has been developed that is smaller and delivers energy more efficiently than its predecessor via the inclusion of Adaptive Tissue Technology. This study was undertaken to compare its dissection capabilities to an advanced bipolar electrosurgery device in benchtop and preclinical evaluations. Methods: In ex vivo testing, Focus+ and LigaSure™ Small Jaw were evaluated for physical dimensions, device and tissue temperature after repeated applications to porcine jejunum, and burst pressure of vessel seals, transection time, and tissue sticking in 3-5 mm porcine carotid arteries. In in vivo testing, the devices were tested on intact porcine carotid arteries for thermal damage via collagen denaturation and in muscle incisions near rat sciatic nerve for acute inflammation via hematoxylin and eosin and for impaired axonal transport via β-APP. Results: Focus+ was smaller than the Small Jaw in width and height, yet it had a longer active blade and larger jaw aperture. Device temperatures were not different after application, but thermal spread (tissue temperature above 50°C) was 78% greater for Small Jaw (9.6 mm) than for Focus+ (5.4 mm). Burst pressures of sealed vessels were not significantly different between the devices: 900 (±466) mmHg for Focus+ versus 974 (±500) mmHg for Small Jaw. Small Jaw had a shorter individual transection time (5.0 seconds compared to 6.3 seconds for Focus+), whereas Focus+ had 70% less tissue sticking. Thermal damage, neural inflammation, and impaired axonal transport were all significantly lower for Focus+ compared to Small Jaw, by 19%, 57%, and 50%, respectively. Conclusion: With the addition of Adaptive Tissue Technology, Harmonic Focus+ builds upon the manifold advantages of ultrasonic devices in procedures requiring meticulous dissecting capability. Improvements in energy sensing and controlled delivery produce lower tissue temperatures and less thermal damage, especially critical when working near nerves. Focus+ produces vessel seal strengths equivalent to advanced bipolar devices and, although individual device activations are longer, the reduction in tissue sticking is expected to materially lessen operative time in clinical practice.

show abstract

Comparison of experimental nerve injury caused by ultrasonically activated scalpel and electrosurgery

Abstract: US instruments may be safer than ES for dissection close to nerves.

Cited by 64 publications

References 10 publications

Horner's syndrome subsequent to minimally invasive video-assisted thyroidectomy in two patients

Horner's syndrome subsequent to minimally invasive video-assisted thyroidectomy in two patients

Efficacy and safety of ultrasonically activated shears in thyroid surgery

Ex vivo and in vivo evaluation of an ultrasonic device for precise dissection, coagulation, and transection

Contact Info

Product

Resources

About