Evaluating the safety of the Harmonic Scalpel around the recurrent laryngeal nerve

Jiang, Hang; Shen, Hongliang; Jiang, Dao-Zhen; Xiao, Zheng; Zhang, Wei; Lü, Lei; Jiang, Zhiguo; Qiu, Ming

doi:10.1111/j.1445-2197.2010.05436.x

Cited by 28 publications

(25 citation statements)

References 18 publications

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“…Postoperative transient hoarseness occurred in 3 (8.1%) patients. To avoid nerve injury, surgeons should maintain a safe distance between the ultrasonic scalpel and the nerve, and avoid more than 5 seconds of continuous action time of energy instruments …”

Section: Discussionmentioning

confidence: 99%

Feasibility and safety of needle‐assisted endoscopic thyroidectomy with lateral neck dissection for papillary thyroid carcinoma: a preliminary experience

et al. 2019

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Background: Endoscopic thyroidectomy is popular among patients with cosmetic requirements. However, when lateral neck dissection (LND) is required, endoscopic surgery may be challenging. Therefore, we introduced needle-assisted endoscopic technique to achieve endoscopic LND procedure and evaluated its safety and feasibility in the present study. Methods: Medical records of 37 patients who underwent needle-assisted endoscopic thyroidectomy with LND were retrospectively reviewed. Results: All of 37 patients had excellent cosmetic outcomes. The mean operative time was 338.2 ± 58.74 minutes. Mean number of lymph nodes retrieved in the lateral was 33.5 ± 11.69 and 15.9 ± 7.51 in the central neck. The rates of transient and permanent hypocalcemia were 32.4% and 2.7% and the rates of transient and permanent recurrent laryngeal nerve palsy were 8.1% and 0%, respectively. Conclusions: Needle-assisted endoscopic thyroidectomy with lateral neck dissection shows potential feasibility but further study is needed to better characterize its safety and applicability. K E Y W O R D Spapillary thyroid carcinoma, endoscopic thyroidectomy, lateral neck dissection, needle assisted, anterior chest approach

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Section: Discussionmentioning

confidence: 99%

Feasibility and safety of needle‐assisted endoscopic thyroidectomy with lateral neck dissection for papillary thyroid carcinoma: a preliminary experience

et al. 2019

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“…24 A study of ET in rabbits yielded a recommendation that, at a power level of 3, the activated ultrasonic scalpel tip be kept at least 2 mm away from the RLN, and the duration of any incision be kept at or below 3 seconds. 25 For our patients, functional US blades were turned upward and kept at least 5 mm away from the RLN, parathyroid gland, and trachea. Incision times were maximally decreased, in part by adopting fractionation during coagulation.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Thyroidectomy: The Development in a Chinese Center

Chen

Wang²,

Xuan³

et al. 2012

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…To our knowledge, the present study is the first to have examined the effect of HS application in the vicinity of the RLN during thyroidectomy in large animal. There is a study using the rabbit but it did not used laryngoscopy to evaluate the vocal cord function [15]. …”

Section: Discussionmentioning

confidence: 99%

Development of a canine model for recurrent laryngeal injury by harmonic scalpel

et al. 2012

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Various energy devices had been used in thyroid surgery. Aim of study is to develop canine model for recurrent laryngeal nerve injury by harmonic scalpel and to evaluate feasibility of using this model for evaluating the safety use of harmonic scalpel during thyroid surgery. Nine dogs were divided into 3 groups according to distance between harmonic scalpel application and recurrent laryngeal nerve; group 1 (1 mm), 2 (2 mm), and 3 (3 mm). Vocal cord function was assessed pre- and postoperatively using video laryngoscopy. Harmonic scalpel was applied adjacent to left recurrent laryngeal nerve and, two weeks later, right recurrent laryngeal nerve at assigned distances. Recurrent laryngeal nerves were evaluated for subacute and acute morphologic changes. Laryngoscopy demonstrated 3 abnormal vocal cords in group 1, 1 in group 2, and no in group 3 (P=0.020). Subacute histologic changes were observed in nerves with abnormal function. Acute histologic changes were observed 5/8 (62.5%) in group 1, 1/7 (14.3%) in group 2, and not in group 3. We developed canine model for recurrent laryngeal injury. The functional outcomes matched with the histologic changes. These warrant further study to determine the safety margin for energy device in vicinity of recurrent laryngeal nerve.

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Evaluating the safety of the Harmonic Scalpel around the recurrent laryngeal nerve

Abstract: When used near the RLN at a power level of 3, the activated HS tip should be ≥2 mm from the nerve and the duration of incision should be ≤3 s.

Cited by 28 publications

References 18 publications

Feasibility and safety of needle‐assisted endoscopic thyroidectomy with lateral neck dissection for papillary thyroid carcinoma: a preliminary experience

Feasibility and safety of needle‐assisted endoscopic thyroidectomy with lateral neck dissection for papillary thyroid carcinoma: a preliminary experience

Endoscopic Thyroidectomy: The Development in a Chinese Center

Development of a canine model for recurrent laryngeal injury by harmonic scalpel

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