Harmonic Scalpel versus Conventional Dissection Technique in Pylorus-Preserving Partial Duodenopancreatectomy

Abstract

Background/Aims: Pancreatic head resection is performed with low mortality, but morbidity remains high. Extensive preparation, long operating times, intraoperative blood loss and the need for blood transfusions are risk factors for postoperative morbidity. The aim of our study was to evaluate the feasibility and safety of the ultrasonic dissection device in pylorus-preserving duodenopancreatectomy (PPPD). Methods: Fifty consecutive patients who underwent PPPD with an ultrasonic dissection device (group 1) were compared with a match-controlled group of 50 consecutive patients who underwent PPPD with conventional dissection techniques (group 2). Duration of surgery, intraoperative blood loss, blood units, complications, mortality and duration of hospital stay were analyzed. Results: There was no difference in age, gender or BMI between groups. In group 1, mean blood loss (446 ± 281.8 ml, p = 0.008) and number of blood units (0.32 ± 0.86, p = 0.001) were significantly lower than in group 2 (819 ± 915.4 ml; 1.36 ± 2.83 units). Duration of surgery was shorter in group 1 (345.6 vs. 373 min, p = 0.28). The rate of postoperative complications, mortality and hospital stay were not significantly different. Conclusions: Use of an ultrasonic dissection device in PPPD might significantly reduce intraoperative blood loss and the need for blood transfusions. These results should be verified in a prospective randomized controlled trial.

Ultrasonic Dissection versus Conventional Dissection for Pancreatic Surgery: A Meta-Analysis

“…Of the remaining 16 articles, 10 were excluded for not meeting the inclusion criteria. Ultimately, six studies including two RCTs [ 15 , 18 ] and four non-RCTs [ 16 , 17 , 19 , 20 ] matched the criteria for inclusion. A flow diagram shown in Figure 1 details the selection process.…”

“…All of the studies were published in English-language journals between 1999 and 2014. Four studies [ 15 – 17 , 20 ] were performed in Japan, one [ 19 ] was performed in Germany, and one [ 18 ] was performed in Germany, Italy, and Greece. The patients' mean age ranged from 56.7 years to 72 years.…”

“…Three studies [ 17 – 19 ] reported the incidence of pancreatic fistula after PD/PPPD. Overall, 23 of 120 (19.2%) patients in UD group and 26 of 107 (24.3%) patients in CD group experienced pancreatic fistula.…”

“…For DP, the UD device was applied to transect the parenchyma in all three studies [ 15 , 16 , 20 ]. For PD/PPPD, however, one study [ 17 ] used UD device, while the other two [ 18 , 19 ] used surgical scalpel in their UD groups for pancreas transection. Using a steel scalpel to cut the pancreas may cause abundant bleeding from the cut surface, and satisfying hemostasis will be achieved by clamping the pancreas, silk sutures, or electrocautery [ 29 ].…”

Comparative clinical outcomes of elongated soft palate in brachycephalic dogs by surgical treatment using the ultrasonic scalpel and bipolar sealing device techniques

“…Disadvantages of Sonicision™ is that Sonicision™ generates more heat comparing to bipolar sealing device, which may result in more inflammation and post-operative complications. In human, ultrasonic scalpel have been used for many surgical procedures such as thyroidectomy (Ecker et al, 2010;Melck and Wiseman, 2010), laparoscopy (Devassy et al, 2015), colorectal laparoscopy (Rimonda et al, 2009), and partial duodenopancreatectomy (Heverhagen et al, 2012). In dogs, ultrasonic scalpel has been use for laparoscopic ovariectomy (Spillebeen et al, 2017), lung biopsy (Molnar et al, 2005), and splenectomy (Royals et al, 2005).…”