Hemostasis with the Ultrasonic Scalpel

Abstract

Background and Objectives:The ultrasonically activated scalpel is a surgical instrument that is used in minimally invasive surgery to safely cut and seal vessels. This study reported the experimental observations of the use of a laparoscopic ultrasonic scalpel, including its safety and feasibility. in sealing vessels of different diameters in an in vivo animal model during both physiological and supraphysiological blood pressure (BP) conditions.Methods:One healthy female swine was used. We performed resections of the omentum, biopsies in different regions of the liver, and a hysterectomy. Vessels with diameters ranging from 2 to 10 mm were sealed with the ultrasonic scalpel under regular hemodynamic conditions and during pharmacologically induced arterial hypertension (BP challenge).Results:For 10 random cuts made in the omentum and during the hysterectomy, the ultrasonic scalpel was effective and fast, with no immediate or delayed bleeding. Bipolar energy, sutures, and hemoclips were not required to control bleeding. No bleeding was observed in sealed vessels up to 8 mm, even during BP challenges sustained for longer than 5 minutes. When testing vessels of 10 mm, bleeding occurred in 1 common iliac vein before 10 minutes of waiting (the point of bleeding was easily identified) and bleeding occurred in 1 of the common iliac arteries during the BP challenge.Conclusion:Our findings corroborate that the ultrasonic scalpel can safely seal arteries up to 8 mm in diameter to prevent or control bleeding during laparoscopic procedures, even when BP exceeds normal levels.

Laparoscopic hepatectomy for the treatment of pyogenic liver abscess: A retrospective case-control study

“…The main causes of bleeding are as follows: extensive oozing on the wound surface during adhesion separation; bleeding in the process of hepatectomy because of swelling and congestion of liver tissue; to maintain the patient's hemodynamic stability, the anesthesiologist may infuse too many fluids, leading to high CVP, which results in increased bleeding from the hepatic vein. For oozing in the surgical area, Biclamp was used for hemostasis; blood vessels with diameters less than 3 mm were slowly coagulated with an ultrasonic scalpel; [30] otherwise, they were clipped with a hem-o-lok or titanium clip; when the broken end of the vessel retracted into the liver parenchyma and hemostasis was difficult, the vessel should be sutured; blocking the inflow blood of the liver and controlling the CVP below 5 cmH2O can significantly reduce the intraoperative bleeding. [31] This article has the following limitations: This is a retrospective study, and there may be some confounding factors leading to confounding bias; This study is a regional study in a single center, due to the different demographic characteristics and etiology in other regions, its representativeness needs further external verification, therefore, a multicenter, prospective, controlled, randomized study is necessary.…”

Safe and Efficient Removal of Massive Head and Neck Vascular Malformations Using Vessel Sealing Energy Devices

“…8 We agree with the authors' comments that vascular clamps and suture ligation of vessels can be difficult and tedious, and traditionally, VMs are resected with laborious suture ligation which can put both blood vessels and lymphatic channels at risk of tearing during dissection for proximal and distal vascular control. Vessel sealing devices have the advantage of gaining hemostasis during dissection of vessels 8 mm and larger, 9 and reliably seal surrounding lymphatic channels that may be at risk during traditional dissection/suture ligation techniques. 10 Common vessel sealers on the market are the Impact Ligasure Exact by Medtronic, Enseal, and Harmonic Scalpel by Johnson and Johnson, Bowa Lotus torsional ultrasonic scalpel from Bowa Electronic, and Thunderbeat from Olympus, among others.…”

Practical considerations in the use of a porcine model (Sus scrofa domesticus) to assess prevention of postoperative peritubal adhesions

“…After evaluating adhesion scores under laparoscopic view, the distal uterine horn with oviduct (infundibulum, ampulla and isthmus) and ovary on each side were laparoscopically removed using an ultrasonic scalpel in order to minimize bleeding [25]. The harvested specimens were fixed in 10% neutral buffered formalin solution, and then embedded in paraffin, sectioned, and stained with hematoxylin-eosin for evaluation by a single experienced pathologist (L.C.).…”