Safety assessment of the use of ultrasonic energy in the proximity of the recurrent laryngeal nerve in a porcine model

Chávez, Karla Verónica; Barajas, Elpidio M.; Soroa, Francisco; Gamboa‐Domínguez, Armando; Ordoñez, Samuel; Pantoja, Juan Pablo; Sierra, Mauricio; Velázquez-Fernández, David; Herrera, Miguel F.

doi:10.1016/j.amjsurg.2017.04.013

Cited by 16 publications

(19 citation statements)

References 27 publications

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“…PG autotransplantation not only increases the PH rate but may also cause permanent PH. 25,26 For example, three thermal injuries to the RLN in group L resulted from lateral thermal spread from LigaSure. 14 In this study, the preferred surgical strategy for preserving PG function was in situ preservation.…”

Section: Discussionmentioning

confidence: 99%

“…24 When using an EBD near the RLN, thyroid surgeons must carefully consider the potential risk of RLN injury from lateral thermal spread. 25,26 For example, three thermal injuries to the RLN in group L resulted from lateral thermal spread from LigaSure. Complete loss of EMG signal was found in two of three thermal injuries and resulted in permanent vocal cord palsy.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of hypocalcemia rates between LigaSure and clamp‐and‐tie hemostatic technique in total thyroidectomies

et al. 2019

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Background Postoperative hypocalcemia (PH) is a serious complication after total thyroidectomy. This study aimed to compare PH rates between LigaSure Small Jaw (LSJ) and clamp‐and‐tie hemostatic technique in patients undergoing total thyroidectomy. Methods Four hundred twenty patients were divided into two groups: group L (210 patients) performed with LSJ and group C (210 patients) with clamp‐and‐tie technique. Serum ionized calcium (iCa) was measured before and 12, 24, 48, 72 hours after surgery. PH was defined as iCa lower than 4.2 mg/dL in at least two measurements. Results There was no significant difference between groups in sex, age, extent of surgery, pathology, and the strategy of intraoperative management of parathyroid glands (PG). The PH rate was significantly lower in group L compared to group C (22.9% vs 32.4%, P = .03). Conclusions Compared to clamp‐and‐tie technique, LigaSure is superior to decrease PH rate after total thyroidectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of hypocalcemia rates between LigaSure and clamp‐and‐tie hemostatic technique in total thyroidectomies

et al. 2019

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“…Nevertheless, the published scientific data are controversial: Chávez et al10 reported, in a porcine model, the possibility to use the HF+ at a distance of <1 mm from nerve structure without significant electromyographic alterations; Chen et al3 state that using the instrument 2 mm from the sciatic nerve do not show significant electromyographic or immunochemical alterations. Sutton et al4 declare that the blade temperature at maximum power for 15 seconds does not exceed 60°C, the threshold of protein denaturation; Pogorelic et al18 confirmed that the lateral necrosis is <0.3 mm if the instrument is activated for 10 seconds at maximum power.…”

Section: Discussionmentioning

confidence: 99%

“…A better understanding of the real thermal spread of the new HF+ is needed to prevent thermal injury and improve patient safety, in particular when we operate near nerve structures 3,10–12…”

mentioning

confidence: 99%

Safety Profile of the New Harmonic Focus: Different Emissivity and Temperature Behavior Between the Active and the Inactive Blade

Latteri¹,

Stella

Gueli

et al. 2019

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Ultrasonic devices disperse less energy in the tissues. The new Harmonic Focus+ (HF+) seems to be more efficient but thermal damages have been reported. This study examined the temperature and the emissivity profile of the active and passive blades of the HF+, on a pig tissue model at different power settings. The FLIR System B series thermal imaging camera has been used on various biological pig tissues to evaluate the emissivity of the ultrasonic device. The active blade heats up faster than the passive one and the increase in power increases the speed of the temperature raising only on the active blade. Increasing the power setting reduces the dissection time and the temperature of both blades. Active blade temperatures of <60°C are obtained with cutting times close to 5 seconds; with these cutting times, the inactive blade does not exceed 30°C. The HF+ emissivity profiles demonstrate that the behavior of the inactive blade is significantly different from the active one. To prevent thermal damages, keep the active blade toward the operator, do not exceed 5 seconds of activation, use the maximum power, and avoid the use of the instrument as a dissector immediately after its activation.

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“…One of the most frequent and feared complications during thyroidectomy is injury to the inferior laryngeal nerve, which occurs due to surgical trauma, either mechanical (manipulation, traction or section) or thermal trauma. Experimental studies in pigs with histological analysis have demonstrated that the use of the ultrasonic scalpel in the dissection of adjacent tissues (1 mm) to the inferior laryngeal nerve does not cause thermal nerve damage 44,45 . In another experimental pig model, it was concluded that there is thermal lesion of the inferior laryngeal nerve by lateral heat dissipation in dissections that are distant <1 mm from the nerve 46 .…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of harmonic scalpel in patients submitted to total thyroidectomy: systematic review with meta-analysis

Aires

Matos

Dedivitis

et al. 2018

Rev. Assoc. Med. Bras.

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OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of the harmonic scalpel compared to the conventional technique in patients submitted to total thyroidectomy. METHOD: This is a systematic review with inclusion of randomized controlled trials (RCTs) that compared both techniques. An electronic search was carried out in the Medline and Lilacs databases until June 2017. The outcomes analysed were operation time, intraoperative bleeding, surgical morbidity, and costs. RESULTS: Data from 31 primary studies were included. The use of the harmonic scalpel correlates to a shorter operation time (p <0.001) and a lower volume of intraoperative bleeding (p <0.001). There were no differences in the risk of transient (p = 0.53) and permanent (p = 0.70) hypocalcaemia, transient (p = 0.61) and permanent (p = 0.50) dysfunctions of the inferior laryngeal nerve and hematoma (p = 0.14). CONCLUSION: Total thyroidectomy using a harmonic scalpel is effective and safe compared to the conventional technique.

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Safety assessment of the use of ultrasonic energy in the proximity of the recurrent laryngeal nerve in a porcine model

Cited by 16 publications

References 27 publications

Comparison of hypocalcemia rates between LigaSure and clamp‐and‐tie hemostatic technique in total thyroidectomies

Comparison of hypocalcemia rates between LigaSure and clamp‐and‐tie hemostatic technique in total thyroidectomies

Safety Profile of the New Harmonic Focus: Different Emissivity and Temperature Behavior Between the Active and the Inactive Blade

Effectiveness of harmonic scalpel in patients submitted to total thyroidectomy: systematic review with meta-analysis

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