Shaw Scalpel in Revision Cochlear Implant Surgery

Abstract

The use of traditional electrocautery is prohibited in revision or replacement cochlear implant surgery because of the concern for end organ tissue damage. Additionally, electrical current spread to the malfunctioning device could interfere with an accurate cause-of-failure analysis. Clinical reports have confirmed the utility of the Shaw scalpel for dermatologic, ophthalmic, and head and neck surgery. The Shaw scalpel is a thermally activated cutting blade that provides a bloodless field through immediate capillary and small vessel hemostasis. Avoidance of wound and flap complications is of primary concern in cochlear implant surgery. The long-term wound healing compared favorably to that of other surgical cutting instruments in several experimental reports. We have routinely used the Shaw scalpel in revision cochlear implant surgery and in primary surgery whenever electrocautery was contraindicated. We have retrospectively evaluated 22 cases in which the Shaw scalpel was used for cochlear implant revision and primary surgery. The chart review included patient demographics, the indication for surgery, the contraindication for electrocautery, intraoperative surgical notes, the wound healing evaluation, the evaluation for alopecia, and postoperative speech understanding. No significant complications occurred intraoperatively, and the long-term wound healing results were no different from those obtained with conventional surgical techniques. The explanted devices were undamaged, and valuable diagnostic information could be obtained. All patients performed at or better than their preoperative levels on speech recognition testing. Our results indicate that the Shaw scalpel is a relatively safe, easy-to-use, and effective instrument.

Cochlear Reimplantation: Surgical Techniques and Functional Results

“…Incision and elevation of the skin flaps were performed with the Shaw heated scalpel (Hemostatix Medical Devices, Cherry Hill, NJ) instead of monopolar cautery. 7 In most instances, an inverted‐J incision was used. Monopolar cautery should not be used with an implant in place because the electrical current can damage the implant, precluding proper integrity testing, and can also be carried along the implant directly into the cochlea with damage to the remaining neurons.…”

Ultracision: An Alternative to Electrocautery in Revision Cochlear Implant Surgery

“…It has been shown that the temperature of the Shaw blade may be as high as 280°C and might melt the silicone covering of some cochlear implants. 1 Using Shaw blades was also found to be a significant risk factor for facial weakness during primary parotid surgery. 3 Therefore, caution is needed while working near important structures such as implants and nerves.…”

“…In primary cochlear implantation all the electrocautery instruments have been turned off when the device is brought into the sterile field, but at that point of time hemostasis has already been achieved. 1 In revision cochlear implant surgery, when the implant is placed in the second ear or in patients with another electronic medical device, monopolar electrocautery is strictly contraindicated. 1 Furthermore, bipolar electrocautery within 5 cm of the cochlear implant is not allowed, because of the warranty regulation of the company.…”

“…2 Therefore, in revision cochlear implant surgery and in patients with other electronic medical devices an alternative to electrocautery must be used for hemostasis. Roland et al 1 proposed the use of Shaw scal-pel in revision cochlear implant surgery and retrospectively evaluated 22 patients in whom the Shaw scalpel was used for cochlear implant revision. The authors reported that no significant complications occurred intraoperatively, the long-term wound healing results were no different from those obtained with conventional surgical techniques, and the devices were undamaged.…”

“…The use of electrocautery in the patient with a cochlear implant is harmful to the device and could cause changes in the device settings and, possibly, permanent device damage. 1 The transmission of current damages to the spiral ganglion cells may also damage those cells. Electrocautery instruments are used in all surgical procedures.…”