The impact of the ultrasonic, bipolar and integrated energy devices in the adrenal gland surgery: literature review and our experience

Patrone, Renato; Gambardella, Claudio; Romano, Roberto Maria; Gugliemo, Clarizia; Offi, Chiara; Andretta, Claudia; Vitiello, Antonio; Tartaglia, Ernesto; Flagiello, Luigi; Conzo, Alessandra; Mauriello, Claudio; Conzo, Giovanni

doi:10.1186/s12893-018-0457-5

Cited by 21 publications

(21 citation statements)

References 21 publications

(36 reference statements)

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“…Several studies have concluded that the TB can be as safe as other energy-based devices when used in laparoscopic surgery [20][21][22], thyroid surgery [11] and neck dissections [10]. This study has indicated that the TB is at least as safe as the SED during TL and ND, as the statistically insignificant difference was found in favor of the TB group.…”

Section: Discussionmentioning

confidence: 69%

A comparison of the Thunderbeat and standard electrocautery devices in head and neck surgery: a prospective randomized controlled trial

Kuipers

Kleijn

Wedman

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose New energy-based sutureless vessel ligation devices, such as the Thunderbeat (Olympus Medical Systems Corp., Tokyo, Japan), could reduce operative time and limit blood loss in head and neck surgery; however, efficacy and safety in major head and neck surgery have not been investigated in a prospective, randomized study. Methods This prospective, double-arm, randomized controlled trial consisted of two parts: total laryngectomy (TL) and neck dissection (ND). Thirty patients planned for TL were randomized in two groups. For the ND part, forty-two operative sides were likewise randomized. In both parts, Thunderbeat was used in addition to the standard instrumentation in the intervention groups, while only standard instrumentation was used in the control groups. Primary outcome values were blood loss, operative time and complication rate. Results For the TL part there was no difference in mean blood loss (p = 0.062), operative time (p = 0.512) and complications (p = 0.662) between both hemostatic techniques. For the neck dissection part, there was a reduction in blood loss (mean 210 mL versus 431 mL, p = 0.046) and in operative time (median 101 (IQR 85–130) minutes versus 150 (IQR 130–199) minutes, p = 0.014) when Thunderbeat was used. There was no difference in complication rate between both hemostatic systems (p = 0.261). Conclusion The Thunderbeat hemostatic device significantly reduces operative blood loss and operative time for neck dissections, without increase in complications. In TL, blood loss using Thunderbeat was comparable with the standard technique, but the operative time tended to be shorter. Trial registration UMCG Research Register, Reg. no. 201700041, date of registration: 18/1/2017

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Section: Discussionmentioning

confidence: 69%

A comparison of the Thunderbeat and standard electrocautery devices in head and neck surgery: a prospective randomized controlled trial

Kuipers

Kleijn

Wedman

et al. 2021

Eur Arch Otorhinolaryngol

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“…For one case of Cushing's syndrome, the Harmonic Scalpel and Thunderbeat devices caused hypertensive crisis. 9 There are also reports of hypertensive crisis caused by energy devices used for adrenal separation or hemostasis. [15][16][17] Adrenal ablation was carried out in four ways using a VIO300D generator.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the same output and duration of cauterization, the intensity and extent of degeneration in the adrenal gland differed pathologically depending on the type and application of the device. Although not used in this experiment, there are reports of hypertensive crisis using Thunderbeat 9 and a bipolar searing system. 17 It is not the type of device that is important in preventing hypertensive crisis, but rather, the method used based on the characteristics of the device to avoid degeneration in the medulla.…”

Section: Discussionmentioning

confidence: 99%

“…8 It is a serious complication of soft coagulation for hemostasis of adrenal hemorrhage and of the use of energy devices for laparoscopic adrenalectomy for non-pheochromocytoma. 9 In addition, RFA or cryoablation for adrenal metastasis can cause hypertensive crisis. [10][11][12][13][14] The incidence of hypertensive crisis is 9-46%, and the risk is higher if the tumor diameter is ≤4.5 cm.…”

Section: Introductionmentioning

confidence: 99%

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Mechanism of hypertensive crisis during energy device ablation of the adrenal gland: An experimental animal study

et al. 2021

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Objective: To elucidate the mechanism of hypertensive crisis during energy device ablation of the adrenal gland. Methods: Electrocoagulation on the adrenal glands of six pigs was carried out with the same energy device (VIO300D) using four methods: (i) monopolar coagulation; (ii) monopolar soft coagulation using IO-advanced ball-type electrodes; (iii) bipolar soft coagulation by pinching; and (iv) bipolar soft coagulation by non-pinching (surface contact) using Bipolar forceps Premium. After electrocoagulation for 5 s, blood pressure and pulse changes were monitored, and adrenal hormones were measured from a central vein. The adrenal glands were removed, and the degree of tissue damage was scored histologically.Results: Hypertensive crisis occurred with electrocoagulation of the adrenal gland by the monopolar coagulation, monopolar soft coagulation and bipolar soft coagulation pinching methods. Blood pressure did not change with the bipolar soft coagulation nonpinching method. Pathologically, tissue damage to the adrenal medulla was associated with elevated blood pressure and adrenaline and noradrenaline release. Conclusions: Hypertensive crisis caused by energy device ablation to the adrenal gland is caused by the release of catecholamines due to heat damage to the adrenal medulla rather than the type of energy device. Proper use of an energy device that does not cause thermal degeneration of the medulla is required to prevent hypertensive crisis.

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“…Recently, ultrasonic, ABP and hybrid devices have been characterized as advanced energy devices in cross-specialty literature, given similarities in their various purposes, including hemostasis, sealing, transection and dissection of blood vessels, as well as technological advancements [15][16][17] . For the purpose of this work, we define advanced energy devices as electrosurgical devices that leverage recent advancements on conventional monopolar and bipolar electrosurgical instruments, such as increased compression, integrated cutting blade in ABPs, and algorithmic energy control, to achieve coagulation and transection involved in surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

A device category economic model of electrosurgery technologies across procedure types: a U.S. hospital budget impact analysis

Ferko

Wright

Syed

et al. 2021

Journal of Medical Economics

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Aims:The electrosurgical technology category is used widely, with a diverse spectrum of devices designed for different surgical needs. Historically, hospitals are supplied with electrosurgical devices from several manufacturers, and those devices are often evaluated separately; it may be more efficient to evaluate the category holistically. This study assessed the health economic impact of adopting an electrosurgical device-category from a single manufacturer. Methods: A budget impact model was developed from a U.S. hospital perspective. The uptake of electrosurgical devices from EES (Ethicon Electrosurgery), including ultrasonic, advanced bipolar, smoke evacuators, and reusable dispersive electrodes were compared with similar MED (Medical Energy Devices) from multiple manufacturers. It was assumed that an average hospital performed 10,000 annual procedures 80% of which involved electrosurgery. Current utilization assumed 100% MED use, including advanced energy, conventional smoke mitigation options (e.g. ventilation, masks), and single-use disposable dispersive electrode devices. Future utilization assumed 100% EES use, including advanced energy devices, smoke evacuators (i.e. 80% uptake), and reusable dispersive electrodes. Surgical specialties included colorectal, bariatric, gynecology, thoracic and general surgery. Systematic reviews, network meta-analyses, and meta-regressions informed operating room (OR) time, hospital stay, and transfusion model inputs. Costs were assigned to model parameters, and price parity was assumed for advanced energy devices. The costs of disposables for dispersive electrodes and smokeevacuators were included. Results: The base-case analysis, which assessed the adoption of EES instead of MED for an average U.S. hospital predicted an annual savings of $824,760 ($101 per procedure). Savings were attributable to associated reductions with EES in OR time, days of hospital stay, and volume of disposable electrodes. Sensitivity analyses were consistent with these base-case findings. Conclusions: Category-wide adoption of electrosurgical devices from a single manufacturer demonstrated economic advantages compared with disaggregated product uptake. Future research should focus on informing comparisons of innovative electrosurgical devices.

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The impact of the ultrasonic, bipolar and integrated energy devices in the adrenal gland surgery: literature review and our experience

Cited by 21 publications

References 21 publications

A comparison of the Thunderbeat and standard electrocautery devices in head and neck surgery: a prospective randomized controlled trial

A comparison of the Thunderbeat and standard electrocautery devices in head and neck surgery: a prospective randomized controlled trial

Mechanism of hypertensive crisis during energy device ablation of the adrenal gland: An experimental animal study

A device category economic model of electrosurgery technologies across procedure types: a U.S. hospital budget impact analysis

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