The use of harmonic shears (Ultracision) for laparoscopic lymphadenectomies in women with gynaecological malignancies

Abstract

The purpose of this paper is to evaluate the safety and efficacy of the harmonic scalpel for laparoscopic pelvic and para-aortic lymphadenectomy in the management of gynaecologic cancers. A prospective study of 21 consecutive patients with gynaecologic cancer, including cervical (11), endometrial (3), ovarian (6) and tubal (1). Eleven patients had pelvic nodes retrieval only, two had para-aortic nodes retrieval only and eight had both. Eighteen patients had transperitoneal lymphadenectomies, one had extraperitoneal and two had both. Eleven patients had a hysterectomy or salpingooophorectomy in addition to the laparoscopic lymphadenectomy. In all cases, the harmonic scalpel was used as the only instrument to achieve haemostasis. Average nodal yields were 21.4 for bilateral pelvic lymphadenectomies. The mean estimated blood loss was 132.7 ml. There were no intraoperative complications. Laparoscopic pelvic and para-aortic lymphadenectomy using the harmonic scalpel appears to be both safe and efficient in the management of patients with gynaecologic cancers. Its main advantage is that it enables simultaneous and safe tissue dissection, haemostasis and cutting, avoiding the exchange of several instruments. It could become the first choice instrument for this procedure.

Laparoscopic surgical staging for uterine malignancies using harmonic shears (UltraCision) in comparison to electrosurgery: operative technique, feasibility and complications

“…Nezhat et al [8] and Giannopoulos et al [15] found ultrasound energy to be relatively safe. Compared with electrosurgery, UltraCision appears to provide us with potential advantages.…”

An umbrella review of the surgical performance of Harmonic ultrasonic devices and impact on patient outcomes

“…In comparison to ABP devices, there was a trend toward improved operating time with Harmonic devices in thyroidectomy. Reductions in operating time with Harmonic devices could be attributed with combined hemostasis, dissection, and cutting with a single instrument and reduced instrument exchanges [ 100 ]. Also, higher temperatures associated with electrosurgical devices produce smoke that can reduce surgical field visibility, whereas Harmonic devices operate at lower temperatures, thus producing less smoke [ 100 – 103 ].…”

“…Reductions in operating time with Harmonic devices could be attributed with combined hemostasis, dissection, and cutting with a single instrument and reduced instrument exchanges [ 100 ]. Also, higher temperatures associated with electrosurgical devices produce smoke that can reduce surgical field visibility, whereas Harmonic devices operate at lower temperatures, thus producing less smoke [ 100 – 103 ]. Notably, the operating time for tonsillectomy was essentially the same for Harmonic devices and conventional techniques based on one available SLR that was published in 2011 [ 37 ].…”

Occlusion of the Thoracic Duct Using Ultrasonically Activated Shears in Six Dogs

“…Hence lymphangiographic studies were available in all dogs to document TDO using the UAS. Others have successfully used open mesenteric, percutaneous popliteal lymph node injection, or contrast computed tomography (CT) as an alternative to the cannulation method we used …”

“…Much of the work has been for otolaryngology applications where tonsillectomy performed with UAS is faster and creates less hemorrhage compared to cold excision . Other reports have focused on the use of the UAS for laparoscopic lymphadenectomy in various types of gynecologic cancers to reduce the incidence of postoperative lymphatic leakage . The UAS also creates a strong bond exceeding physiologic pressures in the TD of people.…”