Ultrasonic Incisions Produce Less Inflammatory Mediator Response during Early Healing than Electrosurgical Incisions

Abstract

As the use of laparoscopic surgery has become more widespread in recent years, the need has increased for minimally-invasive surgical devices that effectively cut and coagulate tissue with reduced tissue trauma. Although electrosurgery (ES) has been used for many generations, newly-developed ultrasonic devices (HARMONIC® Blade, HB) have been shown at a macroscopic level to offer better coagulation with less thermally-induced tissue damage. We sought to understand the differences between ES and HB at a microscopic level by comparing mRNA transcript and protein responses at the 3-day timepoint to incisions made by the devices in subcutaneous fat tissue in a porcine model. Samples were also assessed via histological examination. ES-incised tissue had more than twice as many differentially-expressed genes as HB (2,548 vs 1,264 respectively), and more differentially-expressed proteins (508 vs 432) compared to control (untreated) tissue. Evaluation of molecular functions using Gene Ontology showed that gene expression changes for the energized devices reflected the start of wound healing, including immune response and inflammation, while protein expression showed a slightly earlier stage, with some remnants of hemostasis. For both transcripts and proteins, ES exhibited a greater response than HB, especially in inflammatory mediators. These findings were in qualitative agreement with histological results. This study has shown that transcriptomics and proteomics can monitor the wound healing response following surgery and can differentiate between surgical devices. In agreement with clinical observations, electrosurgery was shown to incur a greater inflammatory immune response than an ultrasonic device during initial iatrogenic wound healing.

Energy based surgical instruments : With particular focus on collateral thermal injury

“…ese results were in agreement with other studies concluding UD creates less tissue trauma and in ammation than ES [126,127]. A comparison beween UD and ES has been made at the molecular level, by studying gene transcript expression and protein levels a er subcutaneous incisions in pig [128]. UD produced fewer di erentially expressed genes and proteins than ES, especially those involved in the in ammatory mediation.…”

Syndrome de Wiedemann-Beckwith – glossectomie de réduction par Ultracision® : une approche novatrice

“…Les études in vivo chez l'animal ont démontré microscopiquement que ces vibrations respectaient les tissus avec une section sans lésion périphérique [1,2,3]. Macroscopiquement, les avantages sur l'oedème et le résultat postopératoire immé-diat sont également démontrés, notamment sur les liftings cervico-faciaux [4].…”

“…L'échauffement localisé par ces vibrations assure une hémostase de qualité sans diffusion de chaleur dans les structures adjacentes et sans risque de lésion vasculaire ou nerveuse involontaire [1]. Des études ont démontré que l'absence de diffusion d'un courant électrique était associée à une cicatrisation plus précoce et à moins d'oedème postopératoire [2][3][4]. Dans le syndrome de Wiedemann-Beckwith, la prévalence de la macroglossie varie de 80 à 99 % [5].…”

Sealing vessels up to 7 mm in diameter solely with ultrasonic technology

“…The purely mechanical action of ultrasonic devices, without the flow of electrical current that occurs in electrosurgery, allows usage of the devices in the vicinity of nerves, with greatly reduced risk of injury 3. Recently, the differences between ultrasonic and electrosurgery have been examined at a molecular level via transcriptomics and proteomics 17. These studies demonstrated that in the acute phase of wound healing following incisions in subcutaneous tissue, ultrasonic energy produced lower levels of immunological and inflammatory mediators, indicating a reduced amount of iatrogenic trauma.…”