Use of an Ultrasonic Blade Facilitates Muscle Repair After Incision Injury

Ūsas, Arvydas; Usaite, Dovile; Huard, Johnny; Clymer, Jeffrey W.; Malaviya, Prasanna

doi:10.1016/j.jss.2010.12.042

Cited by 16 publications

(14 citation statements)

References 33 publications

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“…The transcript functional groups of immunity (primarily innate) and inflammation (including genes related to the classic signs of heat, redness, pain and loss of function) were associated more significantly with the ES incisions than those made with HB. This finding on the gene level is consistent with comparisons of ES and HB via macroscopic observations of immune response and inflammation [4],[5].…”

Section: Discussionsupporting

confidence: 86%

“…Ultrasonic incisions in rabbit muscle resulted in less infiltration of markers of acute inflammation (e.g., neutrophils) during wound healing than electrosurgical incisions [4]. Ultrasonic incisions in murine muscle also showed less inflammation and faster decrease in fibrosis than electrosurgery [5]. In a study showing reduced effect of ultrasonic incisions on nerve physiology, reduced leukocyte infiltration and axonal transport impairment was observed compared to electrosurgical incisions [6].…”

Section: Introductionmentioning

confidence: 93%

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

et al. 2013

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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.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 93%

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

et al. 2013

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“…e lesions detected were more common in the Bipolar ES group. 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].…”

Section: Nerve Injuries From Ebdsupporting

confidence: 90%

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

Carlander¹

2015

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“…Based on lower heat production in the tissue, incisions made with ultrasonic devices result in less inflammation than those made with electrosurgery,15 along with enhanced revascularization and faster fibrosis remodeling 16. 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.…”

Section: Discussionmentioning

confidence: 99%

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

Timm¹,

Asher²,

Tellio³

et al. 2014

MDER

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IntroductionUltrasonic energy is a mainstay in the armamentarium of surgeons, providing multifunctionality, precision, and control when dissecting and sealing vessels up to 5 mm in diameter. Historically, the inability to seal vessels in the 5–7 mm range has been perceived as an inherent limitation of ultrasonic technology. The purpose of this study was to evaluate sealing of vessels up to 7 mm in diameter with an ultrasonic device that modulates energy delivery during the sealing period.MethodsIn ex vivo benchtop and in vivo acute and survival preclinical models, a new ultrasonic device, Harmonic ACE®+7 Shears (Harmonic 7), was compared with advanced bipolar devices in sealing vessels 1–7 mm in diameter with respect of burst pressure, seal reliability, and seal durability. Lateral thermal damage and transection time were also evaluated.ResultsEx vivo tests of Harmonic 7 demonstrated significantly greater median burst pressures than an advanced bipolar device both for vessels <5 mm in diameter (1,078 mmHg and 836 mmHg, respectively, P=0.046) and for those in the range of 5–7 mm (1,419 mmHg and 591 mmHg, P<0.001). In vivo tests in porcine and caprine models demonstrated similar rates of hemostasis between Harmonic 7 and advanced bipolar devices, with high success rates at initial transection and seal durability of 100% after a 30-day survival period.ConclusionSealing 5–7 mm vessels is not a limitation of the type of energy used but of how energy is delivered to tissue. These studies document the ability of ultrasonic energy alone to reliably seal large vessels 5–7 mm in diameter, with significantly greater burst pressure observed in in vitro studies than those observed with an advanced bipolar technology when energy delivery is modulated during the sealing cycle. Furthermore, the seals created in 5–7 mm vessels are shown to be reliable and durable in in vivo preclinical studies.

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Use of an Ultrasonic Blade Facilitates Muscle Repair After Incision Injury

Cited by 16 publications

References 33 publications

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

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

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

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

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