Ultrasonic surgical dissection in the dog spleen

Safety and efficacy of UltraShape Contour I treatments to improve the appearance of body contours: multiple treatments in shorter intervals

BACKGROUND

The UltraShape Contour I System (CE 0344; UltraShape Ltd., Yoqneam, Israel) is a noninvasive fat reduction and body contouring system currently approved for use outside the United States that utilizes focused ultrasound to selectively disrupt adipocytes.

OBJECTIVE

To evaluate the clinical safety and efficacy of the Contour I system when the intervals between treatments are shortened.

METHODS

Twenty-five healthy Caucasian women were selected from the patient population at two clinics in Paris, France, and received three 30- to 90-minute Contour I treatments in the abdominal region at two-week intervals. Safety parameters evaluated included adverse events, local skin reaction, and pain. Efficacy parameters evaluated included treatment area circumference, body weight, and comparison of before and after photos. Untreated thigh areas served as an internal control. Subjects were followed for 84 days after the last treatment (day 112).

RESULTS

No adverse events occurred. The majority of subjects (n = 23; approximately 90%) reported no pain. Mean midline circumference (2 cm below midline) was reduced by 2.47 cm (P < .001) on day 14 after the first Contour I treatment, 3.51 cm (P < .001) on day 56, and 3.58 cm (P < .001) on day 112. Peak midline circumference reduction was 3.12 cm on day 112. Most patients (n = 14; 63%) reported a positive change in body contour. Mean thigh circumference (the control area) was unchanged; the relative change between treated and untreated areas of the abdomen was significantly different at all time points. Circumference and weight reduction were significantly correlated (r = 0.42-0.71) at all time points; mean weight decrease was not statistically significant. Circumference reduction on day 112 positively correlated with patients' subjective satisfaction scores.

CONCLUSIONS

Our data showed that successive Contour I treatments at two-week intervals were safe and tolerable and also significantly reduced treatment area circumference.

The tissue effects of ultrasound-assisted lipoplasty

The objective of our study was to investigate the effects of ultrasonic energy on tissues, using a porcine model, performed under various instrumental and procedural parameters. Domestic pigs were anesthetized and prepared for surgery. An incision was made on the side of the hip randomly assigned to the right or left side. Tumescence solution was infiltrated via a blunt tip, small diameter cannula, followed by performance of standard liposuction. On the contralateral side, a similar incision was made. For ultrasonic liposuction experiments without the sheath, a percutaneous introducer was inserted into the incision, which was protected at the entry site from contact with the cannula. Tumescence solution was infiltrated via a blunt tip, small diameter cannula, and then the site was treated with ultrasonic energy at maximum output from the machine with liposuction concurrent through the hollow cannula. The experiments with the sheath did not require a pretreatment with tumescence solution but consisted of tumescence solution pumped through the sheath at a low infusion rate, with concurrent treatment utilizing ultrasonically assisted liposuction through the central lumen of the cannula. In all cases, the lipoaspirate was preserved for biochemical analysis. After treatment, the pigs were euthanized, and samples for histopathology were taken. The pigs were then perfused with a radio-opaque solution through the left ventricle following preperfusion with saline. The groups were ultrasound-assisted liposuction with sheath (n = 3), ultrasound-assisted without sheath (n = 4), and tumescence alone (n = 1), with standard liposuction performed on the contralateral side for all ultrasound-assisted liposuction animals. The lipoaspirates from the ultrasonically assisted liposuction with the sheath showed significantly less blood loss (measured as hemoglobin in the aspirate) than standard liposuction (p = 0.012) at comparable levels of fat (measured as triglycerides in the aspirate). The lipoaspirates from ultrasound-assisted liposuction without the sheath showed blood loss comparable to that experienced with standard liposuction. The ratio of hemoglobin to triglyceride was lowest in the ultrasound-assisted group with (p = 0.01) and without (p = 0.06) the sheath when compared to traditional liposuction. In both of these treated groups, the radiograms of the perfused areas showed significantly less vascular disruption when compared with suction-assisted liposuction. Histopathologic examination of specimens taken from various treated areas showed substantial tissue damage comparable in ultrasound- and suction-assisted liposuction treated groups. This preliminary experimental study showed that ultrasound-assisted lipoplasty is comparable to traditional suction-assisted lipoplasty. Treatment with ultrasound provided more significant hemoglobin/triglyceride ratios, indicative of more lipid aspirated per hemoglobin lost, and better preservation of vascular tissues as demonstrated by our perfusion studies. Treatment with the sheath showed a significantly lower hemoglobin release with a diminished volume infused into the subcutaneous space during the procedure.

Intracapsular subtotal prostatectomy in normal dogs: use of an ultrasonic surgical aspirator

In an attempt to reduce postoperative incontinence associated with excisional prostatectomy and the recurrence of prostatic disease after less radical surgeries, a new technique for subtotal prostatectomy was developed using an ultrasonic surgical aspirator. During laparotomy, a longitudinal incision was made in the ventral surface of each lobe of the prostate gland. Biopsies for histology and culture were taken. Through the ventral incisions, the ultrasonic surgical aspirator was used to resect approximately 85% of the glandular tissue from inside the capsule. The ultrasonic surgical aspirator allowed resection of the glandular tissue without damaging the vessels, nerves, and connective tissue stroma. The ventral portion of the capsule was excised. The dorsal portions of the capsule were apposed on the ventral midline by suturing their ventral margins to form a periurethral cuff. As preclinical research, seven intact male dogs were evaluated by physical examination, complete blood cell count, serum urea nitrogen, urinalyses, and urethral pressure profile (UPP) with urethral electromyograms (EMGs). The dogs underwent subtotal prostatectomy and castration. All dogs were continent after surgery. UPPs and EMGs at 1 and 2 months after surgery were no different than before surgery. This contrasts to our previous studies in which excisional prostatectomy reduced maximal urethral closure pressure (MUCP) in dogs without prostatic disease. The use of the ultrasonic surgical aspirator for intracapsular subtotal prostatectomy facilitated removal of glandular tissue with decreased hemorrhage and provided preservation of the prostatic urethra, nerves, and vessels involved in maintaining urinary continence.

Changing attitudes toward the management of blunt splenic trauma in adults

During the past decade, one of the most controversial issues in the surgical literature has been the question of what is the most appropriate management of splenic trauma. An increased understanding of the physiologic importance of splenic function must now be weighed against the life-threatening risk of exsanguinating splenic hemorrhage. In this article, postsplenectomy sepsis and mortality in adults and the selective management of blunt splenic trauma are discussed. Although the risks of postsplenectomy sepsis and serious infection are low, they do exist. A policy of individual assessment of cases is recommended when the merits of splenectomy versus those of splenic preservation are considered. Similarly, in cases of blunt splenic trauma, a policy of individual assessment is not only intellectually attractive but also safe, rational, and effective from a clinical standpoint. In selected cases of blunt splenic trauma, nonoperative management and splenorrhaphy are acceptable alternatives; however, in many instances splenectomy remains the most appropriate and only course of action.

The cavitron ultrasonic surgical aspirator system. An anatomical and physiological study of the effect of its use on the rat facial nerve

The Cavitron Ultrasonic Surgical Aspirator System was used to clear the facial nerve from adjacent tissues in the rat. Acute damage to the nerve was manifest electrophysiologically by a significant decrease in amplitude of the conducted nerve action potential (P less than 0.0001) and increase in latency of the muscle action potential (P less than 0.01). Impairment of neural activity was temporary. In the majority of rats facial movements and neural activity returned to their preoperative state within 14 days. The nerves were prepared for light and transmission electron microscopy. The histopathological correlate of the documented functional impairment was disruption of the perineurium and a variable degeneration of the nerve fibres. Regeneration was evident by the end of the second postoperative week, but degenerative changes seen in some of these new fibres cast doubt on their viability.

Embryotoxic and teratogenic effect of high intensity, low frequency ultrasonic vibration on chicken embryos

Controlled exposure of chicken embryos to continuous 30 W/cm2, 29 kHz ultrasonic vibration in a water medium produced, in proportion to exposure, progressively retarded growth or death. Analysis supports, and observation confirms, the presence of cavitation in the water medium. The effects reported here differ substantially from published observations of megaHertz insonation of chicken embryos at similar intensities. The experiments closely resemble in method of application, frequency and intensity the operation of several ultrasonic surgical and dental instruments.

Histological appearances of intracranial biopsies obtained using the Cavitron ultrasonic surgical aspirator

The Cavitron ultrasonic surgical aspirator causes localised ultrasonic tissue fragmentation and has recently been used to remove intracranial tumours. We have examined tissue fragments from 17 operations in which the apparatus was used: in all cases a definitive diagnosis could be made from the material aspirated. This finding has not been previously described.