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Abi Antoun M, Etrusco A, Chiantera V, Laganà AS, Feghali E, Khazzaka A, Stabile G, Della Corte L, Dellino M, Sleiman Z. Outcomes of conventional and advanced energy devices in laparoscopic surgery: a systematic review. MINIM INVASIV THER 2024; 33:1-12. [PMID: 38164811 DOI: 10.1080/13645706.2023.2274396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/04/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Hemostasis is an important step in all surgical procedures. Mechanical methods of hemostasis have been gradually abandoned in favor of electrosurgery. The aim of this systematic review was to evaluate the effectiveness of electrosurgical instruments utilized in minimally invasive gynecological procedures. MATERIAL AND METHODS We performed a systematic review, including randomized controlled trials, prospective and retrospective studies, comparing the outcomes of different energy devices (EDs) used in laparoscopic gynecologic surgeries. We extracted data about blood loss (BL), mean operative time, post-operative pain, hospital stay and complications associated with each electrosurgical device. RESULTS We included 30 studies reporting comparative outcomes concerning conventional (bipolar and monopolar) and innovative EDs (Harmonic scalpel, LigaSure, Plasma kinetic gyrus, Thunderbeat, EnSeal, Marseal, Caiman and ALAN). New EDs were found to be more efficient in complex surgeries due to less intraoperative BL and shorter operative time. No significant decrease in hospital stay, post-operative pain or complications was found with the use of new energy instruments. CONCLUSIONS Although new electrosurgical devices seem an appealing and safer option, there is still insufficient evidence for one vessel-sealing technology to be considered superior to another. Therefore, monopolar and conventional bipolar (CB) are still widely used in laparoscopic gynecology.
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Affiliation(s)
- Melissa Abi Antoun
- Obstetrics and gynecology department, Saint Joseph University, Beirut, Lebanon
| | - Andrea Etrusco
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Edwin Feghali
- Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Aline Khazzaka
- Surgical Research Lab, Saint Joseph University, Beirut, Lebanon
| | - Guglielmo Stabile
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Miriam Dellino
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Zaki Sleiman
- Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
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Kawabata R, Takiguchi S, Kimura Y, Imamura H, Fujita J, Tamura S, Fujitani K, Kishi K, Yamamoto K, Fujiwara S, Kurokawa Y, Mori M, Doki Y. A randomized phase II study of the clinical effects of ultrasonically activated coagulating shears (Harmonic scalpel) in open gastrectomy for gastric cancer. Surg Today 2015. [PMID: 26198895 DOI: 10.1007/s00595-015-1213-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The Harmonic Ace ultrasonic scalpel has been popular in abdominal surgery; however, only a few clinical studies have evaluated the efficacy of this device in radical open gastrectomy for gastric cancer. METHODS The present study was designed as a multicenter, prospective, randomized, controlled trial. Patients with resectable gastric cancer were randomly assigned to gastrectomy using the Harmonic scalpel or conventional monopolar electrosurgery. RESULTS A total of 248 patients were enrolled, and 123 patients were included in the Harmonic group and 114 patients were included in the conventional group. The demographics of the patients were well balanced between the groups. There was no significant difference in the length of the operation from skin incision to resection of the gastric specimen (141 ± 36 min in the Harmonic group vs. 147 ± 13 min in the conventional group; p = 0.276) nor in the amount of blood lost (365 ± 293 vs. 336 ± 272 mL; p = 0.434). There was also no significant difference in the incidence of surgical complications or the post-surgical hospital stay between the groups. CONCLUSION The Harmonic scalpel procedure was not superior to the conventional monopolar electrosurgery with regard to reducing the length of the operation, blood loss, postoperative complications, or postoperative hospital stay in radical open gastrectomy.
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Affiliation(s)
- Ryohei Kawabata
- Department of Surgery, Osaka Rosai Hospital, Osaka, Japan.,Department of Surgery, Sakai City Hospital, Osaka, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Yutaka Kimura
- Department of Surgery, Sakai City Hospital, Osaka, Japan
| | - Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | | | | | | | - Kentaro Kishi
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | | | - Shinichi Fujiwara
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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LITTA PIETRO, SACCARDI CARLO, GIZZO SALVATORE, CONTE LORENA, AMBROSI GIULIA, SISSI CLAUDIA, PALUMBO MANLIO. Inflammatory cytokine expression following the use of bipolar electrocoagulation, ultracision harmonic scalpel and cold knife biopsy. Mol Med Rep 2015; 12:2985-90. [DOI: 10.3892/mmr.2015.3677] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 01/21/2015] [Indexed: 11/06/2022] Open
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Shabbir A, Dargan D. Advancement and benefit of energy sealing in minimally invasive surgery. Asian J Endosc Surg 2014; 7:95-101. [PMID: 24754878 DOI: 10.1111/ases.12101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/03/2014] [Accepted: 03/09/2014] [Indexed: 10/25/2022]
Abstract
Energy sealing has advanced rapidly in the last decade with many new devices becoming available. The rate and variety of advances in technology facilitate new and existing techniques, with ultrasonic shears and electrothermal bipolar graspers forming a vital but changing part of the modern surgeon's armamentarium. Advances including the combination of ultrasonic and bipolar systems, the addition of cutting blades, tissue impedance sensors, and electrode configurations with reduced lateral thermal spread have heralded new opportunities in laparoscopic and minimally invasive surgery. Reduced operating times, lower postoperative pain scores, and shorter length of stay are offset by the additional cost of such instruments. Reduced instrument exchange, improved smoke evacuation, and shorter surgeries by trainees with some devices are benefits that set the scene for further innovation in this vibrant sector.
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Affiliation(s)
- Asim Shabbir
- Department of Surgery, National University Hospital Singapore, Singapore
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Hotta T, Takifuji K, Yokoyama S, Matsuda K, Higashiguchi T, Tominaga T, Oku Y, Watanabe T, Nasu T, Hashimoto T, Tamura K, Ieda J, Yamamoto N, Iwamoto H, Yamaue H. Literature review of the energy sources for performing laparoscopic colorectal surgery. World J Gastrointest Surg 2012; 4:1-8. [PMID: 22347536 PMCID: PMC3277876 DOI: 10.4240/wjgs.v4.i1.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Revised: 10/26/2011] [Accepted: 12/08/2011] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic surgery for colorectal disease has become widespread as a minimally invasive treatment. This is important because the increasing availability of new devices allows us to perform procedures with a reduced length of surgery and decreased blood loss. We herein report the results of a literature review of energy sources for laparoscopic colorectal surgery, focused especially on 6 studies comparing ultrasonic coagulating shears (UCS) and other instruments. We also describe our laparoscopic dissection techniques using UCS for colorectal cancer. The short-term outcomes of surgeries using UCS and Ligasure for laparoscopic colorectal surgery were superior to conventional electrosurgery. Some authors have reported that the length of surgery or blood loss when Ligasure was used for laparoscopic colorectal surgery is less than when UCS was used. On the other hand, a recent study demonstrated that there were no significant differences between the short-term outcomes of UCS and Ligasure for laparoscopic colorectal surgery. It is therefore suggested that the choice of technique used should be made according to the surgeon’s preference. We also describe our laparoscopic dissection techniques using UCS (Harmonic ACE) for colorectal cancer with regard to the retroperitoneum dissection, dissection technique, dissection technique around the feeding artery, and various other dissection techniques. We therefore review the outcomes of using various energy sources for laparoscopic colorectal surgery and describe our laparoscopic dissection techniques with UCS (Harmonic ACE) for colorectal cancer.
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Affiliation(s)
- Tsukasa Hotta
- Tsukasa Hotta, Katsunari Takifuji, Shozo Yokoyama, Kenji Matsuda, Takashi Higashiguchi, Toshiji Tominaga, Yoshimasa Oku, Takashi Watanabe, Toru Nasu, Tadamichi Hashimoto, Koichi Tamura, Junji Ieda, Naoyuki Yamamoto, Hiromitsu Iwamoto, Hiroki Yamaue, Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama 641-8510, Japan
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Laparoscopic treatment for endometrial cancer: A meta-analysis of randomized controlled trials (RCTs). Gynecol Oncol 2009; 112:415-21. [DOI: 10.1016/j.ygyno.2008.09.014] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 09/09/2008] [Accepted: 09/13/2008] [Indexed: 11/23/2022]
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Cost Comparison of Reusable and Single-Use Ultrasonic Shears for Laparoscopic Bariatric Surgery. Obes Surg 2008; 20:512-8. [DOI: 10.1007/s11695-008-9723-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Accepted: 09/16/2008] [Indexed: 10/21/2022]
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Pancreatic injury response is different depending on the method of resecting the parenchyma. J Surg Res 2008; 154:203-11. [PMID: 19394638 DOI: 10.1016/j.jss.2008.08.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 08/14/2008] [Accepted: 08/18/2008] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The present study was performed to compare the pancreatic injury response on the parenchymal resection either with ultrasonic scissors, electrocautery, or surgical scalpel. METHODS A 1 x 0.5 cm piece of rat pancreas was resected from side of the pancreas either with ultrasonic scissors (Harmonic Scalpel; UltraCision, Ethicon Endosurgery Inc., Cincinnati, OH) or electrocautery (Force FX; Valleylab, Tyco Healthcare Group LP, Boulder, CO) at two power levels, 1 and 3; 8W and 25W, respectively, or with surgical scalpel. Hemostasis was provided after surgical scalpel either with cellulose patch (Interceed; Johnson and Johnson Medical, Inc., New Brunswick, NJ), three stitches of 6-0 polydioxanone at tightness of 0.6N or fibrin glue (Tisseel Duo Quick; Baxter AG, Wien, Austria). Blood sample and pancreas specimens, both at the resection site and far away, were taken 1, 7, and 21 days postoperatively from exposed animals, sham operated animals (n = 18 in each) and from unexposed baseline animals (n = 5). Necrosis, edema, leukocyte infiltration, hemorrhage, vacuolization, and fibrosis were histologically assessed separately. RESULTS Each resection and sham operation induced similar increase in the amylase activity on day 1 with normalization by day 7. Resection with ultrasonic scissors and electrocautery induced more tissue injury to the pancreas than resection with surgical scalpel independent of the method for hemostasis. The injury, although somewhat milder in intensity, was also observed in parts of the pancreas located far away from the site of resection. CONCLUSIONS Of the compared methods, surgical scalpel resection plus cellulose patch or fibrin glue hemostasis induced the least histological changes in the pancreatic parenchyma. This injury response spread over the pancreas.
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Fleisch MC, Newton J, Steinmetz I, Whitehair J, Hallum A, Hatch KD. Learning and teaching advanced laparoscopic procedures: do alternating trainees impair a laparoscopic surgeon's learning curve? J Minim Invasive Gynecol 2007; 14:293-9. [PMID: 17478358 DOI: 10.1016/j.jmig.2006.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Revised: 10/11/2006] [Accepted: 10/13/2006] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE In this study we investigated whether teaching advanced laparoscopic procedures like laparoscopic-assisted surgical staging (LASS) for endometrial cancer negatively affects the learning curve of the attending surgeon. DESIGN Retrospective study (Canadian Task Force classification II-3.) SETTING Department of Obstetrics and Gynecology, University of Arizona, Tucson. PATIENTS One hundred twenty-four patients undergoing LASS for endometrial cancer at our institution from 1992 through 2004 were included for analysis. INTERVENTIONS Cases were classified into 3 groups. Group A comprised the initial learning phase where 2 attending gynecologic oncologists used other faculty as assistants (first 30 cases). Groups B and C comprised procedures after the learning phase involving attendings (n = 27, group B) or obstetrics and gynecology residents (n = 67, group C) as trainees. Groups were compared with respect to general outcome parameters and disease-free survival. MEASUREMENTS AND MAIN RESULTS Patients within all groups were comparable with respect to age and height or body mass index. In the subgroup analysis, a decrease in blood loss and length of stay occurred mainly during the group B series. Pelvic lymph node yield reached oncologic standards during the initial learning curve (median 12-13) and remained stable during both teaching phases. Intraoperative and postoperative complications occurred in 2.4% and 13.7% of cases, respectively. Ninety percent of intraoperative and 64% of postoperative complications occurred within the first half of the series and were not correlated with type of assistance. Survival data were obtainable in 65% of cases with a median follow-up of 3.6 years. Disease free-survival was 92.5% in stage I disease and without significant difference among the groups. CONCLUSION After gaining proficiency in the procedure, more or less surgically experienced trainees can be actively included without hampering the progress of the attending's learning curve.
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Affiliation(s)
- Markus C Fleisch
- Department of Obstetrics and Gynecology, University of Arizona Health Sciences Center, Tucson, AZ 85724, USA
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Nezhat F, Yadav J, Rahaman J, Gretz H, Gardner GJ, Cohen CJ. Laparoscopic lymphadenectomy for gynecologic malignancies using ultrasonically activated shears: analysis of first 100 cases. Gynecol Oncol 2005; 97:813-9. [PMID: 15943988 DOI: 10.1016/j.ygyno.2005.02.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2004] [Revised: 01/29/2005] [Accepted: 02/02/2005] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the feasibility, safety and utility of the ultrasonic shears for laparoscopic pelvic and para-aortic lymph node retrieval in the treatment of gynecologic cancers. METHODS Data on laparoscopic lymphadenectomy performed for gynecologic malignancies using ultrasonic shears over a 5-year period were collected and analyzed prospectively. RESULTS Laparoscopic lymphadenectomy using ultrasonic shears was performed on 100 patients with a median age of 58 (17-87) years. The types of malignancies included cervical (n = 29), endometrial (n = 48), ovarian (n = 15), fallopian tube (n = 2), malignant mixed mesodermal tumor (n = 2), vaginal (n = 2) and synchronous ovarian and endometrial cancers (n = 2). Sites of lymphadenectomy included pelvic (n = 49), para-aortic (n = 30) or both pelvic and para-aortic (n = 21). The median nodal yield was 22 (0-87). 66/100 were complete lymphadenectomies with a median nodal yield of 28 (2-71). The median length of hospital stay was 2 (1-13) days and the average blood loss was 148 (0-500) ml. Overall complication rate was 13%. There were 3 intra-operative complications, which were all managed laparoscopically. There were no unplanned conversions to laparotomy. There were 10 post-operative complications including port-site metastasis in a patient with positive nodes (n = 1), trocar-site hernia requiring a second laparoscopy (n = 1), deep leg vein thrombosis (n = 1), and a small bowel obstruction (n = 1). CONCLUSIONS This is the largest series to date demonstrating the safety and efficacy of ultrasonic shears in laparoscopic lymphadenectomy for gynecologic malignancies. In addition to the potential for lowering the risk for tissue damage, ultrasonic shears offer multifunctionality which allows for a simpler technique with the use of fewer instruments.
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Affiliation(s)
- Farr Nezhat
- Division of Gynecologic Oncology, Department of Obstetric, Gynecology and Reproductive Sciences, The Mount Sinai Hospital, 1176 Fifth Avenue, Box 1173, New York, NY 10029, USA.
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