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Balazic E, Muskat A, Kost Y, Cohen JL, Kobets K. The role of laser and energy-assisted drug delivery in the treatment of alopecia. Lasers Med Sci 2024; 39:73. [PMID: 38381230 PMCID: PMC10881732 DOI: 10.1007/s10103-024-04015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/02/2024] [Indexed: 02/22/2024]
Abstract
It has been recently established that laser treatment can be combined with topical or intralesional medications to enhance the delivery of drugs and improve overall results in a variety of different dermatological disorders. The aim of this review is to evaluate the use of laser and energy-assisted drug delivery (LEADD) for the treatment of alopecia with a specific focus on ablative fractional lasers (AFL), non-ablative fractional lasers (NAFL), and radiofrequency microneedling (RFMN). A comprehensive PubMed search was performed in December 2022 for "laser-assisted drug delivery" as well as "laser" and "alopecia." The evidence regarding LEADD for alopecia treatment is limited to two specific alopecia subtypes: alopecia areata (AA) and androgenetic alopecia (AGA)/pattern hair loss (PHL). LEADD with minoxidil and platelet-rich plasma (PRP) were evaluated for efficacy in both treatments of AA and AGA. LEADD with topical corticosteroids and intralesional methotrexate were studied for the treatment of AA, while LEADD with growth factors and stem cells were studied for the treatment of AGA. Multiple RCTs evaluated LEADD for topical corticosteroids with ablative fractional lasers for the treatment of AA. There is evidence in the literature that supports the use of topical minoxidil in combination with all devices for the treatment of AGA/PHL. All the reviewed studies show a positive treatment effect with LADD; however, some trials did not find LEADD to be superior to monotherapy or microneedling-assisted drug delivery. LEADD is a rapidly emerging treatment modality for the treatment of AGA and AA.
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Affiliation(s)
- Eliza Balazic
- Division of Dermatology, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY, 10461, USA.
| | - Ahava Muskat
- Division of Dermatology, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY, 10461, USA
| | - Yana Kost
- Division of Dermatology, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY, 10461, USA
| | - Joel L Cohen
- AboutSkin Dermatology & AboutSkin Research, Greenwood Village, CO, USA
| | - Kseniya Kobets
- Division of Dermatology, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY, 10461, USA
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Alexiades M. Radiofrequency Microneedling. Facial Plast Surg Clin North Am 2023; 31:495-502. [PMID: 37806682 DOI: 10.1016/j.fsc.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Radiofrequency microneedling is a technique that allows energy to be delivered to specified target depths in the skin via needle electrodes and measures temperature and impedance within the tissue. This method of delivery and real-time feedback has increased safety and efficacy, providing clinically significant improvements in skin laxity, rhytids, and cellulite.
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Affiliation(s)
- Macrene Alexiades
- Yale University School of Medicine, New Haven, CT, USA; Dermatology & Laser Surgery Center of New York, NY, USA.
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Spartalis E, Giannakodimos A, Giannakodimos I, Ziogou A, Papasilekas T, Patelis N, Schizas D, Troupis T. The role of LigaSure™ and Harmonic Scalpel in the preservation of recurrent laryngeal nerve during thyroidectomy. Ann R Coll Surg Engl 2021; 104:324-329. [PMID: 34415202 DOI: 10.1308/rcsann.2021.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Transient or permanent damage to the recurrent laryngeal nerve (RLN) during thyroidectomy is of paramount importance for patient quality of life. The aim of this study is to systematically review the literature concerning the role of the most popular energy-based vessel-sealing devices (LigaSure™ (LS) and Harmonic Scalpel (HS)) in preservation of the RLN during thyroidectomy. The safety and inferiority or superiority of LS and HS compared with conventional haemostatic techniques are highlighted. METHODS A systematic search of the literature was performed. Clinical trials, prospective and retrospective studies that significantly compared the use of LS and HS with conventional haemostasis regarding the postoperative incidence of RLN palsy were included. FINDINGS The search resulted in 43 studies, including 17,953 patients treated using energy-based devices or conventional haemostatic methods. Concerning the incidence of RLN palsy, 40 studies showed no significant difference between the energy-based device and conventional groups, whereas two studies demonstrated a significant superiority in performance for LS and HS compared with conventional haemostasis. Only one study exhibited significant inferiority of LS and HS compared with conventional methods. No statistical relationship was observed between energy-based devices and conventional techniques regarding permanent damage to the RLN. CONCLUSION The performance of both LS and HS shows no inferiority compared with conventional haemostatic techniques, regarding damage to the laryngeal nerve. Further well-designed studies are needed to investigate their potential benefit in preservation of the RLN.
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Affiliation(s)
- E Spartalis
- National and Kapodistrian University of Athens, Greece
| | | | | | - A Ziogou
- National and Kapodistrian University of Athens, Greece
| | - T Papasilekas
- National and Kapodistrian University of Athens, Greece
| | - N Patelis
- National and Kapodistrian University of Athens, Greece
| | - D Schizas
- National and Kapodistrian University of Athens, Greece
| | - T Troupis
- National and Kapodistrian University of Athens, Greece
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Spartalis E, Giannakodimos A, Ziogou A, Giannakodimos I, Paschou SA, Spartalis M, Schizas D, Troupis T. Effect of energy-based devices on post-operative parathyroid function and blood calcium levels after total thyroidectomy. Expert Rev Med Devices 2021; 18:291-298. [PMID: 33666537 DOI: 10.1080/17434440.2021.1899805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Introduction: Energy-based devices are widely used in thyroid surgery in order to achieve optimal hemostasis, while their role in the incidence of hypocalcemia and hypoparathyroidism comprises a topic evaluated in numerous studies.Areas covered: The aim of this systematic review is to investigate the potential benefit of Ultrasonic Shears and Electrothermal Bipolar (Radiofrequency) System in thyroid surgery regarding the incidence of post-operative hypocalcemia and hypoparathyroidism. A systematic review of the literature in PubMed/Medline and Scopus databases was conducted. Forty-nine studies met the inclusion criteria and were analyzed. A statistically decreased rate of transient hypocalcemia and hypoparathyroidism was reported in 15 studies and 4 studies, respectively, when using energy-based devices. However, 18 and 13 surveys examined transient hypocalcemia and hypoparathyroidism, respectively, and demonstrated no statistical difference between energy-based devices and conventional hemostasis. No difference was observed between the groups concerning permanent hypocalcemia. Out of 13 studies, only 2 showed a significant reduction in the occurrence of permanent hypoparathyroidism in the energy-based device group.Expert opinion: Energy-based devices reduced the rate of transient hypocalcemia and hypoparathyroidism after thyroid surgeries in 42.8% and 23.5% of the included studies, respectively. Further studies are needed to evaluate their impact on permanent post-operative hypocalcemia and hypoparathyroidism.
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Affiliation(s)
- Eleftherios Spartalis
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece.,Laboratory of Experimental Surgery and Surgical Research "N.S Christeas," National and Kapodistrian University of Athens, Medical School, Athens, Greece.,Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Alexios Giannakodimos
- 2 Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Afroditi Ziogou
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Ilias Giannakodimos
- 1st Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula A Paschou
- Division of Endocrinology, Diabetes and Metabolism, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Spartalis
- Laboratory of Experimental Surgery and Surgical Research "N.S Christeas," National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodore Troupis
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Gentile RD. Evaluating, Purchasing, and Incorporating High-Tech Equipment into a Facial Plastic Surgery Practice. Facial Plast Surg Clin North Am 2020; 28:443-50. [PMID: 33010862 DOI: 10.1016/j.fsc.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In this article the authors discuss and analyze technological devices also known as energy-based devices and their use in skin rejuvenation, facial contouring, skin tightening, and other applications in facial plastic surgery. Energy has been applied in some form to tissue since the beginning of recorded history. The practice of applying heat to tissue with the use of cauters was used for thousands of years as an invaluable method of controlling hemorrhage. Continuous improvement of methods for using the beneficial effects of heat on tissue eventually led to the development of the basic concepts of electrosurgery we know today.
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Abstract
The use of energy-based devices as surgical tools during rhytidectomy was introduced in early 2007 to 2008 and occurred when the first fiber laser was approved for laser lipolysis. It became evident that the fiber laser-assisted rhytidectomy could offer several advantages compared with conventional rhytidectomy. The use of energy devices now includes temperature-controlled radiofrequency and helium plasma devices. Energy devices continue to offer advantages compared with knife and scissor approaches: improved hemostasis; an ability to dissect into areas without full flap elevation; and the shrink-wrap late effects of collagen remodeling after energy-based treatment, which improves the results of rhytidectomy.
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Affiliation(s)
- Richard D Gentile
- Gentile Facial Plastic & Aesthetic Laser Center, Facial Plastic Surgery, The Cleveland Clinic Akron General Hospital, Akron, OH, USA.
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Shobeiri SA, Kerkhof MH, Minassian VA, Bazi T. IUGA committee opinion: laser-based vaginal devices for treatment of stress urinary incontinence, genitourinary syndrome of menopause, and vaginal laxity. Int Urogynecol J 2018; 30:371-376. [PMID: 30523374 DOI: 10.1007/s00192-018-3830-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/14/2018] [Indexed: 11/26/2022]
Abstract
This committee opinion reviews the laser-based vaginal devices for treatment of genitourinary syndrome of menopause, vaginal laxity, and stress urinary incontinence. The United States Food and Drug Administration has issued a warning for unsubstantiated advertising and use of energy-based devices. Well-designed case-control studies are required to further investigate the potential benefits, harm, and efficacy of laser therapy in the treatment of genitourinary syndrome of menopause, vaginal laxity, and stress urinary incontinence. The therapeutic advantages of nonsurgical laser-based devices in urogynecology can only be recommended after robust clinical trials have demonstrated their long-term complication profile, safety, and efficacy.
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Affiliation(s)
- S Abbas Shobeiri
- Department of Obstetrics and Gynecology, INOVA Women's Hospital, Falls Church, VA, USA.
- Department of Biomedical Engineering, George Mason University, Fairfax, VA, USA.
| | - M H Kerkhof
- Curilion Female Health Clinic, Haralem, Netherlands
| | - Vatche A Minassian
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Tony Bazi
- Department of Obstetrics and Gynecology, The American University of Beirut, Beirut, Lebanon
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Tamura A, Tsutsui H, Yano Y, Ohara R, Hoshi M, Nagai T, Nagao T, Ikeda N. Thermal effects of the Thunderbeat ™ device on the recurrent laryngeal nerve during thyroid surgery. Surg Today 2018; 48:1076-80. [PMID: 29987357 DOI: 10.1007/s00595-018-1692-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To investigate the safety of the Thunderbeat™ (TB) device in thyroid surgery by clarifying its thermal effects on the recurrent laryngeal nerve (RLN). METHODS We performed thyroidectomy using TB on four female pigs under general anesthesia. TB was applied 0, 1, and 2 mm from the RLN. The effects of incisions made in tissues in the vicinity of the RLN were evaluated by intraoperative neuromonitoring and pathological examination. RESULTS The value of the neural integrity monitor (NIM) was unchanged at 2 and 1 mm, but there was loss of signal at 0 mm. The differences between 2 and 0 mm were not clear from the pathological findings. CONCLUSIONS When using the TB device during thyroid surgery, it is recommended that it is visually kept from making any contact with the RLN.
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Uludag SS, Teksoz S, Arikan AE, Tarhan O, Yener HM, Ozcan M, Liddy W, Randolph GW. Effect of energy-based devices on voice quality after total thyroidectomy. Eur Arch Otorhinolaryngol 2017; 274:2295-302. [PMID: 28238161 DOI: 10.1007/s00405-016-4444-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
Abstract
Voice alteration is an important complication of thyroid surgery and is closely related to patients' quality of life. There are no studies analyzing effect of energy-based devices (EBD) on voice quality (VQ). Aim of this prospective study is to evaluate impact of sutureless total thyroidectomy performed with EBDs on objective voice parameters of patients without recurrent laryngeal nerve (RLN) and/or external branch of superior laryngeal nerve (EBSLN) injury. Sixty patients underwent total thyroidectomy with meticulous dissection of EBSLN. Patients were assigned to Group L (Ligasure™), Group H (Harmonic), or Group C (Conventional) through random ballot. For analysis of alteration in VQ, digital videolaryngostroboscopy (VLS), voice handicap index (VHI), multidimensional voice program (MDVP), and electroglottography (EGG) were used. VLS was performed by 70°-angled indirect laryngoscopy and evaluation was standardized by VLS scale and laryngeal function scoring. This study is registered on clinicaltrials.gov with number NCT01865006. Forty eight patients were female. There was no difference on demographic data. On post-operative laryngoscopic examination, none of the patients had vocal fold palsy. When mean VHI scores at post-operative 1st week and 2nd month were compared to pre-operative values for each groups, groups L and H demonstrated a significant increase in VHI in the early post-operative evaluation, while there was no significant increase for group C. No significant increase was seen in late post-operative period compared to pre-operative period for any groups. In the early post-operative period, VQ is better with the conventional technique than EBDs; however, in late post-operative period, VQ is detected better in EBDs (especially in Group L) than the conventional technique, but no statistical difference was observed.
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Robinson TN, Olasky J, Young P, Feldman LS, Fuchshuber PR, Jones SB, Madani A, Brunt M, Mikami D, Jackson GP, Mischna J, Schwaitzberg S, Jones DB. Fundamental Use of Surgical Energy (FUSE) certification: validation and predictors of success. Surg Endosc 2015; 30:916-24. [PMID: 26275533 DOI: 10.1007/s00464-015-4334-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/11/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Fundamental Use of Surgical Energy (FUSE) program includes a Web-based didactic curriculum and a high-stakes multiple-choice question examination with the goal to provide certification of knowledge on the safe use of surgical energy-based devices. The purpose of this study was (1) to set a passing score through a psychometrically sound process and (2) to determine what pretest factors predicted passing the FUSE examination. METHODS Beta-testing of multiple-choice questions on 62 topics of importance to the safe use of surgical energy-based devices was performed. Eligible test takers were physicians with a minimum of 1 year of surgical training who were recruited by FUSE task force members. A pretest survey collected baseline information. RESULTS A total of 227 individuals completed the FUSE beta-test, and 208 completed the pretest survey. The passing/cut score for the first test form of the FUSE multiple-choice examination was determined using the modified Angoff methodology and for the second test form was determined using a linear equating methodology. The overall passing rate across the two examination forms was 81.5%. Self-reported time studying the FUSE Web-based curriculum for a minimum of >2 h was associated with a passing examination score (p < 0.001). Performance was not different based on increased years of surgical practice (p = 0.363), self-reported expertise on one or more types of energy-based devices (p = 0.683), participation in the FUSE postgraduate course (p = 0.426), or having reviewed the FUSE manual (p = 0.428). Logistic regression found that studying the FUSE didactics for >2 h predicted a passing score (OR 3.61; 95% CI 1.44-9.05; p = 0.006) independent of the other baseline characteristics recorded. CONCLUSION(S) The development of the FUSE examination, including the passing score, followed a psychometrically sound process. Self-reported time studying the FUSE curriculum predicted a passing score independent of other pretest characteristics such as years in practice and self-reported expertise.
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Affiliation(s)
- Thomas N Robinson
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Jaisa Olasky
- Department of Surgery, Harvard University, Boston, MA, USA
| | | | | | | | | | - Amin Madani
- Department of Surgery, McGill University, Montreal, Canada
| | - Michael Brunt
- Department of Surgery, Washington University, St. Louis, MO, USA
| | - Dean Mikami
- Department of Surgery, Ohio State University, Columbus, OH, USA
| | | | - Jessica Mischna
- Society of American Gastrointestinal Endoscopic Surgeons, Los Angeles, CA, USA
| | | | - Daniel B Jones
- Department of Surgery, Harvard University, Boston, MA, USA
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