The CUSA Clarity Soft Tissue Removal Study: Clinical Performance Investigation of the CUSA Clarity Ultrasonic Surgical Aspirator System for Soft Tissue Removal During Liver Surgery

Background: Intraoperative blood loss has an unfavorable impact on the outcome of patients undergoing liver surgery. Today, the use of devices capable of minimizing this risk with high technical performance becomes mandatory. Into this scenario fits the CUSA® Clarity Ultrasonic Surgical Aspirator System. This prospective survey involving five liver surgery centers had the objective of investigating whether this innovative ultrasonic surgical aspirator is safe and effective in the transection of the liver parenchyma. Materials and Methods: This clinical study was a prospective, multicenter, single-arm Post-Market Clinical Follow-up study investigating 100 subjects who underwent liver surgery using the CUSA Clarity Ultrasonic Surgical Aspirator System at five centers during a period of 1 year and 8 months. After collecting all the patient's clinical information and instrument usage details, surgeons completed a brief survey giving their opinions on the performance of CUSA. Therefore, safety and efficacy outcomes were evaluated. Results: Surgeons had a 95% success rate in complete removal of the mass with an average overall operative time of 4 hours and 34 minutes. Overall, there were no complications or device deficiencies. Conclusion: The CUSA Clarity Ultrasonic Surgical Aspirator System performs well during liver surgery with a low complication rate. ClinicalTrials.gov Identifier: NCT04298268.

Identification of Factors Related to the Quality of Lymphadenectomy for Lung Cancer: Secondary Analysis of Prospective Randomized Trial Data

The outcomes of non-small cell lung cancer surgery are influenced by the quality of lymphadenectomy. This study aimed to evaluate the impact of different energy devices on lymphadenectomy quality and identify additional influencing factors. This secondary analysis of the prospective randomized trial data (clinicaltrials.gov: NCT03125798) compared patients who underwent thoracoscopic lobectomy with the LigaSure device (study group, n = 96) and monopolar device (control group, n = 94). The primary endpoint was the lobe-specific mediastinal lymphadenectomy. Lobe-specific mediastinal lymphadenectomy criteria were met in 60.4% and 38.3% of patients in the study and control groups, respectively (p = 0.002). In addition, in the study group, the median number of mediastinal lymph node stations removed was higher (4 vs. 3, p = 0.017), and complete resection was more often achieved (91.7% vs. 80.9%, p = 0.030). Logistic regression analysis indicated that lymphadenectomy quality was positively associated with the use of the LigaSure device (OR, 2.729; 95% CI, 1.446 to 5.152; p = 0.002) and female sex (OR, 2.012; 95% CI, 1.058 to 3.829; p = 0.033), but negatively associated with a higher Charlson Comorbidity Index (OR, 0.781; 95% CI, 0.620 to 0.986; p = 0.037), left lower lobectomy (OR, 0.263; 95% CI, 0.096 to 0.726; p = 0.010) and middle lobectomy (OR, 0.136; 95% CI, 0.031 to 0.606, p = 0.009). This study found that using the LigaSure device can improve the quality of lymphadenectomy in lung cancer patients and also identified other factors that affect the quality of lymphadenectomy. These findings contribute to improving lung cancer surgical treatment outcomes and provide valuable insights for clinical practice.

Proficient One-Step Heat-Up Synthesis of Manganese Sulfide Quantum Dots for Solar Cell Applications

The necessity to develop renewable energy resources that are highly durable and flexible with superior energy density and capacitance ability has attracted considerable interest in the field of solar cell research. Semiconducting compound materials that are easily available, hazard-free and cost-effective are emerging as potential solutions to tackle this challenge. Herein, we present multiple molecular precursors used to grow manganese sulfide nanoparticles through a proficient one-step heat-up approach. For all of the tested samples, the X-ray diffraction peaks correspond to a γ-MnS hexagonal wurtzite structure. UV-Vis spectroscopy yielded absorption wavelengths of 359-420 nm and band-gap energies of 3.78-4.0 eV. Photoluminescence analysis shows characteristics of red and blue shift from 451-602 nm. High-resolution transmission electron microscopy (HRTEM) and selected-area electron diffraction (SAED) reveal a narrow size distribution with nanosticks and large contact areas, which are critical for improved catalytic performance. The current study provides an improved pathway to a well-grown and uniform nanocrystal structure for applications in energy devices.

Delayed tracheal rupture following transoral endoscopic thyroidectomy vestibular approach: Case report and review of the literature

BACKGROUND

Although the transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been proven to be a safe procedure for select patients, as it is a novel approach, all associated complications require adequate attention.

METHODS

We presented a 49-year old woman who underwent TOETVA developed delayed tracheal rupture 1 week after surgery. An extensive search of literature was carried out using PubMed, Embase, and Web of Science for studies reporting tracheal injury following endoscopic thyroidectomy.

RESULTS

Thirteen cases of endoscopic thyroidectomy were analyzed, including eight cases of TOETVA. Tracheal injury occurred during various procedures, including accidental dissection, surgical needle puncture, Hegar dilation and trocar placement, and thermal injury by the energy device.

CONCLUSIONS

Tracheal injury following TOETVA is an underreported complication that can be induced by various factors. Thermal injury to the trachea is more likely to cause a delayed rupture. Careful blunt dissection and standardized use of energy devices are suggested.

The Effect of Energy Devices, Nerve Monitors, and Drains on Thyroidectomy Outcomes: An American College of Surgeons National Surgical Quality Improvement Project Database Analysis

The effect of energy devices, nerve monitors, and drains on thyroidectomy outcomes has been examined for each tool independently. Current literature supports the routine use of energy devices and nerve monitors and does not support the routine use of drains. The effect of these operative tools is interrelated and should be examined concurrently. The aim of this study was to describe the risk-adjusted effect of each of these tools on thyroidectomy outcomes. A retrospective analysis of 17 985 open thyroidectomy procedures was conducted using the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) 2016-2018 thyroidectomy targeted procedure database. All open thyroidectomies were included. The risk-adjusted effect of energy devices, nerve monitors, and drains on 30-day outcomes was calculated by multiple logistic regression. Energy devices were associated with a decreased risk of hematoma and decreased extended length of stay without increased risk of hypocalcemia or recurrent laryngeal nerve injury. Nerve monitors were associated with a decreased risk of overall morbidity, decreased recurrent laryngeal nerve injury, and decreased extended length of stay without an increased risk of adverse outcomes. Drains were associated with an increased risk of bleeding, reoperation, and extended length of stay without decreasing hematoma. Our results support the routine use of energy devices and nerve monitors for thyroidectomy and do not support the routine use of drains for thyroidectomy.

Customized Treatment Using Microfocused Ultrasound with Visualization for Optimized Patient Outcomes: A Review of Skin-tightening Energy Technologies and a Pan-Asian Adaptation of the Expert Panel's Gold Standard Consensus

BACKGROUND: Noninvasive facial-rejuvenation devices, such as nonablative radiofrequency (RF) and laser-assisted technology, are increasingly replacing higher-risk surgeries for face and body skin laxity. OBJECTIVE: We sought to review published information on noninvasive energy device safety and efficacy in aesthetic skin tightening, compare these with our experiences in Asian patients, and disseminate a consensus for optimizing microfocused ultrasound with visualization (MFU-V) in Asian patients. METHODS: A broad, nonexhaustive, nonsystematic literature search of published studies indexed in PubMed was performed to compare selected energy technologies to MFU-V for noninvasive face and body skin tightening, in particular, among Asian patients. This was supplemented with internal documents to provide evidence and support arguments if no peer-reviewed data were available. RESULTS: We highlighted the differences between devices and platforms and identified factors requiring attention and caution. Due to the increase in new devices lacking strong supporting clinical evidence of both safety and efficacy in Asia, it is necessary to convene physicians with substantial experience in MFU-V and devise a consensus on Asian patient selection, treatment planning, and customization. CONCLUSION: Many platforms duplicate or claim similar technologies, efficacy, or safety without significant peer-reviewed scientific or clinical evidence. We showed that MFU-V satisfies this clinical imperative. Further, the patented DeepSEE^® technology allows users to noninvasively "see" through the skin to ensure treatment precision, facilitate optimal skin lifting and tightening, and enhance patient comfort and safety. Therefore, we believe that MFU-V is the gold standard for nonsurgical lifting and skin tightening.

Mesoporous Carbon Fibers with Tunable Mesoporosity for Electrode Materials in Energy Devices

To improve the properties of mesoporous carbon (MC), used as a catalyst support within electrodes, MC fibers (MCFs) were successfully synthesized by combining organic–organic self-assembly and electrospinning deposition and optimizing heat treatment conditions. The pore structure was controlled by varying the experimental conditions. Among MCFs, MCF-A, which was made in the most acidic condition, resulted in the largest pore diameter (4–5 nm), and the porous structure and carbonization degree were further optimized by adjusting heat treatment conditions. Then, since the fiber structure is expected to have an advantage when MCFs are applied to devices, MCF-A layers were prepared by spray printing. For the resistance to compression, MCF-A layers showed higher resistance (5.5% change in thickness) than the bulk MC layer (12.8% change in thickness). The through-plane resistance was lower when the fiber structure remained more within the thin layer, for example, +8 mΩ for 450 rpm milled MCF-A and +12 mΩ for 800 rpm milled MCF-A against the gas diffusion layer (GDL) 25BC carbon paper without a carbon layer coating. The additional advantages of MCF-A compared with bulk MC demonstrate that MCF-A has the potential to be used as a catalyst support within electrodes in energy devices.

Lightning-Rod Effect of Plasmonic Field Enhancement on Hydrogen-Absorbing Transition Metals

The plasmonic enhancement of electromagnetic field energy density at the sharp tips of nanoparticles or nanoscale surface roughnesses of hydrogen-absorbing transition metals, Pd, Ti, and Ni, is quantitatively investigated. A large degree of energy focusing is observed for these transition metals in the microwave region, even surpassing the enhancement for noble metals according to the conditions. Pd, for instance, exhibits peak field enhancement factors of 6000 and 2 × 108 in air for morphological aspect ratios of 10 and 100, respectively. Metal surfaces possibly contain such degrees of nano- or micro-scale native random roughnesses, and, therefore, the field enhancement effect may have been unknowingly produced in existing electrical and optical systems. In addition, for future devices under development, particularly in hydrogen-related applications, it is desirable to design and optimize the systems, including the choice of materials, structures, and operating conditions, by accounting for the plasmonic local energy enhancement effect around the metal surfaces.

Efficacy and safety of a vessel sealing system in oral cancer resection and reconstructive surgery

OBJECTIVE

Currently, many studies are being performed that focus on the efficacy and safety of the vessel sealing system (VSS) in various fields of surgery. However, in the field of oral cancer surgery, the efficacy and safety of VSS use have not been clarified.

METHODS

One hundred and fifty-one patients underwent oral cancer resection and reconstructive surgery. They were divided into two groups: Ligasure vessel sealing system (LVSS) group and conventional surgery (CS) as control. Intra-operative blood loss, operating time, and incidence of post-operative complications and recurrence were analyzed.

RESULTS

LVSS use significantly reduced intra-operative blood loss. The operating time was shortened only in mandibular gingiva cancer surgery. There were no differences between the two groups with regard to the incidence of post-operative complications and recurrence.

CONCLUSIONS

LVSS use was found to be effective and proved to be efficient and safe, and may be useful in oral cancer surgery.

Clinical Impact of a Surgical Energy Device in Advanced Ovarian Cancer Surgery Including Bowel Resection

AIM

To evaluate the clinical impact of the use of the Caiman® articulating energy device in advanced ovarian cancer (AOC) including rectosigmoid resection [e.g. modified posterior exenteration (MPE)].

PATIENTS AND METHODS

This was a prospective single-institution observational study with women undergoing MPE where all soft-tissue dissections and vessel ligations were performed using the Caiman® device. Intraoperative and postoperative surgical data were collected. Bladder function after nerve-sparing surgery was analyzed before and 6 months after surgery.

RESULTS

Forty patients were registered in the study. The median time for specimen removal using Caiman® was 86 min (range=70-120 min). Major vessel ligation was successful in all patients with a median of a single (range=1-4) Caiman® application to seal major vessels. No intraoperative or postoperative complications or bladder dysfunctions associated with the use of Caiman® were noted.

CONCLUSION

Caiman® can be safely used in AOC surgery and may save time through faster dissection. However, comparative studies with other energy devices are needed to confirm this finding.

Growth of Wafer-Scale Standing Layers of WS2 for Self-Biased High-Speed UV-Visible-NIR Optoelectronic Devices

This work describes the wafer-scale standing growth of (002)-plane-oriented layers of WS₂ and their suitability for use in self-biased broad-band high-speed photodetection. The WS₂ layers are grown using large-scale sputtering, and the effects of the processing parameters such as the deposition temperature, deposition time, and sputtering power are studied. The structural, physical, chemical, optical, and electrical properties of the WS₂ samples are also investigated. On the basis of the broad-band light absorption and high-speed in-plane carrier transport characteristics of the WS₂ layers, a self-biased broad-band high-speed photodetector is fabricated by forming a type-II heterojunction. This WS₂/Si heterojunction is sensitive to ultraviolet, visible, and near-infrared photons and shows an ultrafast photoresponse (1.1 μs) along with an excellent responsivity (4 mA/W) and a specific detectivity (∼1.5 × 10¹⁰ Jones). A comprehensive Mott-Schottky analysis is performed to evaluate the parameters of the device, such as the frequency-dependent flat-band potential and carrier concentration. Further, the photodetection parameters of the device, such as its linear dynamic range, rising time, and falling time, are evaluated to elucidate its spectral and transient characteristics. The device exhibits remarkably improved transient and spectral photodetection performances as compared to those of photodetectors based on atomically thin WS₂ and two-dimensional materials. These results suggest that the proposed method is feasible for the manipulation of vertically standing WS₂ layers that exhibit high in-plane carrier mobility and allow for high-performance broad-band photodetection and energy device applications.

Relationship between tissue tension and thermal diffusion to peripheral tissue using an energy device

The aim of the study was to assess the relationship between tissue tension and thermal diffusion to peripheral tissues using an electric scalpel, ultrasonically activated device, or a bipolar sealing system. The mesentery of pigs was excised with each energy device (ED) at three tissue tensions (0, 300, 600 g). The excision time and thermal diffusion area were monitored with thermography, measured for each ED, and then histologically examined. Correlations between tissue tension and thermal diffusion area were examined. The excision time was inversely correlated with tissue tension for all ED (electric scalpel, r = 0.718; ultrasonically activated device, r = 0.949; bipolar sealing system, r = 0.843), and tissue tension was inversely correlated with the thermal diffusion area with the electric scalpel (r = 0.718) and bipolar sealing system (r = 0.869). Histopathologically, limited deep thermal denaturation occurred at a tension of 600 g with all ED. We conclude that thermal damage can be avoided with adequate tissue tension when any ED is used.

Superelastic supercapacitors with high performances during stretching

A fiber-shaped supercapacitor that can be stretched over 400% is developed by using two aligned carbon nanotube/polyaniline composite sheets as electrodes. A high specific capacitance of approximately 79.4 F g(-1) is well maintained after stretching at a strain of 300% for 5000 cycles or 100.8 F g(-1) after bending for 5000 cycles at a current density of 1 A g(-1). In particular, the high specific capacitance is maintained by 95.8% at a stretching speed as high as 30 mm s(-1).