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Cureus Dec 2023In modern surgical practice, the focus extends beyond simply making and closing incisions. We aim to investigate the various complex aspects that redefine the criteria... (Review)
Review
In modern surgical practice, the focus extends beyond simply making and closing incisions. We aim to investigate the various complex aspects that redefine the criteria for achieving effective surgical outcomes. This narrative combines current knowledge, integrating practical experiences and academic viewpoints to comprehend the changing field of surgical care thoroughly. The tapestry explores the detailed aspects of surgical safety, examining the most recent progress in protocols, technology, and team dynamics that strive to reduce procedural risks. Examining precision in surgery, this narrative goes beyond conventional limits to explore the incorporation of advanced technologies, such as robotics and navigational systems. The complex interplay between the surgeon's proficiency and these technology aids is crucial in attaining unparalleled accuracy and favorable patient results. The focal point of this investigation is the patient's well-being, encompassing postoperative care, rehabilitation, and long-term health. Actual accounts from surgical procedures highlight the significant influence of comprehensive patient-centered methods, emphasizing the crucial need for empathy, communication, and individualized care plans in promoting healing and adaptability. As we explore this complex situation, the combination of real-life stories and academic discussions creates a clear and detailed image of a surgical environment that goes far beyond the boundaries of the operating room. "Beyond the Scalpel" seeks to engage practitioners, scholars, and stakeholders in a conversation that redefines the criteria for surgical success. It aims to establish a new benchmark that combines safety, precision, and patient well-being, ultimately shaping the future of surgical practice.
PubMed: 38205460
DOI: 10.7759/cureus.50316 -
Brazilian Journal of Otorhinolaryngology 2021Thyroidectomy is the most common surgery in the cervical region. Currently, several techniques are available for intraoperative hemostasis.
INTRODUCTION
Thyroidectomy is the most common surgery in the cervical region. Currently, several techniques are available for intraoperative hemostasis.
OBJECTIVE
To compare the performance of three techniques (monopolar and bipolar electrical and ultrasonic) on operative time and postoperative complications.
METHODS
Patients submitted to total thyroidectomy without prior treatment were included in this prospective series study, using a scientific design.
RESULTS
A total of 834 patients were included; 661 women (79.3%) and 173 men (20.7%). The diagnosis was malignant neoplasia in 528 patients (63.3%) and benign disease in 306 patients (36.7%). The monopolar electric scalpel was used in 280 patients (33.6%), bipolar scalpel in 210 patients (25.2%) and ultrasonic scalpel in 344 patients (41.3%). The operative time was significantly shorter with the ultrasonic or bipolar scalpel when compared to the electric scalpel. In a linear regression model, gender, malignancy diagnosis and power energy type were significant for the procedure duration. Patients who underwent surgery with an ultrasound or bipolar scalpel had a significantly lower incidence of hypoparathyroidism.
CONCLUSION
The use of ultrasonic or bipolar scalpel significantly reduces operative time and the incidence of transient hypoparathyroidism.
Topics: Female; Humans; Hypoparathyroidism; Male; Operative Time; Postoperative Complications; Prospective Studies; Surgical Instruments; Thyroidectomy
PubMed: 31668788
DOI: 10.1016/j.bjorl.2019.08.004 -
Journal of Maxillofacial and Oral... Dec 2019Labial frenectomy is a common procedure in the oral surgery specialty. Nowadays, laser surgery seems to provide better post-operative results than scalpel surgery. Thus,... (Review)
Review
INTRODUCTION
Labial frenectomy is a common procedure in the oral surgery specialty. Nowadays, laser surgery seems to provide better post-operative results than scalpel surgery. Thus, the aim of this study was to analyze whether trans-surgical and postoperative variables of labial frenectomy are better when performed with laser than with conventional scalpel.
MATERIALS AND METHODS
A systematic review has been performed based on PRISMA criteria. The search included three databases, with no limitations of time or language. After screening, seven papers were included in qualitative analysis and six in meta-analysis. Bias analysis was performed according to Cochrane Handbook. Pain during the first (MD - 3.18, 95% CI - 4.03 to - 2.32) and seventh post-surgical days (MD - 1.04, 95% CI - 1.45 to - 0.64); discomfort during speech on the first (MD - 2.15, 95% CI - 3.94 to - 0.37) and the seventh post-surgical days (MD - 1.60, 95% CI - 1.96 to - 1.24); discomfort during chewing on the first (MD - 2.90, 95% CI - 3.35 to - 2.45) and the seventh days (MD - 1.56, 95% CI - 2.21 to - 0.91); and average surgery time (MD - 1.84, 95% CI - 3.22 to - 0.46) were lower in the laser group than in the scalpel group.
CONCLUSION
The results of this systematic review have shown better results to laser group in the following variables: pain, discomfort during speech and chewing. However, the evidence is limited due the high risk of bias.
PubMed: 31624426
DOI: 10.1007/s12663-019-01196-y -
Frontiers in Surgery 2023Due to the sensitivity of the surgical site and a higher probability of injury, the use of a scalpel and electrocautery to create an incision in the spine is discussed....
Comparing the intraoperative and postoperative complications of the scalpel and electrocautery techniques for severing the inner layers of the lumbar disc during discectomy surgery.
BACKGROUND
Due to the sensitivity of the surgical site and a higher probability of injury, the use of a scalpel and electrocautery to create an incision in the spine is discussed. In this study, we will compare the intraoperative and postoperative complications of the scalpel and electrocautery techniques for severing the inner layers of the lumbar disc during discectomy surgery.
MATERIALS AND METHODS
This study was conducted in Iran as a randomized controlled trial with double-blinding (1,401). Sixty candidates for spine surgery were randomly divided into two groups of 30 using electrocautery (A) and a scalpel (B) based on available sampling. The VAS scale was used to assess postoperative pain. The duration of the incision and intraoperative blood loss were recorded. The infection and fluid secretions were determined using the Southampton scoring scale. Utilizing the Manchester scar scale, the wound healing status was evaluated. The SPSS version 16 software was used for data analysis (-test, Mann-Whitney , ANOVA).
RESULTS
The electrocautery group had substantially lower bleeding, pain, and wound healing rates than the scalpel group ( > 0.05). However, the electrocautery group had significantly longer surgical times, more secretions, and a higher infection rate than the scalpel group ( > 0.05). In terms of demographic and clinical characteristics, there was no significant difference between the two groups ( < 0.05).
CONCLUSION
Electrocautery reduces postoperative hemorrhage and, potentially, postoperative pain in patients. However, as the duration of surgery increases, so does the duration of anesthesia, and patient safety decreases. Additionally, the risk of infection increases in the electrocautery group compared to the scalpel group, and the rate of wound healing decreases.
CLINICAL TRIAL REGISTRATION
https://www.irct.ir/, identifier (IRCT20230222057496N1).
PubMed: 37841816
DOI: 10.3389/fsurg.2023.1264519 -
Atlas of the Oral and Maxillofacial... Sep 2022Temporomandibular joint (TMJ) surgical arthroscopy has become a usual operation to treat different pathologies such as internal derangements and degenerative joint... (Review)
Review
Temporomandibular joint (TMJ) surgical arthroscopy has become a usual operation to treat different pathologies such as internal derangements and degenerative joint diseases and osteoarthritis. Although many instruments such as palpators, forceps, scissors, scrapers, scalpels, and motorized terminals are needed to perform different arthroscopic surgical procedures, it is of paramount importance to have devices that allow the surgeon to cut and coagulate tissues safely. Coblation (cold ablation) is a process that using a radiofrequency electrical energy passing through saline solution and produces plasma that can be applied precisely to tissues to break molecular bonds within cells. This surgical technique has become the best surgical option to perform different arthroscopic surgical techniques. Coblation of synovitis areas, lysis of adhesions, disc mobilization techniques with the anterior release (capsulotomy or myotomy), and posterior coagulation of the retro discal tissues are the most common procedures performed. Disc perforations, bone chondromalacia, synovial chondromatosis (SC), and joint hypermobility can also be treated using coblation technologies.
Topics: Arthroscopy; Electrocoagulation; Humans; Myotomy; Saline Solution; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 36116875
DOI: 10.1016/j.cxom.2022.06.009 -
European Archives of... Mar 2017This meta-analysis compared harmonic scalpel and LigaSure systems with the conventional clamp-and-tie technique in thyroidectomy. Medline, Cochrane, EMBASE, and Google... (Meta-Analysis)
Meta-Analysis Review
This meta-analysis compared harmonic scalpel and LigaSure systems with the conventional clamp-and-tie technique in thyroidectomy. Medline, Cochrane, EMBASE, and Google Scholar databases were searched until December 30, 2015. Randomized controlled studies (RCTs) or two-arm prospective studies were included. The primary outcome was operation time. The data were evaluated both by pair-wise meta-analyses and network meta-analysis within a Bayesian framework using Markov chain Monte Carlo methods. Compared with the conventional hemostasis, there was a significant reduction in operation time with harmonic scalpel (HS) and LigaSure (LS) (difference in means = -24.27 min, 95 % CI -28.11 to -20.44 min, P < 0.001; and difference in means = -13.08 min, 95 % CI -16.88 to -9.27 min, P < 0.001, respectively). For total thyroidectomy and hemi-thyroidectomy, subgroup pair-wise meta-analyses found a reduction of 26.31 and 21.90 min in operation time for harmonic scalpel, and a reduction of 12.77 and 17.48 min for LigaSure, respectively. Among studies with mixed total and hemi-thyroidectomy, no significant difference in operation time was seen between harmonic scalpel and the conventional hemostasis (P = 0.313). Network meta-analysis also found harmonic scalpel and LigaSure to have less operation time than the conventional hemostasis, and that harmonic scalpel was associated with a significant 9.78 min reduction in operation time than LigaSure which was not seen in pair-wise comparison. Harmonic scalpel had significantly less risk of definitive recurrent laryngeal nerve palsy, intra-operation blood loss, and post-operation bleeding than the conventional hemostasis. LigaSure was associated with significantly less intra-operative blood loss than the conventional hemostasis (P = 0.023). There was no significant difference among three different procedures in rates of transient recurrent laryngeal nerve palsy. This study found that harmonic scalpel and LigaSure decreased operation time compared with the conventional hemostasis and that harmonic scalpels was associated with the lowest operation time.
Topics: Blood Loss, Surgical; Hemostasis, Surgical; Humans; Network Meta-Analysis; Operative Time; Surgical Instruments; Thyroidectomy; Vocal Cord Paralysis
PubMed: 27481528
DOI: 10.1007/s00405-016-4190-3 -
Aesthetic Plastic Surgery Jun 2024Abdominoplasty, an emerging surgical procedure worldwide, associated with complications, as seroma, infection, and hematoma. This systematic review and meta-analysis... (Review)
Review
BACKGROUND
Abdominoplasty, an emerging surgical procedure worldwide, associated with complications, as seroma, infection, and hematoma. This systematic review and meta-analysis compare the outcomes of abdominoplasty procedures performed using a scalpel versus a diathermocoagulation device (diathermy monopolar electrocautery), aiming to find a safer approach with fewer complications.
METHODS
We conducted a systematic search in November 2023 using PubMed, Ovid Medline, and Ovid Chocrane databases. The methodological index for nonrandomized studies and the Revised Cochrane Risk of Bias assessment tools were used to assess risk of bias for observational studies and randomized controlled trials, respectively. The data were analyzed using RevMan software.
RESULTS
Six articles (1135 patients) were included, 521 patients were operated using a scalpel and 614 using electrocautery. Our analysis suggests that both seroma and drain output were seen more among the electrocautery group, with an odds ratio (OR) of 0.62 (95% CI [0.39, 0.97], p = 0.04) and - 103.63 (95% CI [- 205.67, - 1.59], p = 0.05), respectively. It is important to note the high heterogeneity seen among the studies discussing the total drain output. Additionally, we did not find any statistical significance between both techniques in terms of the rate of hematoma, wound infection, operation time, and hospital stay length.
CONCLUSION
When comparing the use of scalpel and electrocautery dissection in abdominoplasty, higher rates of seroma and total drain output are significantly associated with electrocautery dissection.
LEVEL OF EVIDENCE II
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
PubMed: 38886194
DOI: 10.1007/s00266-024-04156-1 -
The Journal of Craniofacial Surgery Nov 2018The chin is the most prominent and median sector of the lower third of the face giving harmony to nose and lips. The authors present the application of piezoelectric...
BACKGROUND
The chin is the most prominent and median sector of the lower third of the face giving harmony to nose and lips. The authors present the application of piezoelectric scalpel for the correction of different chin deformities. The distinctive characteristics of this device allow the authors to avoid or reduce the immediate genioplasty complications.
METHODS
Fifty-five patients of defective chin have been treated from January 2006 to April 2008. Intraoral genioplasty was performed during the correction of dentofacial dysmorphisms or associated with nasal surgery. The authors used a piezoelectric cutting device to perform different osteotomies and if necessary, interpositional graft was used to stabilize bony segments.
RESULTS
Piezosurgery has been associated with a fewer number of postoperative complications, especially as regard intraoperative bleeding, nerve injuries (immediate and late), hematomas and seromas, asymmetry (immediate and early). The mean time for completing the complete procedure of genioplasty with piezosurgery was almost the same compared with the saw and drill.
CONCLUSION
Genioplasty represents one of the most common ancillary procedures and may be associated with corrective surgery of dentofacial dysmorphisms. Mental nerve injuries, asymmetries, intraoperative bleeding are the main immediate complications of genioplasty. Distinctive characteristics of ultrasonic piezoelectric osteotomy are selective cut of mineralized structure with less risk of vascular and nervous damage (microvibrations), intraoperative precision (thin cutting scalpel and no macrovibrations), blood free site (cavitation effect). In the authors' experience, piezoelectric scalpel, compared with saw and drill, enables them to reduce or avoid immediate complications of chin surgery, helping the surgeon to reach patients' satisfaction.
Topics: Adolescent; Adult; Chin; Female; Genioplasty; Humans; Male; Osteotomy; Patient Satisfaction; Piezosurgery; Postoperative Complications; Plastic Surgery Procedures; Retrospective Studies; Surgical Instruments; Young Adult
PubMed: 30277941
DOI: 10.1097/SCS.0000000000004773 -
Best Practice & Research. Clinical... Jul 2020Despite the prevalent increase of permanent contraception, there are still 222 million women with unmet needs for contraception; a large proportion of these women could... (Review)
Review
Despite the prevalent increase of permanent contraception, there are still 222 million women with unmet needs for contraception; a large proportion of these women could opt for permanent contraception. New approaches to permanent contraception are in development; in the meantime, services need to be accessible, affordable, safe, and convenient to allow women, men, and couples to realize their reproductive intentions. Among the available approaches, we recommend minilaparotomy and no-scalpel vasectomy. These are proven as safe, effective, and feasible surgical techniques that can be offered through a wide range of service modalities such as static clinics, mobile outreach, and using task sharing. Both of these approaches have low complication rates, these being mostly minor complications, and low failure rates. Programs must ensure that they address the provision of these services under a human rights-based approach that will allow services to thrive and individual needs will be fulfilled.
Topics: Contraception; Family Planning Services; Female; Humans; Male; Vasectomy
PubMed: 32094068
DOI: 10.1016/j.bpobgyn.2019.12.004 -
Head & Neck Jul 2020Guidelines for ultrasonic devices use are imperative because infectious aerosols arising from airway procedures were a key etiologic factor in prior coronavirus... (Review)
Review
BACKGROUND
Guidelines for ultrasonic devices use are imperative because infectious aerosols arising from airway procedures were a key etiologic factor in prior coronavirus outbreaks. This manuscript aims to summarize the available recommendations and the most relevant concepts about the use of ultrasonic scalpel during the SARS-CoV-2 pandemic.
METHODS
Literature review of manuscripts with patients, animal models, or in vitro studies where the ultrasonic scalpel was used and the plume produced was analyzed in a quantitative and/ or qualitative way.
DISCUSSION
Activated devices with tissue produce a biphasic bioaerosol composed (size 68.3-994 nm) of tissue particles, blood, intact and no viable cells, and carcinogenic or irritant hydrocarbons (benzene, ethylbenzene, styrene, toluene, heptene, and methylpropene).
CONCLUSION
It is imperative to use an active smoke evacuator, to avoid ultrasonic scalpel use in COVID-19 positive patients and in upper airway surgery, as well as to follow the protection recommendations of the guidelines for management this type of patients.
Topics: Air Pollutants, Occupational; Betacoronavirus; COVID-19; Contraindications, Procedure; Coronavirus Infections; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Occupational Exposure; Otorhinolaryngologic Surgical Procedures; Pandemics; Pneumonia, Viral; SARS-CoV-2; Surgical Instruments; Ultrasonic Surgical Procedures
PubMed: 32441394
DOI: 10.1002/hed.26278