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Annals of the Royal College of Surgeons... May 2022Transient 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... (Review)
Review
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.
Topics: Humans; Prospective Studies; Quality of Life; Recurrent Laryngeal Nerve; Retrospective Studies; Thyroidectomy; Vocal Cord Paralysis
PubMed: 34415202
DOI: 10.1308/rcsann.2021.0125 -
Journal of Shoulder and Elbow Surgery Apr 2022Electrocautery is a common surgical technique and is often used during shoulder arthroplasty to elevate or transect the subscapularis tendon. The relative amount of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Electrocautery is a common surgical technique and is often used during shoulder arthroplasty to elevate or transect the subscapularis tendon. The relative amount of tissue damage caused by cautery as opposed to sharp transection is not currently known. The purpose of this study was to examine local tissue damage resulting from electrocautery vs. sharp transection with a scalpel. We hypothesized that the electrosurgical unit would cause higher collateral tissue damage and cell death compared with sharp transection.
METHODS
Twelve cadaveric ovine shoulders were randomized to either the electrosurgical or sharp transection group. The infraspinatus tendon was isolated, and a partial-thickness transection was made using either a monopolar electrosurgical device (Bovie) or No. 10 scalpel blade. Tendon explants were then visualized with confocal microscopy to evaluate tissue architecture. A live/dead assay was performed using microscopy imaging analysis software. Comparisons between Bovie and scalpel transection were made using the Mann-Whitney U test, and the cell death percentage at standardized distances from the transection site was compared between groups using a mixed-model analysis. Significance was defined at P < .05.
RESULTS
The cellular and tendon fibril architecture was well maintained beyond the scalpel transection site, whereas Bovie transection disrupted the architecture beyond its transection path. The percentage of dead cells in the Bovie group (74.9% ± 31.2%) was significantly higher than that in the scalpel group (27.6% ± 29.9%, P = .0004). Compared with the transection site, the cell death percentage after Bovie transection significantly declined at 2.5 mm whereas that after scalpel transection significantly declined at 1 mm from the transection site.
CONCLUSION
There was a significantly higher dead cell percentage in the Bovie transection group, indicating extensive damage beyond the local incision site, compared with sharp transection. Electrosurgical transection of the ovine infraspinatus tendon ex vivo caused higher cell death and greater tissue architecture disruption compared with sharp scalpel transection.
Topics: Animals; Electrosurgery; Humans; Rotator Cuff; Rotator Cuff Injuries; Sheep; Surgical Instruments; Tendon Injuries
PubMed: 34582992
DOI: 10.1016/j.jse.2021.08.020 -
Surgery Dec 2022
PubMed: 36410941
DOI: 10.1016/j.surg.2022.10.027 -
Cureus Mar 2022Background and objective Colorectal cancer (CRC) is the third most common malignancy and the second most deadly cancer worldwide. Powered equipment has transformed...
Background and objective Colorectal cancer (CRC) is the third most common malignancy and the second most deadly cancer worldwide. Powered equipment has transformed modern surgery, revolutionizing the delicacy, precision, and accuracy of many surgeries. The safety and efficacy of tissue dissection and artery sealing in colorectal surgery remain highly debatable. With the increased use of minimally invasive procedures in colon and rectal surgery, energy devices for tissue dissection and vascular sealing have become widely used. In light of this, we aimed at comparing the use of bipolar electrocautery and harmonic scalpel in CRC surgeries. Methods Our study was a hospital-based comparative study conducted at our tertiary care hospital. Fifty patients were divided equally into two groups by block randomization, and bipolar electrocautery was used in one group, and harmonic scalpel was used in the second group during surgery. The mean operative time, blood loss, and hospital stay were calculated in both groups. The comparison between bipolar electrocautery and harmonic scalpel was evaluated using independent t-tests. Results The mean operative time, blood loss, and hospital stay were significantly lower in the harmonic scalpel group than in the electrocautery group. The results were statistically significant (p < 0.001). Conclusion Based on our findings, the harmonic scalpel is a better energy source when compared to bipolar electrocautery in CRC surgeries.
PubMed: 35449609
DOI: 10.7759/cureus.23255 -
Muscle & Nerve Mar 2023
Topics: Humans; Peripheral Nervous System Diseases; Trauma, Nervous System; Electrodiagnosis; Electromyography; Peripheral Nerve Injuries
PubMed: 36566354
DOI: 10.1002/mus.27777 -
Anesthesia and Analgesia Aug 2022Emergency front-of-neck access (FONA) is particularly challenging with impalpable neck anatomy. We compared 2 techniques that are based on a vertical midline neck... (Randomized Controlled Trial)
Randomized Controlled Trial
Success and Time to Oxygen Delivery for Scalpel-Finger-Cannula and Scalpel-Finger-Bougie Front-of-Neck Access: A Randomized Crossover Study With a Simulated "Can't Intubate, Can't Oxygenate" Scenario in a Manikin Model With Impalpable Neck Anatomy.
BACKGROUND
Emergency front-of-neck access (FONA) is particularly challenging with impalpable neck anatomy. We compared 2 techniques that are based on a vertical midline neck incision, followed by finger dissection and then either a cannula or scalpel puncture to the cricothyroid membrane.
METHODS
A manikin simulation scenario of impalpable neck anatomy and bleeding was created. Sixty-five anesthesiologists undergoing cricothyrotomy training performed scalpel-finger-cannula (SFC) and scalpel-finger-bougie (SFB) cricothyrotomy in random order. Primary outcomes were time to oxygen delivery and first-attempt success; data were analyzed using multilevel mixed-effects models.
RESULTS
SFC was associated with a shorter time to oxygen delivery on univariate (median time difference, -61.5 s; 95% confidence interval [CI], -84.7 to -38.3; P < .001) and multivariable (mean time difference, -62.1 s; 95% CI, -83.2 to -41.0; P < .001) analyses. Higher first-attempt success was reported with SFC than SFB (47 of 65 [72.3%] vs 18 of 65 [27.7%]). Participants also had higher odds at achieving first-attempt success with SFC than SFB (odds ratio [OR], 10.7; 95% CI, 3.3-35.0; P < .001). Successful delivery of oxygen after the "can't intubate, can't oxygenate" (CICO) declaration within 3 attempts and 180 seconds was higher (84.6% vs 63.1%) and more likely with SFC (OR, 5.59; 95% CI, 1.7-18.9; P = .006). Analyzing successful cases only, SFC achieved a shorter time to oxygen delivery (mean time difference, -24.9 s; 95% CI, -37.8 to -12.0; P < .001), but a longer time to cuffed tube insertion (mean time difference, +56.0 s; 95% CI, 39.0-73.0; P < .001). After simulation training, most participants preferred SFC in patients with impalpable neck anatomy (75.3% vs 24.6%).
CONCLUSIONS
In a manikin simulation of impalpable neck anatomy and bleeding, the SFC approach demonstrated superior performance in oxygen delivery and was also the preferred technique of the majority of study participants. Our study findings support the use of a cannula-based FONA technique for achieving oxygenation in a CICO situation, with the prerequisite that appropriate training and equipment are available.
Topics: Airway Management; Cannula; Cricoid Cartilage; Cross-Over Studies; Humans; Intubation, Intratracheal; Manikins; Oxygen
PubMed: 35245225
DOI: 10.1213/ANE.0000000000005969 -
Current Topics in Behavioral... Dec 2023The last two decades have seen a flourishing of research into the immunobiology of psychiatric phenotypes, in particular major depressive disorder. Both preclinical and...
The last two decades have seen a flourishing of research into the immunobiology of psychiatric phenotypes, in particular major depressive disorder. Both preclinical and clinical data have highlighted pathways and possible mechanisms that might link changes in immunobiology, most especially inflammation, to clinically relevant behaviour. From a therapeutics perspective, a major impetus has been the action of Biologics, often monoclonal antibodies, that target specific cytokines acting as "molecular scalpels" helping to uncover the actions of those proteins. These interventions have been associated with improvements in mood and related symptoms. There are now enough studies and participants to permit meta-analytic analyses of the actions of these and other anti-inflammatory agents.In this chapter, the focus is on the evidence for the role of inflammation biology in depression and the meta-analytic data from trials. The putative mechanisms that might underpin the antidepressant effect of anti-inflammatory drugs are also explored. Lastly, I describe the more stubborn difficulties around heterogeneity, deep phenotyping and stratification as well as improved animal models and greater understanding of the biology that might be addressed by future studies.
PubMed: 38112963
DOI: 10.1007/7854_2023_459 -
Scientific Reports Mar 2023The cold scalpel/scissors (CS) and the monopolar electrocautery (ME) are still the most commonly used instruments for neck dissection in head and neck oncology. However,...
The cold scalpel/scissors (CS) and the monopolar electrocautery (ME) are still the most commonly used instruments for neck dissection in head and neck oncology. However, a direct comparison of these techniques does not exist. This study aims to compare these techniques concerning blood loss, the decline of hemoglobin levels, and surgery duration. Data on 200 patients who received tumor resection, neck dissection and either a radial forearm free flap (RFFF)or a primary closure (PC) were examined retrospectively. The patients were divided according to the performed defect closure (RFFF or PC) and the main instrument usedfor the beck dissection (Group 1: RFFF and ME, Group 2: RFFF and CS, Group 3: PC and ME Group 4: PC and CS). The intraoperative blood loss, decline of hemoglobin values and surgery duration were analyzed and compared between the corresponding groups. The patients where the ME was used lost on average 409.93 ml (group 1 vs. 2) and 242.4 ml (group 3 vs. 4) less blood. The median decrease in the hemoglobin levels was by 1.01 g/dL (group 1 vs. 2) and 0.85 g/dL (group 3 vs. 4) lower for the ME. The median surgery duration was by 102 min (group 1 vs. 2) and 83 min (group 3 vs. 4) shorterfor the ME. All differences were statistically significant. Traditional scalpel and scissors used for neck dissection lead to significantly higher blood loss and longer operation time than the monopolar electrocautery.
Topics: Humans; Neck Dissection; Retrospective Studies; Dissection; Plastic Surgery Procedures; Electrocoagulation
PubMed: 36928769
DOI: 10.1038/s41598-023-31328-x -
The Journal of Craniofacial Surgery Oct 2019
PubMed: 31490447
DOI: 10.1097/SCS.0000000000005977 -
Oral and Maxillofacial Surgery Dec 2023The aim of this study is to compare the repair of incisions performed with microdissection electrocautery tip, conventional electrocautery tip, high potency diode laser,...
PURPOSE
The aim of this study is to compare the repair of incisions performed with microdissection electrocautery tip, conventional electrocautery tip, high potency diode laser, and conventional scalpel blade in a in vivo model.
METHODS
Different incisions were performed in adults Holtzman rats using the four types of instruments: microdissection electrocautery tip, conventional electrocautery tip, high potency diode laser, and conventional scalpel blade, in different periods of healing process. Thirty rats were divided into 5 groups, according to the period of euthanasia-24 h, 48 h, 72 h, 7 days, and 14 days. All animals received four incisions, each by a different method. Quantitative histological and histomorphometric analyses were performed using hematoxylin and eosin (HE) and Picrosirius Red staining.
RESULTS
Inflammatory profile and tissue repair presented small statistically significance differences comparing conventional scalpel blade and microdissection tip; moreover, both presented quantitatively superior to the others.
CONCLUSION
It is believed that the microdissection tip can perform a dynamic incision just as a common scalpel blade, but more effective. Furthermore, it can promote a better hemostatic control of the surgical field that is comparable to conventional electrocautery tip without affecting tissue repair.
Topics: Rats; Animals; Surgical Wound Infection; Surgical Instruments; Lasers, Semiconductor; Electrocoagulation; Models, Animal
PubMed: 35915281
DOI: 10.1007/s10006-022-01105-7