scholarly journals A pilot randomized controlled trial comparing THUNDERBEAT to the Maryland LigaSure energy device in laparoscopic left colon surgery

2021 ◽  
Author(s):  
Jeffrey W. Milsom ◽  
Koianka Trencheva ◽  
Kota Momose ◽  
Miroslav P. Peev ◽  
Paul Christos ◽  
...  
Keyword(s):  
Clinical Performance ◽  
Abdominal Cavity ◽  
Colon Surgery ◽  
Left Colon ◽  
Energy Device ◽  
Energy Devices ◽  
Bipolar Energy ◽  
Tissue Manipulation ◽  
Group 2 ◽  
Group 1

Abstract Background The THUNDERBEAT is a multi-functional energy device which delivers both ultrasonic and bipolar energy, but there are no randomized trials which can provide more rigorous evaluation of the clinical performance of THUNDERBEAT compared to other energy-based devices in colorectal surgery. The aim of this study was to compare the clinical performance of THUNDERBEAT energy device to Maryland LigaSure in patients undergoing left laparoscopic colectomy. Methods Prospective randomized trial with two groups: Group 1 THUNDERBEAT and Group 2 LigaSure in a single university hospital. 60 Subjects, male and female, of age 18 years and above undergoing left colectomy for cancer or diverticulitis were included. The primary outcome was dissection time to specimen removal (DTSR) measured in minutes from the start of colon mobilization to specimen removal from the abdominal cavity. Versatility (composite of five variables) was measured by a score system from 1 to 5 (1 being worst and 5 the best), and adjusted/weighted by coefficient of importance with distribution of the importance as follow: hemostasis 0.275, sealing 0.275, cutting 0.2, dissection 0.15, and tissue manipulation 0.1. Other variables were: dryness of surgical field, intraoperative and postoperative complications, and mortality. Follow-up time was 30 days. Results 60 Patients completed surgery, 31 in Group 1 and 29 in Group 2. There was no difference in the DTSR between the groups, 91 min vs. 77 min (p = 0.214). THUNDERBEAT showed significantly higher score in dissecting and tissue manipulation in segment 3 (omental dissection), and in overall versatility score (p = 0.007) as well as versatility score in Segment 2 (retroperitoneal dissection p = 0.040) and Segment 3 (p = 0.040). No other differences were noted between the groups. Conclusions Both energy devices can be employed effectively and safely in dividing soft tissue and sealing mesenteric blood vessels during laparoscopic left colon surgery, with THUNDERBEAT demonstrating some advantages over LigaSure during omental dissection and tissue manipulation. ClinicalTrial.gov # NCT02628093.

scholarly journals Specific features of the adhesion process of the abdominal cavity in children with different degrees of connective tissue dysplasia

2020 ◽  
Vol 10 (4) ◽  
pp. 381-389
Author(s):  
Sergey V. Minaev ◽  
Sergey I. Timofeev ◽  
Alina N. Grigorova ◽  
Oksana V. Vladimirova ◽  
Elena I. Pashneva ◽  
...  
Keyword(s):  
Growth Factor ◽  
Connective Tissue ◽  
Clinical Course ◽  
Abdominal Cavity ◽  
Type Iii Collagen ◽  
Type I ◽  
Type Iii ◽  
Connective Tissue Dysplasia ◽  
Group 2 ◽  
Group 1

Aim. To assess adhesions of the abdominal cavity in children with varying degrees of connective tissue dysplasia (CTD) severity. Methods. A total of 91 children with average age of 10.6 1.4 years were observed from 2005 to 2019. Composed of 53 boys (58.2%) and 38 girls (41.8%). Patients were divided into two groups: group 1 (69 children without CTD) and group 2 (22 children with CTD). Clinical data and screening cards were used to diagnose DST. All patients underwent an assessment for the clinical course, a macroscopic visual assessment adhesive process severity in the abdominal cavity according to three different scales (Nair, F. Coccolini, N.I. Ayushinova). Immunohistochemistry was performed against collagen I, III, IV type, Laminin 1, angiogenesis factors, transforming growth factor beta (TGF-), and Fibroblast Growth Factor Receptor 1 (FGFR1). A semi-quantitative counting method was used to record the relative number of immunopositive structures. Statistical analysis was carried out by methods of variation statistics using the Chi-square test and MannWhitney U-tests, as well as the Spearman rank correlation method for the reliability of differences between groups. Results. In the adhesive process visualization, the N.I. Ayushinov scale was revealed to be the most informative, showing the average score of 7 0.8 points in group 2 and 14 1.2 in group 1 (rs 0.35; p 0.05). In group 2, the adhesive material showed no (56%) or chaotic fragments (44%) of type I collagen, and the ratio of type I to type III collagen is 2.7: 5.1. In group 1, the ratio of type I to type III collagen is 5.9:1.8. The ratio of collagen IV to type I is 6.5: 2.9. Both groups have a moderate (++) amount of TGF-. TGF- is positive with macrophages. FGFR1 was found in the control group (++++). A positive response was seen in fibroblasts and macrophages (U = 79.00; p = 0.006). Statistically significant analyzes of vascular endothelial growth factor in compared groups (rs = 0.632, p 0.001) had a positive correlation.. Conclusion. Thus, the study showed features of clinical course and morphological changes during the development of adhesions in the abdominal cavity in children with varying degrees of severity of CTD. Data obtained dictate the need for an individual approach in predicting adhesive disease, as well as targeted preventive care.

scholarly journals Effects of peritoneal lavage with lidocaine on survival of rats with fecal peritonitis

2008 ◽  
Vol 23 (1) ◽  
pp. 42-47 ◽  
Author(s):  
Marcos Célio Brocco ◽  
Danilo Nagib Salomão Paulo ◽  
João Florêncio de Abreu Baptista ◽  
Thiago Antunes Ferrari ◽  
Thiago Caetano V. de Azevedo ◽  
...  
Keyword(s):  
Saline Solution ◽  
Peritoneal Lavage ◽  
Abdominal Cavity ◽  
Fecal Peritonitis ◽  
Group 4 ◽  
Lidocaine Solution ◽  
Post Operation ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

PURPOSE: To study the effects of peritoneal lavage with a 2% lidocaine solution, on the survival of the rats submitted to peritonitis caused by their own feces. METHODS: Forty-eight Wistar rats, weighting between 300g and 330g (mean, 311,45 ±9,67g), were submitted to laparotomy 6 hours following induction of fecal peritonitis. Animals were randomly divided into four groups of 12 each as follows: 1- Control, no therapy; 2- Drying of the abdominal cavity; 3- Peritoneal lavage with saline and drying; 4- Peritoneal lavage with a 2% lidocaine solution and drying. Animals that died were submitted to necropsy and the time of their death recorded; survivors were killed on the post-operation 11th day and necropsied. RESULTS: Death occurred within 52 h in all animals of group 1; within 126 h in 100% of those of group 2; within 50 h in 50% of those of group 3. All animals of group 4 survived. Survival on the 11 th day was higher in groups 3 and 4 than in groups 1 and 2 (p<0.001), and higher in group 4 than in group 3 (p<0.01). CONCLUSION: Peritoneal lavage with a 2% lidocaine saline solution without adrenaline, prevented the mortality of all animals with fecal peritonitis .

A prospective trial evaluating the clinical performance of a novel surgical energy device in laparoscopic colon surgery

2014 ◽  
Vol 29 (5) ◽  
pp. 1161-1166 ◽  
Author(s):  
J. W. Milsom ◽  
K. Trencheva ◽  
T. Sonoda ◽  
G. Nandakumar ◽  
P. J. Shukla ◽  
...  
Keyword(s):  
Clinical Performance ◽  
Prospective Trial ◽  
Colon Surgery ◽  
Energy Device ◽  
Laparoscopic Colon Surgery ◽  
Laparoscopic Colon ◽  
Surgical Energy

scholarly journals Randomized comparative study of the effectiveness and safety of various bipolar devices during electrosurgical vaginal hysterectomy

2021 ◽  
Vol 70 (2) ◽  
pp. 45-54
Author(s):  
Andrey N. Plekhanov ◽  
Vitaliy F. Bezhenar ◽  
Tatyana A. Epifanova ◽  
Fyodor V. Bezhenar ◽  
Irina A. Karabak
Keyword(s):  
Vaginal Hysterectomy ◽  
Infrared Camera ◽  
Tissue Temperature ◽  
Maximum Temperature ◽  
Bipolar Devices ◽  
Morphometric Features ◽  
Bipolar Energy ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

AIM: The aim of this study was to investigate the morphometric features of tissues after exposure to bipolar energy of various electrosurgical generators and surgical hemostatic instruments used in vaginal hysterectomy. MATERIALS AND METHODS: The study included 48 individuals who underwent a vaginal hysterectomy. The patients were divided in three groups based on the instrument used for sealing blood vessels: a BiClamp was applied in Group 1 (n = 16), a TissueSeal PLUS COMFORT in Group 2 (n = 16), and a Thunderbeat in Group 3 (n = 16). The maximum temperature of tissue measured using a Fluke FLK TIS 40 9HZ thermal imaging infrared camera was compared within the groups. RESULTS: The maximum tissue temperature between the branches on electroligation, the minimum tissue temperature, and the tissue temperature at the coagulation boundary were significantly lower when using a TissueSeal PLUS COMFORT clamp than when using BiClamp and Thunderbeat clamps (H value = 41.8, p 0.01). Morphometric parameters (prevalence, coagulation depth and area) were the smallest with a TissueSeal PLUS COMFORT clamp compared to other clamps. CONCLUSIONS: Using a TissueSeal PLUS COMFORT clamp during vaginal hysterectomy is effective and safe and has the best thermometric and morphometric characteristics when applied to the tissue, thereby reducing the risk of lateral thermal damage. The possibility of perifocal heat transfer varies with the type of tool and with the temperature at the coagulation boundary.

scholarly journals The peculiarity of appendectomy of patients with high risk of cardiopulmonary insufficiency

2018 ◽  
Vol 22 (3) ◽  
pp. 456-459
Author(s):  
B.S. Zaporozhchenko ◽  
Hasan Yahya ◽  
I.I. Borodaev ◽  
V.N. Kachanov ◽  
O.A. Vasyliev
Keyword(s):  
High Risk ◽  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Abdominal Cavity ◽  
Open Appendectomy ◽  
Pulmonary Insufficiency ◽  
Results Of Treatment ◽  
Cardiopulmonary Failure ◽  
Group 2 ◽  
Group 1

Acute appendicitis (AA) ranks first in the frequency of emergence of urgent surgical diseases in hospitals in Ukraine. In recent years, laparoscopic appendectomy has become one of the “gold standards” of surgery. Of particular interest in this group of patients is a gasless and with small amount of gas laparoscopy, in which the endosurgical space in the abdominal cavity is created with the help of endolifts, in which the abdominal wall is raised mechanically, without creating a pneumoperitoneum. Objective — to determine the feasibility and effectiveness of the use of various techniques for laparoscopic appendectomy of patients with a high risk of cardiopulmonary insufficiency. All patients with АA were divided into 2 groups: Group 1 — 72 patients with АA diagnosis, with a high risk of cardiopulmonary failure, who underwent open appendectomy; Group 2 — 85 patients with АA diagnosis with a high risk of cardiopulmonary failure, who underwent laparoscopic appendectomy with pneumoperitoneum and using laparolifting method of patients. The laparolifting was performed with the help of the device developed by the clinic for laparolifting on Zaporozhchenko-Kolodii. When analyzing the results of treatment of patients with IІ group, it should be noted that laparoscopic appendectomy, especially with laparolifting, may be the operation of choice in the treatment of patients with acute appendicitis. This technique is absolutely safe, reliable and affordable in the implementation of most surgeons. So, laparoscopic appendectomy can be performed in virtually all patients with acute appendicitis with high risk of cardio-pulmonary insufficiency with the avoidance of postoperative complications.

scholarly journals INFLUENCE OF SPLENIC IMPLANTS IN THE SUBCUTANEOUS TISSUE ON ASPLENIC ANIMALS SURVIVAL

2018 ◽  
Vol 31 (2) ◽  
Author(s):  
Renan Kleber Costa TEIXEIRA ◽  
Laryssa de Aquino SANTIAGO ◽  
Yan de Assis SASAKI ◽  
Vitor Nagai YAMAKI ◽  
Daniel Haber FEIJÓ ◽  
...  
Keyword(s):  
Subcutaneous Tissue ◽  
Abdominal Cavity ◽  
Group 3 ◽  
Group 2 ◽  
Preservation Of The Spleen ◽  
Total Splenectomy ◽  
Group 1

ABSTRACT Background: The best site for splenic implant was not defined, mainly evaluating the functionality of the implant. Aim: To evaluate the effects of autogenous splenic implantation on the subcutaneous tissue in the survival of splenectomized rats. Method: Twenty-one randomly assigned rats were studied in three groups (n=7): group 1 - manipulation of the abdominal cavity and preservation of the spleen; group 2 - total splenectomy; group 3 - splenectomy and implant of the tissue removed in the subcutaneous. The animals were followed for 90 days postoperatively. Results: There was a higher mortality in groups 2 (p=0.0072) and 3 (p=0.0172) in relation to group 1. There was no difference between groups 2 and 3 (p=0.9817). Conclusion: The splenic implant in the subcutaneous is ineffective in the survival of rats submitted to splenectomy.

scholarly journals An analysis of pH, pO2 and pCO2 in the peritoneal fluid of dogs with ascites of various etiologies

2016 ◽  
Vol 19 (1) ◽  
pp. 141-145 ◽  
Author(s):  
K. Glińska-Suchocka ◽  
P. Sławuta ◽  
M. Jankowski ◽  
K. Kubiak ◽  
J. Spużak ◽  
...  
Keyword(s):  
Glucose Metabolism ◽  
Peritoneal Fluid ◽  
Proteolytic Enzymes ◽  
Abdominal Cavity ◽  
The Other ◽  
Bacterial Peritonitis ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract The aim of the study was to assess pH, pO2 and pCO2 in peritoneal fluid. The study was conducted on a group of 22 dogs with symptoms of ascites. Group 1 consisted of 4 dogs with adenocarcinoma, group 2 - of 6 dogs with glomerulonephritis, group 3 of 8 dogs with hepatic cirrhosis and group 4 of 4 dogs with bacterial peritonitis. An abdominal cavity puncture was performed in all dogs and the fluid was drawn into a heparinized syringe in order to assess pH, pO2 and pCO2 . The analysis of pH in the peritoneal fluid revealed statistically significant differences between group 4 and groups 1 (p=0.01), 2 (p=0.01), and 3 (p=0.01). The lowest pH value compared to the other studied groups was recorded in group 4. In group 4, the pO2 was the lowest compared to the other groups (group 1 p=0.01, group 2 p=0.01, group 3 p=0.01). The value of pCO2 was the highest in group 4 compared to groups 1, 2, and 3. The study found statistically significant differences in pH, pCO2 and pCO2 between group 4 (the group of dogs with bacterial peritonitis) and the other groups of dogs. This was probably linked to the pathogenesis of peritonitis. As a result of an inflammatory reaction within the peritoneal cavity, there is an increase in fibrin accumulations leading to a decreased oxygen supply causing the oxidative glucose metabolism to change into a non-oxidative glucose metabolism. This, in turn, causes a decrease in pH, acidosis, and a low oxidoreduction potential. It also impairs phagocytosis and activates proteolytic enzymes which create ideal conditions for the growth of anaerobic bacteria. The obtained results indicate that the pH, pO2 and pCO2 may be used to differentiate bacterial peritonitis from ascites of other etiologies.

scholarly journals Application of a New Integrated Bipolar and Ultrasonic Energy Device in Laparoscopic Hysterectomies

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Harvard Z. Lin ◽  
Y. W. Ng ◽  
A. Agarwal ◽  
Y. F. Fong
Keyword(s):  
Laparoscopic Hysterectomy ◽  
Energy Device ◽  
Safe Alternative ◽  
Tissue Handling ◽  
Vessel Sealing ◽  
Bipolar Energy ◽  
Tissue Manipulation ◽  
Operative Performance ◽  
The Cost ◽  
Sealing Device

Objective. A retrospective study to evaluate the Thunderbeat, a new vessel sealing device in a small group of patients undergoing laparoscopic hysterectomy to test the safety and effectiveness in achieving hemostasis. Method. The Thunderbeat was used in 12 cases of total laparoscopic hysterectomy. Operative performance involving hemostasis, sealing/coagulation, cutting, dissection, and tissue manipulation was evaluated. Results. No complications were encountered intraoperatively and postoperatively. Intraoperative experience involving hemostasis, sealing/coagulation, and cutting was optimal. Tissue handling was acceptable except for fine dissection. Conclusion. The Thunderbeat is an efficient and safe alternative to standard bipolar in laparoscopic hysterectomy. Larger studies are required to evaluate the cost-effectiveness and significant reduction in operating times as compared to conventional bipolar energy.

Clinical-ultrasound and clinical-morphological characteristics of adnexal torsion in girls and adolescents

2021 ◽  
Vol 90 (1) ◽  
pp. 81-87
Author(s):  
I.O. Tuchkina ◽  
S.V. Kiebashvili ◽  
O.V. Piontkovska ◽  
N.V. Romanova
Keyword(s):  
Color Doppler ◽  
Abdominal Cavity ◽  
Clinical Signs ◽  
Mucinous Cystadenoma ◽  
Morphological Characteristics ◽  
Torsion Group ◽  
Adnexal Torsion ◽  
Morphological Examination ◽  
Group 2 ◽  
Group 1

Clinical-ultrasound and clinical-morphological characteristics of adnexal torsion to the improvement of early diagnosis and development of optimal ways of organ-preserving surgical tactics of treatment have been determined. An analysis was carried out of 71 patients with adnexal torsion (group 1– 30 girls of 2–12 years, group 2 – 41 adolescents of 13–17 years). The main clinical signs of adnexal torsion were nonspecific and similar to the well-known clinic of acute abdomen. Ultrasound examination with color doppler mapping (CDM) allowed to suspect adnexal torsion in 44 (62 %) patients. The main echographic features of adnexal torsion were: ovarian enlargement, non-typical location and a change in the structure of ovary, the presence of a free liquid in the cavity of a small pelvis or in the abdominal cavity, «a symptom of springs» (a twisted vascular leg), a decrease or absence of blood flow in CDM. The torsion of intact uterine appendages is installed in 29 patients (twice as often in group 1). In 42 cases were detected the torsion of the uterine appendages, compromised by the presence of tumors and tumor-like formations (twice as often in group 2). In both groups, 36 (50.7 %) organ-preserving and 35 (49.3 %) radical operations were carried out. According to the results of morphological examination of the removed tissues, the following data were obtained: follicular cysts – 15, paratubal cysts – 8, corpus luteum cysts – 8, teratomas – 5, serous cystadenomas – 2, mucinous cystadenoma – 1, paraovarian cysts – 3. Differential diagnosis of adnexal torsion in girls and adolescents should include a thorough collection of anamnestic data, taking into account the features of the clinical course of the disease, the results of a comprehensive examination with an assessment of ultrasound data from CDM, computer and magnetic resonance imaging, which will contribute to the advanced adequate selection of tactics of urgent gynecological intervention. The method of choice for the treatment of adnexal torsion is a minimally invasive surgical intervention – a laparoscopy with organ-preserving operations. Keywords: adnexal torsion, girls, ultrasound and morphological characteristics.

Comparison of Concentrations of Sulbactam-Ampicillin Administered by Bolus Injections or Bolus plus Continuous Infusion in Tissues of Patients Undergoing Colorectal Surgery

1998 ◽  
Vol 42 (5) ◽  
pp. 1093-1097 ◽  
Author(s):  
Claude Martin ◽  
Agnès Cotin ◽  
Annick Giraud ◽  
Mireille Beccani-Argème ◽  
Pierre Alliot ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Continuous Infusion ◽  
Bolus Injection ◽  
Abdominal Cavity ◽  
Tissue Samples ◽  
Elective Colorectal Surgery ◽  
Colonic Wall ◽  
Blood Samples ◽  
Group 2 ◽  
Group 1

ABSTRACT The concentrations of sulbactam and ampicillin were determined in sera and different abdominal tissues of 16 patients who underwent elective colorectal surgery. Patients were randomly allocated to two groups. At the time of induction of anesthesia, patients in group 1 (eight patients) were given 1,000 mg of sulbactam with 2,000 mg of ampicillin by intravenous bolus injection (3 min). This dose was administered again after 2 h by bolus injection by the same route. Patients in group 2 (eight patients) were given the same initial dose of sulbactam-ampicillin by bolus injection (3 min). Then, a continuous infusion of 1,000 mg of sulbactam with 2,000 mg of ampicillin in normal saline was immediately started and was administered over a 4-h period. Blood samples were collected to determine peak (10 min) and trough (end of surgery) antibiotic levels. Serial blood samples were also collected at predetermined periods (at the time of opening and closing of the abdominal cavity and at the time of surgical anastomosis). Abdominal wall fat, epiploic fat, and colonic wall tissue samples were collected simultaneously. Antibiotic concentrations were determined by high-performance liquid chromatography. Similar levels of the drugs in serum were observed for the two regimens of administration, with trough sulbactam levels of 33 ± 16 and 37 ± 22 μg/ml in groups 1 and 2, respectively, and trough ampicillin levels of 72 ± 55 and 79 ± 47 μg/ml in groups 1 and 2, respectively. Similar sulbactam concentrations were observed in abdominal tissues whichever regimen of administration was used; in fatty tissues the sulbactam concentrations ranged from 2.7 to 3.8 μg/g for group 1 and from 1.7 to 4.0 μg/g for group 2, and sulbactam concentrations in the colonic wall were 5.6 ± 7.7 and 6.8 ± 3.2 μg/g in groups 1 and 2, respectively (not significant). Again, no influence of the regimen of administration was observed on tissue ampicillin concentrations; in fatty tissues ampicillin concentrations ranged from 4.1 to 5.4 μg/g for group 1 and from 3.2 to 5.8 μg/g for group 2, and sulbactam concentrations in the colonic wall were 7.0 ± 2.8 and 11.0 ± 4.7 μg/g for groups 1 and 2, respectively (not significant). In most patients, the concentrations of ampicillin-sulbactam were greater than the MIC at which 50% of isolates are inhibited (MIC50) for Bacteroides fragilis in the fatty tissues. In the colonic wall, for most patients the concentrations of ampicillin-sulbactam were greater than the MIC90 forB. fragilis. No influence of the regimen of administration was observed on the ratio of the two components in the tissues investigated and in sera. In conclusion, a second intraoperative bolus injection or a continuous infusion were equally effective in maintaining sulbactam-ampicillin concentrations in abdominal tissues. The first method of administration can be recommended since it is easier to handle.

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