scholarly journals Safety and effectiveness evaluation of a two-handed technique combining harmonic scalpel and laparoscopic Peng’s multifunction operative dissector in laparoscopic hemihepatectomy

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jingwei Cai ◽  
Guixing Jiang ◽  
Yuelong Liang ◽  
Yangyang Xie ◽  
Junhao Zheng ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Harmonic Scalpel ◽  
Peak Level ◽  
Bile Leakage ◽  
Liver Parenchyma ◽  
Control Group ◽  
Case Group ◽  
Intraoperative Blood Loss ◽  
And Control

Abstract Objectives This study was designed to evaluate the safety and effectiveness of a two-hand technique combining harmonic scalpel (HS) and laparoscopic Peng’s multifunction operative dissector (LPMOD) in patients who underwent laparoscopic hemihepatectomy (LHH). Methods We designed and conducted a case-control study nested in a prospectively collected laparoscopic liver surgery database. Patients who underwent LHH for liver parenchyma transection using HS + LPMOD were defined as cases (n = 98) and LPMOD only as controls (n = 47) from January 2016 to May 2018. Propensity score matching (1:1) between the case and control groups was used in the analyses. Results The case group had significantly less intraoperative blood loss in milliliters (169.4 ± 133.5 vs. 221.5 ± 176.3, P = 0.03) and shorter operative time in minutes (210.5 ± 56.1 vs. 265.7 ± 67.1, P = 0.02) comparing to the control group. The conversion to laparotomy, postoperative hospital stay, resection margin, the mean peak level of postoperative liver function parameters, bile leakage rate, and others were comparable between the two groups. There was no perioperative mortality. Conclusions We demonstrated that the two-handed technique combing HS and LPMOD in LHH is safe and effective which is associated with shorter operative time and less intraoperative blood loss compared with LPMOD alone. The technique facilitates laparoscopic liver resection and is recommended for use.

scholarly journals Safety and Effectiveness Evaluation of A Two-Handed Technique Combining Harmonic Scalpel and Laparoscopic Peng’s Multifunction Operative Dissector in Laparoscopic Hemihepatectomy

2021 ◽  
Author(s):  
Jingwei Cai ◽  
Guixing Jiang ◽  
Yuelong Liang ◽  
Yangyang Xie ◽  
Junhao Zheng ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Harmonic Scalpel ◽  
Peak Level ◽  
Bile Leakage ◽  
Liver Parenchyma ◽  
Control Group ◽  
Case Group ◽  
Intraoperative Blood Loss ◽  
And Control

Abstract ObjectivesThis study was designed to evaluate the safety and effectiveness of a two-hand technique combining harmonic scalpel (HS) and laparoscopic Peng’s multifunction operative dissector (LPMOD) in patients who underwent laparoscopic hemihepatectomy (LHH).MethodsWe designed and conducted a case-control study nested in a prospectively collected laparoscopic liver surgery database. Patients who underwent LHH for liver parenchyma transection using HS + LPMOD were defined as cases (n = 98) and LPMOD only as controls (n = 47) from January, 2016 to May, 2018. Propensity score matching (1:1) between the case and control groups was used in the analyses. ResultsThe case group had significantly less intraoperative blood loss in mL (169.4 ± 133.5 vs. 221.5 ± 176.3, P = 0.03) and shorter operative time in minutes (210.5 ± 56.1 vs. 265.7 ± 67.1, P = 0.02) comparing to the control group. The conversion to laparotomy, postoperative hospital stay, resection margin, the mean peak level of postoperative liver function parameters, bile leakage rate and others were comparable between the two groups. There was no perioperative mortality. ConclusionsWe demonstrated that the two-handed technique combing HS and LPMOD in LHH is safe and effective which is associated with shorter operative time and less intraoperative blood loss compared with LPMOD alone. The technique facilitates laparoscopic liver resection and is recommended for use.

Effects of Preoperative Iodine Administration on Thyroidectomy for Hyperthyroidism: A Systematic Review and Meta-analysis

2019 ◽  
Vol 160 (6) ◽  
pp. 993-1002 ◽  
Author(s):  
Chung-Hsin Tsai ◽  
Po-Sheng Yang ◽  
Jie-Jen Lee ◽  
Tsang-Pai Liu ◽  
Chi-Yu Kuo ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Blood Loss ◽  
Operative Time ◽  
Meta Analysis ◽  
Thyroid Volume ◽  
Vocal Cord Palsy ◽  
Significant Heterogeneity ◽  
Intraoperative Blood Loss ◽  
Significant Difference ◽  
And Control

Objective The current guidelines recommend that potassium iodide be given in the immediate preoperative period for patients with Graves’ disease who are undergoing thyroidectomy. Nonetheless, the evidence behind this recommendation is tenuous. The purpose of this study is to clarify the benefits of preoperative iodine administration from published comparative studies. Data Sources We searched PubMed, Embase, Cochrane, and CINAHL from 1980 to June 2018. Review Methods Studies were included that compared preoperative iodine administration and no premedication before thyroidectomy. For the meta-analysis, studies were pooled with the random-effects model. Results A total of 510 patients were divided into the iodine (n = 223) and control (n = 287) groups from 9 selected studies. Preoperative iodine administration was significantly associated with decreased thyroid vascularity and intraoperative blood loss. Significant heterogeneity was present among studies. We found no significant difference in thyroid volume or operative time. Furthermore, the meta-analysis showed no difference in the risk of postoperative complications, including vocal cord palsy, hypoparathyroidism/hypocalcemia, and hemorrhage or hematoma after thyroidectomy. Conclusion Preoperative iodine administration decreases thyroid vascularity and intraoperative blood loss. Nonetheless, it does not translate to more clinically meaningful differences in terms of operative time and postoperative complications.

scholarly journals A comparative study between harmonic scalpel hemostasis and conventional hemostasis in total thyroidectomy

2020 ◽  
Vol 7 (4) ◽  
pp. 954
Author(s):  
Waleed Yusif El Sherpiny
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Thyroid Surgery ◽  
Operative Time ◽  
Harmonic Scalpel ◽  
Randomized Study ◽  
Conventional Technique ◽  
Endocrine Surgery ◽  
Intraoperative Blood Loss ◽  
Conventional Thyroidectomy

Background: Thyroidectomy is the most commonly performed procedure in endocrine surgery. Since the thyroid gland is highly vascular, therefore, rapid and absolute hemostasis is extremely required. Conventional thyroidectomy is commonly used with acceptable outcomes, however, it is time‑consuming and resulted in significant intraoperative blood loss with the possible risk of postoperative hemorrhage, injury to parathyroid glands and laryngeal nerves. The advent of focus harmonic devices was encouraging for improving safety, effectiveness, and reduction of operative time, especially in thyroid surgery. Aim of this study: The purpose of this study was to analyze the effectiveness and surgical outcomes of using ultrasonic harmonic scalpel for thyroid surgery compared to conventional techniques.Methods: This was a prospective, randomized study in which 60 patients with various types of goiters presented for thyroidectomy. The patients were divided into two comparable groups. Group A (30 patients) included patients who had focus harmonic thyroidectomy and Group B (30 patients) included patients who underwent conventional thyroidectomy.Results: Focus harmonic thyroidectomy showed a significant reduction in operative time, intraoperative blood loss, volume of postoperative fluid drainage and meantime for hospital stay compared with conventional thyroidectomy. There were no significant differences in the incidence of postoperative hypocalcemia, seroma, hematoma, wound infection and laryngeal nerve injury between both groups.Conclusions: Focus harmonic thyroidectomy was a safe, effective, faster, and appealing alternative to conventional technique since it reduced the operative time, intraoperative blood loss, postoperative drainage and hospital stay with comparable postoperative complications. 

scholarly journals Harmonic Scalpel versus Conventional Haemostasis in Neck Dissection: A Prospective Randomized Study

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Emanuele Ferri ◽  
Enrico Armato ◽  
Giacomo Spinato ◽  
Marcello Lunghi ◽  
Giancarlo Tirelli ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Hospital Stay ◽  
Neck Dissection ◽  
Operative Time ◽  
Harmonic Scalpel ◽  
Intraoperative Blood Loss ◽  
Bipolar Diathermy ◽  
Classic Technique

Purpose.The aim of this prospective randomized trial was to compare operative factors, postoperative outcomes, and surgical complications of neck dissection (ND) when using the harmonic scalpel (HS) versus conventional haemostasis (CH) (classic technique of tying and knots, resorbable ligature, and bipolar diathermy).Materials and methods.Sixty-one patients who underwent ND with primary head and neck cancer (HNSCC) resection were enrolled in this study and were randomized into two homogeneous groups: CH (conventional haemostasis with classic technique of tying and knots, resorbable ligature, and bipolar diathermy) and HS (haemostasis with harmonic scalpel). Outcomes of the study included operative time, intraoperative blood loss, drainage volume, postoperative pain, hospital stay, and incidence of intraoperative and postoperative complications.Results.The use of the HS reduced significantly the operating time, the intraoperative blood loss, the postoperative pain, and the volume of drainage. No significant difference was observed in mean hospital stay and perioperative, and postoperative complications.Conclusion.The HS is a reliable and safe tool for reducing intraoperative blood loss, operative time, volume of drainage and postoperative pain in patients undergoing ND for HNSCC. Multicenter randomized studies need to be done to confirm the advantages of this technique and to evaluate the cost-benefit ratio.

scholarly journals Does tranexamic acid have role in controlling intraoperative blood loss in tonsillectomy?

2020 ◽  
Vol 6 (7) ◽  
pp. 1253
Author(s):  
Heempali Das Dutta ◽  
Pabina Rayamajhi ◽  
Nazeef Ibrahim
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Postoperative Bleeding ◽  
University Teaching ◽  
Control Group ◽  
Study Group ◽  
Intraoperative Blood Loss ◽  
Intraoperative Bleeding ◽  
The Difference ◽  
And Control

<p class="abstract"><strong>Background:</strong> The study was done with the objective to assess the effect of tranexamic acid in controlling intraoperative bleeding in tonsillectomy.</p><p class="abstract"><strong>Methods:</strong> Retrospective study was conducted in the Department of ENT and HNS, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from August 2016 to July 2017. Patients more than 15 years who underwent bilateral tonsillectomy were included in the study. Whereas patients who underwent unilateral tonsillectomy and patients who had hypersensitivity to tranexamic acid were excluded from the study. The patients who received tranexamic acid during surgery were taken as study group whereas the patients who didn’t receive tranexamic acid were taken as control. The amount of the intraoperative blood loss, i.e. mean and the frequency of early post-operative bleeding were evaluated.  </p><p class="abstract"><strong>Results:</strong> A total of 48 patients who fulfilled the inclusion criteria were evaluated. Among whom, 24 patients who received tranexamic acid during tonsillectomy were taken as study group and other 24 patients who did not received tranexamic acid were taken as control. The mean blood loss in study and control group were 92.85 ml and 91.40 ml respectively and the difference was statistically not significant (p=0.785). There were no cases of early postoperative bleeding recorded in either group within the first 24 hours of surgery.</p><p><strong>Conclusions:</strong> There is no significant role of tranexamic acid in controlling intraoperative bleeding in tonsillectomy. </p>

scholarly journals Comparative study of harmonic scalpel haemorrhoidectomy versus conventional (milligan and morgan) haemorrhoidectomy

2017 ◽  
Vol 6 (1) ◽  
pp. 328
Author(s):  
Tariq Ahmed Mala ◽  
Shahid Amin Malla ◽  
Ajaz Ahmad Shah ◽  
Maria Kapoor ◽  
Ved Bushan Gupta
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Harmonic Scalpel ◽  
Symptomatic Relief ◽  
Treatment Modalities ◽  
Control Group ◽  
Case Group ◽  
Early Return ◽  
Routine Work

Background: Haemorrhoids are dilated veins occurring in relation to the anus. There are various treatment modalities for haemorrhoids and among them surgical treatment is considered to be most effective one. Harmonic scalpel hemorrhoidectomy was compared with conventional in terms of symptomatic relief and complications.Methods: The aim of our study was to compare harmonic scalpel haemorrhoidectomy with conventional in terms of various intraoperative and postoperative factors for the treatment of grade III and IV haemorrhoids.Results: In our case study of 25 patients average time taken was 17.68 ± 2.84 minutes, while it was 28.44 ±3.69 minutes in control group. The mean blood loss was 8.96 ± 2.15 ml, 31.72 ± 3.28 ml in the case and control group respectively. Postoperative pain with VAS in case group on the first postoperative day was 5.92 ± 0.72, while it was 8.52 ± 0 in the control group. The dose of analgesia was less in case group. The postoperative wound site soakage was less in case study, early ambulation and return to normal work was faster in case study group.Conclusions: Harmonic scalpel haemorrhoidectomy is a simple, bloodless, safe and effective procedure in terms of blood loss, postoperative pain early return to routine work because of less lateral thermal injury.

scholarly journals A STUDY OF THE EFFECT OF VASOPRESSIN IN REDUCING BLOOD LOSS IN GYNAECOLOGICAL SURGERIES

2021 ◽  
pp. 68-70
Author(s):  
Swati Swati ◽  
Rakhi Kumari ◽  
Sagar Dulal Sinha
Keyword(s):  
Blood Loss ◽  
Vaginal Hysterectomy ◽  
Transfusion Requirement ◽  
Adverse Outcome ◽  
Control Group ◽  
P Value ◽  
Case Group ◽  
Intraoperative Blood Loss ◽  
Operative Morbidity ◽  
Duration Of Surgery

BACKGROUND: The use of vasopressin in major surgeries like hysterectomy and myomectomy can decrease the morbidity of the patient by controlling the intra-operative blood loss. MATERIAL AND METHODS: About 100 patients undergoing elective vaginal hysterectomy and myomectomy were selected for the study. They were divided into two groups, in case group vasopressin in diluted form was inltrated intraoperatively in the surgical eld and in control group no inltration was done. The two groups were compared in terms of intraoperative blood loss, mean post operative hemoglobin decrease, hospital stay and associated adverse outcome. Statistical analysis was performed using statistical package for social science (SPSS) for windows version 19.0 software Chicago, SPSS. RESULT CONCLUSION: Vasopressin is a drug which can play a key role in reducing post-operative morbidity in the patients undergoing major gynaecological operations (vaginal hysterectomy and myomectomy) by decreasing intraoperative blood loss. In the present study estimated intraoperative blood loss in vasopressin group was 145.27 ml which was signicantly low in comparison to no injection group in which was 266.45 ml (p value <0.05). This resulted in lesser fall in post-operative heamoglobin level and reduced blood transfusion requirement in vasopressin group. Parameters like duration of surgery, change in vitals during surgery and post-operative complications showed no signicant change in vasopressin group (P<0.0001).

scholarly journals Use of linear radiofrequency device in liver resection

2010 ◽  
Vol 67 (11) ◽  
pp. 910-915 ◽  
Author(s):  
Miroslav Stojanovic ◽  
Milan Radojkovic ◽  
Goran Stanojevic
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Liver Parenchyma ◽  
High Price ◽  
Control Group ◽  
Liver Ischemia ◽  
Intraoperative Blood Loss ◽  
Liver Transection ◽  
Disposable Device ◽  
Parenchyma Transection

Background/Aim. Linear radiofrequency device (LRFD) is disposable tool designed for liver parenchyma transection using controlled radiofrequency to 'seal' blood vessels and bile ducts, making liver resection easier and safer compared to classical resectional techniques. The aim of this study was to determine real value of the LRFD compared to the standard 'keliclasia' technique. Methods. This prospective study analyzed the significant intraoperative parameters and postoperative results of the 200 patients who underwent surgery at the Surgery Clinic of Clinical Centre in Nis, between January 1, 2001, and January 1, 2009. The patients were divided into two groups: the control Keli group (144 patients) with the 'keliclasia' resection technique and the control RF group (with resection performed using LRFD - Tissue Link / Dissection Sealer (DS - 3.0) (56 patients). The following parameters were analyzed: duration of liver ischemia, liver parenchyma transection time, intraoperative blood loss, significant intraoperative and postoperative complication rate, duration of hospitalization and mortality. Results. LRFD was used in 56 liver resections. The average duration of liver ischemia in the RF group was shorter than in the Keli group (7 versus 22 minutes). Parenchymal liver transection was significantly slower in the RF group than in the Keli group (2.05 versus 4.34 cm2/minutes, respectively). There was less intraoperative bleeding using LRFD 'Keliclasia' tehniquethan in the control group (390 mL compared to 420 mL, respectively). After the use of LRFD two cases of biliary leak and 4 pleural effusions were registered. Conclusion. LRFD is simple device for safe liver transection with decreased need for liver ischemia and singificant reducing of the intraoperative blood loss. High price for disposable device and slow parenchyma transection are disadvantages of this device.

Harmonic Scalpel Tonsillectomy in Children: A Randomized Prospective Study

2003 ◽  
Vol 128 (3) ◽  
pp. 318-325 ◽  
Author(s):  
J. Paul Willging ◽  
Brian J. Wiatrak
Keyword(s):  
Blood Loss ◽  
Prospective Study ◽  
Postoperative Morbidity ◽  
Operative Time ◽  
Harmonic Scalpel ◽  
Patient Comfort ◽  
Postoperative Blood Loss ◽  
Intraoperative Blood Loss ◽  
Pain Scores ◽  
Operation Duration

OBJECTIVE: In this randomized prospective study, we evaluated postoperative morbidity after use of the Harmonic Scalpel (HS), an ultrasonic dissector coagulator (Ethicon Endo-Surgery Inc, Cincinnati, OH), or conventional electrocautery (EC) during tonsillectomy. STUDY DESIGN AND SETTINGS: Pediatric subjects at 2 sites were randomized and underwent tonsillectomy. Intraoperative blood loss and operation duration were recorded. Postoperative parameters and complications were recorded. RESULTS: One hundred seventeen subjects completed the study. For the HS group, mean operative time was significantly longer ( P < 0.001), but intraoperative blood loss was equivalent ( P = 1.000). HS subjects slept soundly on postoperative days 1, 2, 3, and 14 ( P = 0.041, 0.013, 0.022, and 0.038, respectively, compared with EC group). Mean postoperative pain scores trended lower for HS subjects on postoperative days 2, 3, and 4. CONCLUSION: The use of the HS in pediatric tonsillectomy showed no increase in intraoperative or postoperative blood loss compared with the use of EC, and HS provided possible clinical advantages over EC in patient comfort. SIGNIFICANCE: Tonsillectomy subjects in the HS group showed a statistically significant ability to sleep soundly, suggesting that the subjects experienced less pain. These data correlate with the observed decrease in pain scores.

Double-blind, randomized controlled trial of tranexamic acid in minor lumbar spine surgery: no effect on operative time, intraoperative blood loss, or complications

2019 ◽  
Vol 31 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Signe Elmose ◽  
Mikkel Ø. Andersen ◽  
Else Bay Andresen ◽  
Leah Yacat Carreon
Keyword(s):  
Placebo Group ◽  
Lumbar Spine ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Spine Surgery ◽  
Operative Time ◽  
Decompressive Surgery ◽  
Lumbar Spine Surgery ◽  
Intraoperative Blood Loss ◽  
Double Blind

OBJECTIVEThe purpose of this study was to investigate the effect of tranexamic acid (TXA) compared to placebo in low-risk adult patients undergoing elective minor lumbar spine surgery—specifically with respect to operative time, estimated blood loss, and complications. Studies have shown that TXA reduces blood loss during major spine surgery. There have been no previous studies on the effect of TXA in minor lumbar spine surgery in which these variables have been evaluated.METHODSThe authors enrolled patients with ASA grades 1 to 2 scheduled to undergo lumbar decompressive surgery at Middelfart Hospital into a double-blind, randomized, placebo-controlled, parallel-group study. Patients with thromboembolic disease, coagulopathy, hypersensitivity to TXA, or a history of convulsion were excluded. Patients were randomly assigned, in blocks of 10, to one of 2 groups, TXA or placebo. Anticoagulation therapy was discontinued 2–7 days preoperatively. Prior to the incision, patients received either a bolus of TXA (10 mg/kg) or an equivalent volume of saline solution (placebo). Independent t-tests were used to compare differences between the 2 groups, with statistical significance set at p < 0.05.RESULTSOf the 250 patients enrolled, 17 patients were excluded, leaving 233 cases for analysis (117 in the TXA group and 116 in the placebo group). The demographics of the 2 groups were similar, except for a higher proportion of women in the TXA group (TXA 50% vs placebo 32%, p = 0.017). There was no significant between-groups difference in operative time (49.53 ± 18.26 vs 54.74 ± 24.49 minutes for TXA and placebo, respectively; p = 0.108) or intraoperative blood loss (55.87 ± 48.48 vs 69.14 ± 83.47 ml for TXA and placebo, respectively; p = 0.702). Postoperative blood loss measured from drain output was 62% significantly lower in the TXA group (13.03 ± 21.82 ml) than in the placebo group (34.61 ± 44.38 ml) (p < 0.001). There was no significant difference in number of dural lesions or postoperative spinal epidural hematomas, and there were no thromboembolic events.CONCLUSIONSTranexamic acid did not have a statistically significant effect on operative time, intraoperative blood loss, or complications. This study gives no evidence to support the routine use of TXA during minor lumbar decompressive surgery.Clinical trial registration no.: NCT03714360 (clinicaltrials.gov)

Sign in / Sign up

Export Citation Format

Share Document