Sutureless, bloodless, safe new circumcision technique

Background: Several techniques of circumcision are available such as conventional surgical technique, the device (Gomco, Plastibell), mono and bipolar diathermy and sutureless methods such as fibrin glue. Our knowledge, the first report of using harmonic scalpel in circumcision was published by Peng et al, in the Asian journal of andrology but the study was done on dogs, this one of the little studies describe the use of the harmonic scalpel in male circumcision in humans. Aim was to describe the technique of the harmonic scalpel circumcision and report its outcomes in the term of safety and efficacy.Methods: This was a prospective observational study performed in the general surgery department at Sohag university hospital, Sohag, Egypt from 1st January 2015 to 31 December 2016.Results: 90 male patients were included in this study. Their age ranged between 3 and 18 years. The most common indication was religious circumcision 50%. No intraoperative blood loss or a postoperative bleeding. One case of wound infection and three cases of a postoperative edema respond to conservative treatment. No injury to the surrounding structure.Conclusions: The result of this study determines that the harmonic scalpel circumcision not associated with intraoperative blood loss or postoperative bleeding and a good postoperative cosmetic result, with a minimal complication. So, it is an appropriate alternative to the traditional scalp and suture technique.

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

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02311-5 ◽

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.

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Influence of PAI-1 Gene Promoter-675 (4G/5G) Polymorphism on Fibrinolytic Activity After Cardiac Surgery Employing Cardiopulmonary Bypass

Medicina ◽

10.3390/medicina48100075 ◽

2012 ◽

Vol 48 (10) ◽

pp. 75

Author(s):

Agnese Ozolina ◽

Eva Strike ◽

Inta Jaunalksne ◽

Jelena Serova ◽

Tatjana Romanova ◽

...

Keyword(s):

Blood Loss ◽

Plasminogen Activator ◽

Postoperative Bleeding ◽

Gene Promoter ◽

Plasminogen Activator Inhibitor ◽

University Hospital ◽

Postoperative Blood Loss ◽

Bleeding Volume ◽

Pai 1 ◽

D Dimer

Background and Objective. The plasminogen activator inhibitor type-1 (PAI-1) gene promoter contains 675 (4G/5G) polymorphism. The aim of this study was evaluate the effect of the PAI-1 promoter-675 (4G/5G) polymorphism on the concentrations of PAI-1 and tissue plasminogen activator/PAI-1 (t-PA/PAI-1) complex and bleeding volume after on-pump cardiac surgery.Material and Methods. A total of 90 patients were included in the study at Pauls Stradins Clinical University Hospital. Seven patients were excluded due to surgical bleeding. Eighty-three patients were classified according to the PAI-1 genotype: 21 patients had the 4G/4G genotype; 42, the 4G/5G genotype; and 20, the 5G/5G genotype. The following fibrinolysis parameters were recorded: the PAI-1 level preoperatively, D-dimer level at 0, 6, and 24 hours after surgery, and t-PA/ PAI-1 complex level 24 hours postoperatively. A postoperative bleeding volume was registered in mL 24 hours after surgery.Results. The patients with the 5G/5G genotype had significantly lower preoperative PAI-1 levels (17 [SD, 10.8] vs. 24 ng/mL [SD, 9.6], P=0.04), higher D-dimer levels at 6 hours (371 [SD, 226] vs. 232 ng/mL [SD, 185], P=0.03) and 24 hours (326 [SD, 207] vs. 209 ng/mL [SD, 160], P=0.04), and greater postoperative blood loss (568 [SD, 192] vs. 432 mL [168], P=0.02) compared with the 4G/4G carriers. There were no significant differences in the levels of the t-PA/PAI-1 complex comparing different genotype groups.Conclusions. The carriers of the 5G/5G genotype showed the lower preoperative PAI-1 levels, greater chest tube blood loss, and higher D-dimer levels indicating that the 5G/5G carriers may have enhanced fibrinolysis.

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Fahmy's four quadrant sutures: a new technique for control of blood loss during cesarean delivery for placenta previa

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20183291 ◽

2018 ◽

Vol 7 (8) ◽

pp. 3004

Author(s):

Mohamed S. Fahmy ◽

Laila Ezzat ◽

Maraey M. Khalil ◽

Ahmed H. Elsayed ◽

Sherif S. Fahmy ◽

...

Keyword(s):

Blood Loss ◽

Cesarean Delivery ◽

Simple Procedure ◽

Placenta Previa ◽

Suture Technique ◽

University Hospital ◽

New Technique ◽

Artery Ligation ◽

The Mean ◽

Four Quadrant

Background: The objective of this study is to assess the efficacy and safety of Fahmy's four quadrant suture technique (FFQS) in controlling blood loss during cesarean delivery for placenta previa (PP).Methods: The study was carried out in a tertiary University Hospital between January 2017 to December 2017 involved 12 women with heavy bleeding occurred after removal of the placenta from the lower section during cesarean delivery for PP. The FFQS technique consisted of two sutures to ligate the uterine branches on both sides and two sutures on the anterior and posterior wall of the lower uterine segment. Details regarding the management and maternal outcomes were recorded.Results: The mean age of the study participants was 29.58±5.29 years and the mean parity was 2.25±1.14. The mean gestational age at termination of pregnancy was 36.91±1.38 weeks. The mean duration of the whole surgery was 78.75±43.28 minutes, while the mean duration of FFQS technique was only 10±2.09 minutes. The technique was exclusively effective in 8 out of 12 cases (66.67%) while 2 cases needed bilateral internal iliac artery ligation and 2 cases needed hysterectomy. The mean amount of blood loss in all cases was 2433.33±833.76 ml. the mean amount of transfused packed RBCs was 3.92±1.68 units and fresh frozen plasma (FFP) was 3.42±1.44 units. All cases had uneventful postoperative course and no mortality cases in present series.Conclusions: The new technique; FFQS represents a rapid, effective, and inexpensive opportunity for women with bleeding from the lower segment of uterus due to PP. This simple procedure should be attempted before other complex measures to achieve good hemostasis.

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Evaluation of measured postpartum blood loss after vaginal delivery using a collector bag in relation to postpartum hemorrhage management strategies: a prospective observational study

Journal of Perinatal Medicine ◽

10.1515/jpm-2015-0200 ◽

2016 ◽

Vol 44 (4) ◽

Cited By ~ 5

Author(s):

Christian Bamberg ◽

Katja Niepraschk-von Dollen ◽

Laura Mickley ◽

Anne Henkelmann ◽

Larry Hinkson ◽

...

Keyword(s):

Blood Loss ◽

Observational Study ◽

Vaginal Delivery ◽

Postpartum Hemorrhage ◽

Prospective Observational Study ◽

Management Strategies ◽

Population Based ◽

University Hospital ◽

Hemoglobin Content ◽

Vaginal Deliveries

AbstractTo evaluate the incidence of postpartum hemorrhage (PPH) and severe PPH via routine use of a pelvic drape to objectively measure blood loss after vaginal delivery in connection with PPH management.This prospective observational study was undertaken at the obstetrical department of the Charité University Hospital from December 2011 to May 2013 and evaluated an unselected cohort of planned vaginal deliveries (n=1019 live singletons at term). A calibrated collecting drape was used to meassure blood loss in the third stage of labor. PPH and severe PPH were defined as blood loss ≥500 mL and ≥1000 mL, respectively. Maternal hemoglobin content was evaluated at admission to delivery and at the first day after childbirth.During the study period, 809 vaginal deliveries were analysed. Direct measurement revealed a median blood loss of 250 mL. The incidences of PPH and severe PPH were 15% and 3%, respectively. Mean maternal hemoglobin content at admission was 11.9±1.1 g/dL, with a mean decrease of 1.0±1.1 g/dL. Blood loss measured after vaginal delivery correlated significantly with maternal hemoglobin decrease.This study suggests that PPH incidence may be higher than indicated by population-based data. Underbuttocks drapes are simple, objective bedside tools to diagnose PPH. Blood loss should be quantified systematically if PPH is suspected.

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A novel electrosurgical divider: performance in a self-controlled tonsillectomy study

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-07008-9 ◽

2021 ◽

Author(s):

Gerold Besser ◽

Stefan Grasl ◽

Elias L. Meyer ◽

Julia Schnoell ◽

Tina J. Bartosik ◽

...

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Postoperative Bleeding ◽

Neck Surgery ◽

Controlled Clinical Trial ◽

Intraoperative Blood Loss ◽

Bleeding Events ◽

Surgical Time ◽

Secondary Bleeding ◽

Temperature Controlled

Abstract Purpose Tonsillectomies are among the most common surgeries in otorhinolaryngology. A novel electrosurgical temperature-controlled instrument (device) promises rapid tonsillectomies and might reduce postoperative pain, but comparative studies to assess performance are warranted. Methods This randomized self-controlled clinical trial was conducted from October 2019 to October 2020 at the Department of Otorhinolaryngology, Head and Neck Surgery of the Medical University of Vienna. Forty-eight patients underwent a tonsillectomy with the device on one side and using cold-steel with localized bipolar cauterization on the other side (control). Main outcomes were the time for tonsil removal (per side) and the time to stop bleeding (per side). Secondary measurements were postoperative pain, assessed once on day 0 and five times on days 1, 3, 5, 7, and 10. Postoperative bleeding episodes and consequences were recorded. Results Device tonsillectomies were performed significantly faster than controls; the mean surgical time difference was 209 s (p < 0.001, 95% CI 129; 288). Intraoperative blood loss was significantly lower on the device side (all p < 0.05). Postoperative measurements of pain and bleeding were similar for both sides. Two return-to-theatre secondary bleeding events were recorded for the control side. Conclusion The novel electrosurgical temperature-controlled divider reduced the tonsillectomy surgical time and intraoperative blood loss, with no apparent negative effects on postoperative pain or bleeding, compared to a cold-steel tonsillectomy with localized bipolar cauterization. In time-restricted settings, the device could be beneficial, particularly after familiarization with device handling. Trial registration ClinicalTrials.gov Identifier: < Blinded for review >

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

International Surgery Journal ◽

10.18203/2349-2902.isj20201372 ◽

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.

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EVALUATING THE OUTCOMES OF TONSILLECTOMY BY BIPOLAR ELECTROCAUTERY

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2017.4.13 ◽

2017 ◽

pp. 90-94

Author(s):

Thanh Thai Le ◽

Thanh Tuan Nguyen

Keyword(s):

Blood Loss ◽

Key Words ◽

Recovery Time ◽

Postoperative Bleeding ◽

University Hospital ◽

Rapid Recovery ◽

Bleeding Complications ◽

The Mean ◽

Surgical Duration ◽

Short Time

Objective: To evaluate the outcomes of tonsillectomy by bipolar electrocautery. Materials and Methods: Including 65 patients performed tonsillectomy by bipolar electrocautery from 04/2016 to 05/2017, at the Department of Otorhinolaryngology, at Hue University Hospital, and the results were studied by descriptive, prospective methods. Results: The mean surgical duration was 19.38± 5.144 minutes. Blood loss during the operation averaged 8.34 ± 5.597 ml. Postoperative bleeding complications occurred in 3.1% (2 of 65) of the cases. The first day after surgery patients reported pain severity was moderate, thenthe severity decreased steadily till seventh day, and on the fourteenth daymost patients reported no pain or only mild pain. The time needed to return to normal eating was 7.43 days, 72.3% pseudomembranceunsticked at the fourteenth day. Conclusion: Tonsillectomy by bipolar electrocautery have the advantages: decreasing the blood loss, operation in short time, relatively pain-free, limiting postoperative bleeding complications and rapid recovery time. Key words: tonsillectomy, bipolar electrocautery

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Postoperative Bleeding in Tonsillectomy Patients

Ear Nose & Throat Journal ◽

10.1177/014556139607500611 ◽

1996 ◽

Vol 75 (6) ◽

pp. 373-376 ◽

Cited By ~ 21

Author(s):

Wasyl Szeremeta ◽

Norman J. Novelly ◽

Michael Benninger

Keyword(s):

Retrospective Study ◽

Blood Loss ◽

Postoperative Bleeding ◽

The Other ◽

Intraoperative Blood Loss ◽

Age And Gender ◽

And Gender

A three-year retrospective study was performed on 494 patients to compare the effects of two techniques of tonsillectomy, with respect to rates of postoperative bleeding. One surgeon performed primarily mechanical dissections, while the other primarily performed electrocautery dissections. Intraoperative blood loss was assessed and correlated to the age and gender of the patient and to the size of the tonsil. Postoperative bleeding was seen in 2.8% of patients who underwent electrocautery tonsillectomy and in 7.6% of patients who underwent mechanical tonsillectomies. Patients undergoing electrocautery dissection lost an average of 37 ml of blood intraoperatively, whereas those undergoing mechanical dissection lost 105 ml. Mechanical tonsillectomies exhibited higher intraoperative blood loss than electrocautery tonsillectomies. A higher rate of postoperative bleeding was seen in mechanical tonsillectomies, but this difference was lost when peritonsillar abscesses were removed from the study.

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Effect of Modern Fibrin Glue on Bleeding after Tonsillectomy and Adenoidectomy

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940311200504 ◽

2003 ◽

Vol 112 (5) ◽

pp. 410-414 ◽

Cited By ~ 26

Author(s):

Michael Vaiman ◽

Nathan Shlamkovich ◽

Efraim Eviatar ◽

Samuel Segal

Keyword(s):

Blood Loss ◽

Fibrin Glue ◽

Randomized Study ◽

Postoperative Bleeding ◽

Postoperative Hemorrhage ◽

Control Group ◽

Surgical Trauma ◽

Intraoperative Blood Loss ◽

Secondary Hemorrhage ◽

Needle Point

We performed a prospective randomized study in 179 patients to examine the second-generation surgical fibrin sealant Quixil as an effective substitute for different types of electrocautery in tonsillectomy and adenoidectomy. We compared the rates of hemorrhagic complications in a group with bipolar or needle point electrocautery and in a group in whom fibrin glue was used to stop intraoperative bleeding and to prevent postoperative bleeding. The operations were performed under general anesthesia in typical fashion with sharp dissection. For the control group, hemostasis was achieved by bipolar or needle point electrocautery. For the fibrin glue group, hemostasis was achieved by spraying Quixil fibrin glue approximately 0.5 mL to each tonsillar fossa and 0.5 mL to the nasopharynx (in adenoidectomy). The results were excellent in all the patients of the fibrin glue group, with complete hemostasis and resolution of the major symptoms. In this group, the intraoperative blood loss averaged 15 mL in tonsillectomy and 9 mL in adenoidectomy. There were no cases of postoperative hemorrhage or any other complications. The electrocautery group required a longer time for healing, and its intraoperative blood loss (tonsillectomy) averaged 29 to 33 mL. The incidence of posttonsillectomy bleeding in this group was 4.35% (4 patients). Three patients (3.26%) had primary hemorrhage (bleeding that occurs within the first 24 hours of surgery), and 1 patient (1.09%) had secondary hemorrhage (bleeding that occurs after the first 24 hours). We conclude that Quixil fibrin glue application to the operative sites in tonsillectomy and adenoidectomy provides effective hemostasis and sealing with good systemic and local compatibility. With the help of Quixil, we minimized surgical trauma and achieved absolute hemostasis at the same time. We found this fibrin glue to be a more convenient and effective hemostatic sealant than bipolar or needle point coagulation.

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Coblation Versus Diode Laser Tonsillectomy: A Comparative Study

10.21203/rs.3.rs-582705/v1 ◽

2021 ◽

Author(s):

Ameer A. Alaqeedy ◽

Rasheed Ali Rashid ◽

Raid M. Al-Ani

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Comparative Study ◽

Diode Laser ◽

Operative Time ◽

Postoperative Bleeding ◽

P Value ◽

Intraoperative Blood Loss ◽

Laser Technique ◽

Significant Difference

Abstract Introduction: The study aimed to compare the 2 procedures of tonsillectomy (coblation and diode laser) concerning the operative time, the amount of blood loss, postoperative pain, and other complications. Materials and Methods: A comparative study was conducted at many Private Hospitals, Baghdad, Iraq from February 2019- February 2020. Coblation and laser tonsillectomy were performed on the same patient (one for each side) which was blinded to the patients or their caregivers and the surgeon who did the tonsillectomy. Data concerning the age, gender, indications for tonsillectomy, operative time, the amount of the blood loss, post-tonsillectomy pain by VAS scores, and other complications were recorded for each patient. Results: Out of 62 participants, there were 34 (54.8%) females. The majority were from the age group ≤18 years (n=54, 87.1%). The operative time and amount of the intraoperative blood loss were significantly lower in the coblation than a diode laser tonsillectomy. However, the postoperative pain scores in the diode laser were a statistically significant difference less than the coblation group at the periods 3 hours, 8 hours, 24 hours, and 7 days (P-value<0.05). While there was no statistically significant difference between the two groups at 2 weeks postoperative period (P-value=0.392). No primary or secondary postoperative bleeding in all patients. Conclusion: coblation was better than diode laser because of shorter operative time and less intraoperative blood loss. However, the diode laser technique had lesser postoperative pain at the postoperative periods 3 hours, 8 hours, 24 hours, and 7 days than coblation.

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