Video-Assisted Thyroidectomy Using a Surgical Energy Device: Initial Experience in a Japanese Single-Center Cohort

<b><i>Objective:</i></b> Video-assisted thyroidectomy (VAT) was approved for coverage under the Japanese public health insurance system in 2016. In our department, we introduced VAT in 2018, and we have since been performing the procedure with the assistance of surgical energy devices. We herein summarize our cases undergoing VAT, including a review of points to consider when introducing the procedure, and characteristics of the surgical energy devices. <b><i>Methods:</i></b> We enrolled 24 patients (14 women and 10 men; age: 24–83 years; mean: 59.0 years) with thyroid/parathyroid tumors who underwent VAT between January 2018 and March 2021 at our department. The medical records of the patients were reviewed, and demographic data, clinical characteristics, histological type, treatment outcomes, and complications were analyzed. <b><i>Results:</i></b> The surgical energy devices used were LigaSure® in the first 4 cases, Acrosurg®. Scissors S17 in the next 13 cases, and Acrosurg®. Revo S15 in the latest 7 cases. The operation time (range: 72–250 min; mean: 147 min), intraoperative blood loss (range: 5–370 mL; mean: 33 mL), indwelling time of wound drain (range: 2–6 days; mean: 3.5 days), and hospitalization period (range: 3–8 days; mean: 5.5 days) were within acceptable ranges. In this study, it is suggested that Acrosurg®. Revo S15 can shorten the indwelling time and the hospitalization period. There were no serious complications, but 1 patient developed transient vocal cord paralysis, which improved 3 months after surgery. It was suggested that the microwave energy devices, Acrosurg®. Scissors S17 and Acrosurg®. Revo S15, may be more effective with respect to sealing/hemostasis/coagulation capacity and controllability than the high-frequency electrosurgical device, LigaSure®. <b><i>Conclusion:</i></b> Based on this initial experience, VAT using surgical energy devices appeared to be a safe, effective, and minimally invasive procedure for the treatment of thyroid/parathyroid tumors. Further studies confirming these early findings are needed.

Novel microwave surgical instrument for use in various lung resection situations

A novel surgical energy device with high sealing ability using microwave technology has been developed. This novel microwave surgical instrument (MSI) is capable of sealing and dissecting a vessel ≤ 5 mm in diameter. The high sealing ability of the MSI enables fine dissection of the lung parenchyma by a scissor-type blade. This device is particularly useful in situations wherein the use of an automatic suturing instrument is difficult. Here, we describe the dissection of the lung parenchyma using this device in three patients (cases 1–3). This device was used for wedge resection of a tumor located close to the pulmonary hilum, for subsegmentectomy, and for dividing incomplete interlobar fissure (cases 1–3, respectively). In all the cases, the postoperative course was uneventful. This MSI is effective for resection of the lung parenchyma, allowing fine tissue dissection and excellent tissue sealing. This technique could assist surgeons in various lung resection cases.

Knowledge Assessment among Surgeons about Energy Devices safe use: A Multicenter Cross Sectional Study

Objective: To assess General Surgery trainee’s knowledge about safe use of energy devices in two tertiary hospitals in Riyadh, Saudi Arabia Background: Electro surgery is the use of high-frequency electrical energy to achieve cutting, and coagulation. This method has become ubiquitous worldwide for the purpose of achieving rapid hemostasis and rapid dissection of tissues Methods: Participants completed a 35-item multiple choice question examination, testing critical knowledge of ES. The examination was developed according to the objectives and blueprints of SAGES’ Fundamental Use of Surgical Energy curriculum. Sections of the examination included: principles of ES, ES-related adverse events, monopolar and bipolar devices, and pediatric considerations and interference with implantable devices.’’ Scores were compared between juniors and seniors participants. Results: A total of 51 general surgical trainees from two academic hospitals completed the assessment. 15.69% of the participants correctly answered 30 questions out of 35 questions, 39.22% of the participants responded correctly to 20 questions out of 35 answers, and 45.09 who responded correctly to less than 20 questions. It was found that 52.2% of the individuals with a low level of understanding were junior residents as opposed to 87.5% of the participants with the highest level of understanding were senior residents with a significant P-value of 0.04. Conclusions: majority of general surgery residents enrolled in the Saudi Arabian board of surgery lack adequate knowledge about the safe and efficient use of surgical energy devices. The level of understanding is lower among the junior residents than seniors.

EFFECTS OF HIGH-FREQUENCY SURGICAL ENERGY ON OVARIAN STRUCTURE IN TOTAL TUBAL HYSTERECTOMY

На современном этапе развития медицины, не смотря на разработку эффективных препаратов, основным методом лечения доброкачественных заболеваний матки, является хирургический. Качество жизни пациенток, перенесших гистерэктомию, является важным критерием оценки эффективности проведенного лечения, значительное внимание исследователей уделяется вопросу оценки функционального состояния сохраненных после гистерэктомии яичников. В современной клинической медицине при выполнении оперативных вмешательств широко используются высокочастотные хирургические энергии, но изучение их влияния на ткани не завершено. Мы проанализировали опубликованные результаты исследований по интересующей нас проблеме. The question of the condition of the ovaries after a hysterectomy with simultaneous removal of the fallopian tubes remains unresolved. According to some authors, the ovarian function does not change, while others provide evidence of decreased ovarian function. The effect of the applied electrocoagulation on ovarian function is also still being studied. This article presents the results of our published studies concerning the function of the ovaries after hysterectomy, including simultaneous bilateral hysterectomy. After reviewing the available studies, we concluded that it is necessary to conduct an experimental study in order to study the morphological changes in the ovaries after the use of high-frequency surgical energy used in hysterectomy with fallopian tubes.

Operative Hemostasis in Trauma and Acute Care Surgery: The Role of Biosurgical Agents

Trauma and acute care surgery (TACS) constitutes the foundation of emergency surgical services in the United States. Blunt and penetrating traumatic injuries are a leading cause of death worldwide. Non-trauma general surgical emergencies are also a major source of morbidity and mortality. Operative interventions performed within the scope of TACS often revolve around the core principles of contamination control, hemostasis, surgical repair, and subsequent functional restoration. Hemorrhage control is an integral part of emergent operative interventions, and while most instances of surgical bleeding require direct suture ligation or some other form of direct tissue intervention, some circumstances call for the use of adjunctive means of hemostasis. This is especially applicable to situations and settings where direct applications of surgical energy, suture ligation, or direct compression are not possible. Difficult-to-control bleeding can be highly lethal and operative control can be very challenging when confounded by the lethal triad of acidosis, coagulopathy and hypothermia. Topical biosurgical materials (BSM) are of great value in such scenarios, and their use across a variety of settings, from pre-hospital trauma application to emergency general surgery operations, represents an important adjunct to improve patient outcomes. Here we present the different BSMs, discuss their various uses, and provide insight on future applications and developments in this important area.

Combustion of pneumoperitoneum: a rare danger in the operating room

Fire or combustion occurring during laparotomy is an uncommon and potentially hazardous event that can be precipitated by the use of surgical energy devices in the presence of enteric gases or exogenous materials present in the abdomen such as alcohol. Oxygen necessary for a combustive event can be increased in the setting of a proximal enteric injury and with higher concentrations of inspired oxygen during anaesthesia. We report on a case of combustion on entry to the abdomen using monopolar diathermy during exploratory laparotomy for gastric antral perforation in the presence of alcohol and enteric gases.