The ultrasonic harmonic scalpel for circumcision： experimental evaluation using dogs

Male circumcision is one of the most commonly performed operations worldwide, and many novel techniques have been developed for better postoperative outcomes. The purpose of this study was to explore the feasibility of applying the ultracision harmonic scalpel （UHS） for circumcision by using dogs. Sixteen adult male dogs were divided into two groups： the UHS group and the control group. The dogs were circumcised with either the UHS or a conventional scalpel. The UHS circumcision procedure and the effects were imaged 1 week after surgery. The two groups were compared with respect to the operative time and volume of blood loss. Postoperative complications, including oedema, infection, bleeding of the incision and wound dehiscence, were recorded for both groups. The mean operative time for the UHS group was only 5.1 min compared with the 35.5 min of the conventional group. The mean blood loss was less than 2 ml for the UHS group and 15 ml for the conventional group. There was only one case of mild oedema in the UHS group, but the postoperative complications in the conventional group included two cases of mild oedema, one infection of the incision and one Case of bleeding of the incision. In conclusion, circumcision using UHS is a novel technique to treat patients with phimosis and excessive foreskin, and this method has a short operative time, less blood loss and fewer complications than the conventional scalpel method. This small animal study orovides a basis for embarking on a larger-scale clinical trial of the UHS.

Harmonic scalpel versus traditional scissors in laparoscopic partial nephrectomy:A propensity score-based analysis

Objective:The present study aims to compare the clinical efficacy of laparoscopic partial nephrectomy using a harmonic scalpel versus traditional scissor.Methods:A retrospective review was conducted in patients with localized renal tumors and scheduled for laparoscopic partial nephrectomy from January 2015 to December 2019.Eventually,225 patients joined this retrospective study.Patients were divided into the harmonic scalpel group or scissor group based on the method used,with 71 cases and 154 cases respectively.Propensity score matching(1:1)was performed to adjust for potential baseline confounders,and each group had 57 cases.Patient characteristics,perioperative clinical results,complications,and oncological results were compared between the two groups.Results:After matching,patient characteristics were not significantly different between the two groups.The scissor group was associated with a significantly shorter operative time(105 min vs.130 min,p<0.001),shorter warm ischemia time(19.35 min vs.22.07 min,p?0.005).However,the harmonic scalpel group was associated with significantly less estimated blood loss(20 mL vs.30 mL,p?0.013)and shorter length of stay(8 d vs.10 d,p?0.040).There was no significantly difference in indwelling time of drainage tube,perioperative complication,oncological outcomes or recurrence rates.Conclusions:The harmonic scalpel is used safely and effectively in laparoscopic partial nephrectomy,and has benefits in intraoperative blood loss and length of stay.

Harmonic Scalpel Assisted Uvalopalatopharyngoplasty

Objectives: To investigate the evaluation of the harmonic scalpel-assisted uvulopalatopharyn-goplasty (UPPP) surgery with posterior wall of uvula mucosa sutured with anterior wall. Design: According to the diagnostic criteria published by Chinese medical association of otolaryngology-head and neck, 21 cases were performed UPPP with the harmonic scalpel. The Regional Ethics Committee of our hospital approved the study protocol. Informed written consent was obtained from all participants. Setting: A single specialist hospital. Participants: 21 patients with OSAHS. Participants were not randomized in groups and were performed UPPP with the harmonic scalpel. Main Outcome Measures: Part of the uvula muscle and the anterior wall of the uvula mucosa were removed, and the mucosa of posterior wall was preserved. The mucosa of the posterior wall was sutured with the remaining part of the anterior wall. The AHI and LaSO2 were measured both before and six months after the operation by Polysomnography (PSG). Results: This study reported a significant improvement (p ± s) was 48.6 ± 12.65, and LSaO2 (± s) was 67.4% ± 9.18%;postoperative AHI was 10.9 ± 9.29, and postoperative LSaO2 was 91.0 ± 1.47. The mean operation duration was 30.1 minutes. Conclusion: The use of HS in UPPP is efficient and shows some advantages over conventional method: its use provided a blood free surgery field, and shorter operation duration.

Evaluation of the harmonic scalpel in open surgery for abdominal aortic aneurysm

The harmonic scalpel is a hemostatic device primarily designed for use in laparoscopic surgery.During the last few years,many surgeons have begun to use the harmonic scalpel in open surgery.Several papers have cited the benefits of the device compared with conventional knot-tying techniques;however,no evidence showing the advantages of using the harmonic scalpel in complicated abdominal aortic aneurysm(AAA)surgery has been presented.The aim of the present study is to determine the value of the harmonic scalpel in open operation for AAA.A total of 153 patients who underwent open surgery for AAA at the Department of Vascular Surgery of Guangdong General Hospital,China between January 2001 and December 2010,were retrospectively analyzed.Open surgery performed with the harmonic scalpel on 105 patients was compared with open operation using conventional knot-tying techniques on 48 patients.The operative time,intraoperative blood loss,total postoperative drainage fluid volumes,hospital stay,and postoperative complications between the two groups were compared.The harmonic scalpel group was associated with a shorter operation time(113.2±23.6 min vs.232.1±39.2 min,P<0.01)and lower intraoperative blood loss(126.1±96.6 ml vs.592.1±207.2 ml,P<0.01).Postoperative drainage fluid volumes were greater in the conventional surgery group than in the harmonic scalpel group(702.1±192.8 ml vs.198.5±97.4 ml,P<0.01).The hospital stay was shorter for the harmonic scalpel group than for the conventional surgery group(10.7±3.3 d vs.16.5±4.7 d,P<0.05).No differences between the postoperative complications or hospital mortality of the two groups were found.The harmonic scalpel is a safe and minimally invasive tool in open surgery for AAA and is associated with shorter operative time,shorter hospital stay,and lower intraoperative blood loss and postoperative drainage fluid volumes compared with conventional knot-tying techniques.

Randomized controlled trial of bipolar diathermy vs ultrasonic scalpel for closed hemorrhoidectomy

AIM:To compare hemorrhoidectomy with a bipolar electrothermal device or hemorrhoidectomy using an ultrasonically activated scalpel.METHODS:Sixty patients with grade Ⅲ or Ⅳ hemorrhoids were prospectively randomized to undergo closed hemorrhoidectomy assisted by bipolar diathermy(group 1) or hemorrhoidectomy with the ultrasonic scalpel(group 2).Operative data were recorded,and patients were followed at 1,3,and 6 wk to evaluate complications.Independent assessors were assigned to obtain postoperative pain scores,oral analgesic requirement and satisfaction scores.RESULTS:Reduced intraoperative blood loss median 0.9 mL(95% CI:0.8-3.7) vs 4.6 mL(95% CI:3.8-7.0),P = 0.001 and a short operating time median 16(95% CI:14.6-18.2) min vs 31(95% CI:28.1-35.3) min,P < 0.0001 was observed in group 1 compared with group 2.There was a trend towards lower postoperative pain scores on day 1 group 1 median 2(95% CI:1.8-3.5) vs group 2 median 3(95% CI:2.6-4.2),P = 0.135.Reduced oral analgesic requirement during postoperative 24 h after operation median 1(95% CI:0.4-0.9) tablet vs 1(95% CI:0.9-1.3) tablet,P = 0.006 was observed in group 1 compared with group 2.There was no difference between the two groups in the degree of patient satisfaction or number of postoperative complications.CONCLUSION:Bipolar diathermy hemorrhoidectomy is quick and bloodless and,although as painful as closed hemorrhoidectomy with the ultrasonic scalpel,is associated with a reduced analgesic requirement immediately after operation.

Tissue pad degradation of ultrasonic device may enhance thermal injury and impair its sealing performance in liver surgery

BACKGROUND Ultrasonic devices are widely used in many surgical fields,including hepatectomy;however,the negative effects of tissue pad degradation of ultrasonic devices,including those in liver surgery,remain unknown.The Harmonic®1100(H-1100)scalpel has advanced heat control technology than previous models,such as the Harmonic®HD1000i(H-HD1000i).We hypothesized that,because of its advanced temperature-control technology,the H-1100 scalpel would show less tissue pad degradation,resulting in superior sealing performance,compared to that with the H-HD1000i scalpel.AIM To elucidate ultrasonic device tissue pad degradation effects on instrument temperature and sealing performance using ex vivo porcine liver/vessel models.METHODS Two different harmonic scalpels were used and compared:A newer model,the H-1100 scalpel,and an older model,the H-HD1000i scalpel.Using ex vivo porcine livers,each instrument was activated until the liver parenchyma was dissected.The device temperature(passive jaw temperature)was measured after every 10 consecutive activations,until 300 transections of the porcine liver were performed.Tissue pad degradation was evaluated after 300 activations.Sealing performance was evaluated using excised porcine carotid vessels;vessel sealing speed and frequency of vessel burst pressure below 700 mmHg were determined after 300 transections of porcine liver parenchyma.RESULTS The temperature of the H-HD1000i scalpel was approximately 10℃higher than that of the H-1100 scalpel,and gradually increased as the number of activations increased.The median passive jaw temperature of the H-HD1000i scalpel was significantly higher than that of the H-1100 scalpel(73.4℃vs 65.1℃;P<0.001).After 300 transections of porcine liver parenchyma,less tissue pad degradation was observed with the H-1100 scalpel than with the H-HD1000i scalpel(0.08 mm vs 0.51 mm).The H-1100 scalpel demonstrated faster vessel-sealing speed(4.9 sec.vs 5.1 sec.)and less frequent vessel burst pressure<700 mmHg(0%vs 40%)after 300 activations than the H-HD1000i scalpel;however,the difference did not reach statistical significance(P=0.21 and P=0.09,respectively).CONCLUSION In an ex vivo porcine hepatectomy model,the H-1100 scalpel shows lower passive jaw temperature and maintains its sealing performance by avoiding tissue pad degradation compared to that with the H-HD1000i.