Ultrasonic scalpel based on fusiform phononic crystal structure

In response to the ultrasonic scalpels with the vibrational modal coupling which leads to a decrease in efficiency,an ultrasonic scalpel based on fusiform phononic crystals(PnCs)is proposed.An accurate theoretical model is constructed,which is mainly composed of electromechanical equivalent circuit models to analyze the frequency response function and the frequency response curves of the admittance.Bragg band gaps exist in the fusiform PnCs owing to the periodic constraint,which can suppress the corresponding vibrational modes.The vibration characteristics(vibration mode,frequency,and displacement distribution)of the ultrasonic scalpel are analyzed,and the validity of the electromechanical equivalent circuit method is verified.The results indicate that other vibration modes near the working frequency can be isolated.In addition,blades based on fusiform PnCs have a function akin to that of the horn,which enables displacement amplification.

Multi-Objective Optimization of the Ultrasonic Scalpel Rod and Tip with Improved Performance:Vibration Frequency,Amplitude,and Service Life

Ultrasonic scalpel design for minimally invasive surgical procedures is mainly focused on optimizing cutting performance.However,an important issue is the low fatigue life of traditional ultrasonic scalpels,which affects their long-term reliability and effectiveness and creates hidden dangers for surgery.In this study,a multi-objective optimal design for the cutting performance and fatigue life of ultrasonic scalpels was proposed using finite element analysis and fatigue simulation.The optimal design parameters of resonance frequency and amplitude were determined.By setting the transition fillet and keeping the gain structure away from the node position to enable the scalpel to have a high service life with excellent cutting performance.The frequency modulation method of setting the vibration node bosses at the node position and setting the vibration antinode grooves at the antinode position was compared.Then,the mechanism of the influence of various design elements,such as tip,shank,node position,and antinode position,on the resonance frequency,amplitude,and fatigue life of the ultrasonic scalpel was analyzed,and the optimal design principles of the ultrasonic scalpel were obtained.The proposed ultrasonic scalpel design was confirmed by simulations,impedance measurements,and liver tissue cutting experiments,demonstrating its feasibility and enhanced performance.This research introduces innovative design strategies to improve the fatigue life and performance of ultrasonic scalpels to address an important issue in minimally invasive surgery.

Totally laparoscopic left hepatectomy using the Torsional Ultrasonic Scalpel

Minimal invasive techniques have allowed for major surgical advances.We report our initial experience of performing total laparoscopic left hepatectomy(segmentsⅡ-Ⅳ)with the Lotus(laparoscopic operation by torsional ultrasound)Ultrasonic Scalpel.The perioperative and postoperative courses of the young female patient were uneventful and she is in a good general condition without complaints 18 mo after surgery.To the best of our knowledge,this is the first total laparoscopic hemihepatectomy to be performed in Greece,as well as the first laparoscopic liver resection using Lotus shears.

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.

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.

Resection of giant gastric GIST with a new generation ultrasonic scalpel device

Gastrointestinal stroma tumours(GIST) are the most common mesenchymal tumour in the digestive tract and commonly found in the stomach. The patient described in this report presented with collapse and a palpable abdominal mass. He was found to have a large gastric GIST that penetrated through the mesocolon. Resection of the GIST was technically challenging but facilitated by a new generation ultrasonic scalpel device. In resection of gastric cancer the use of ultrasonic scalpels has been shown to reduce operating time, blood loss and length of stay. We feel that in technically challenging cases of gastric GIST the use of an ultrasonic scalpel device may be justified as well.

外科新技术—水刀(water jet scalpel)

介绍近年出现的外科新技术-水刀(waterjetscalpel)及其在肝胆外科、颌面外科、骨外科、神经外科、泌尿外科、耳鼻喉科和眼科手术中的应用。

No-scalpel vasectomy outside China

Since 1985, the no-scalpel vasectomy technique has been widely used outside China. The prevalence of this tech-nique has helped to increase the acceptability of male sterilization in many parts of the world. More than 5000 physi-cians in twenty-five developing countries have been trained in the no-scalpel vasectomy technique. In the United Statesin 1995, nearly one third of vasectomies employed the no-scalpel technique, and in the whole Northern American re-gion, a total of 1100 doctors have been made familiar with the technique. Doctors believe that there are several advan-tages of the no-scalpel technique, including no incision, no stitches, faster procedure, faster recovery, less chance ofbleeding, less discomfort and high efficacy. The key steps of the technique include fixation of the vas and infiltrationanaesthesia of the spermatic cord, as well as grasping, delivering and isolating the vas. No-scalpel technique providesa good approach to expose the vas, in conjunction with which, different vas-end occlusion methods may be used.(Asian J Androl 2000; 2: 21 - 24)

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.

Application of High-frequency Electrosurgical Scalpel and Methylene Blue Staining in Endonasal Dacryocystorhinostomy

Purpose: To evaluate the application of a high-frequency electrosurgical scalpel and methylene blue staining in the endonasal dacryocystorhinostomy.Methods: This retrospective study included 37 patients(43eyes).undergoing endonasal dacryocystorhinostomy in our hospital between 2011 and 2013 using methylene blue staining of the lacrimal sac and a high-frequency electrosurgical scalpel for cutting nasal mucosa, intraoperative stanch, and fixation of lacrimal sac and nasal mucosal flaps. Surgical efficacy, intraoperative challenges, and corresponding handling methods were evaluated and summarized.Results: Among 43 eyes, 42 were successfully cured(97.7%)and the symptoms in 1 eye were improved(2.3%). Total efficacy rate was 100%. All surgeries were successfully performed. No severe intraoperative complications were observed.Conclusion: A high-frequency electrosurgical scalpel, combined with methylene blue staining of the lacrimal sac, is efficacious for nasal mucosal cutting, intraoperative stanch, and fixation of mucosal flap by cauterization, which significantly alleviates intraoperative complications and enhances surgical success rate. It deserves widespread application in clinical practice.

Process planning and contour-based error compensation for precision grinding of miniature scalpels

Miniature scalpels are mainly used in microsurgeries such as ophthalmic and cardiovascular surgeries.The size of a miniature scalpel is only a few millimeters,and the precision of the blade shape is high,which makes production of miniature scalpels extremely difficult.This study proposes a new sharpening process for grinding miniature scalpels on a four-axis machine tool.A post-processing algorithm for a four-axis grinding machine based on a kinematics model is established.We then propose a corresponding parameter calibration method for the parameters used in the kinematics model.Because of possible errors in the parameter calibration,a contour-based error compensation method is proposed for accurate adjustments to the edge shape following grinding.This can solve the problem of large deviations between the actual edge shape after grinding and the ideal edge shape.The effectiveness of the proposed process planning and error compensation method is verified experimentally,and the grinding process parameters of the miniature scalpel are optimized to improve its surface processing quality.The sharpness of the optimized miniature scalpel is less than 0.75 N,and the blade shape is symmetrical,which meets the technical requirements of miniature scalpels.

Design and Performance Study of an Ultrasonic Bone Scalpel with Composite Horn Structure

The ultrasonic bone scalpel was often used in all kinds of clinical orthopedic surgery as a new type of medical instrument.Based on the working theory of the ultrasonic bone scalpel and combined with the design method of a quarter wavelength transducer and horn,this study proposed an optimization design method for the ultrasonic bone scalpel with a composite horn structure.The structure of the ultrasonic bone scalpel was simplified,and its length was shortened.Finite element analysis,modal analysis,and harmonic response analysis were used to optimize the design of the ultrasonic bone scalpel.The performance of the ultrasonic bone scalpel was explored through impedance analysis,amplitude measurement,temperature measurement,and cutting tests,and the feasibility of the design was verified through torque analysis.The results showed that when the torque force was 4.0 N,the resonance frequency of the ultrasonic bone scalpel was 30,540 Hz,and the maximum amplitude of the ultrasonic bone scalpel could reach 62μm.After spray cooling,the maximum surface temperature of the rear end cover was reduced from 51.8 to 36.3℃,the maximum surface temperature of the composite horn was reduced from 71 to 45.3℃,and the maximum surface temperature of the cutter head was reduced from 101 to 46.1℃,demonstrating a good cooling effect.Under 89 Voltage,the optimal cutting force for cutting chicken leg bones was 0.1 N,the optimal cutting force for cutting pork ribs was 0.3 N,and the cutting process showed tissue selectivity.

Application of ultrasonic scalpel in gynecologic operative laparoscopy

Objective To investigate the applied value of the ultrasonic scalpel in gynecologic operative laparoscopy. Methods Gynecologic operations were performed using the ultrasonic scalpel under laparoscopy. Operative bleeding and time, perioperative body temperature and hemogram, and tissue damage were observed.Results Forty-two cases of benign gynecologic diseases were treated with the ultrasonic scalpel under laparoscopy. Among them, there were 4 hysterectomies, 9 ovarian cystectomies, 18 salpingotomies, 4 ectopic pregnancies, 3 myomectomies, 3 adhesiolysis and 1 adnexectomy. The amount of operative bleeding, operating time and the tissue injury were related to the type of operation. The minimual operative bleeding amount, operating time, depth of tissue necrosis, tissue injury score and fibrin deposition score were 24.77±4.71ml, 23.39±3.01 min, 0.22±0.10mm, 0.98±0.21 and 0.38±0.26, respectively. The maximal operative bleeding amount, operating time, depth of tissue necrosis, tissue injury score and fibrin deposition score were 166.7±47.18ml, 127.2±16.99 min, 0.35±0.20mm, 1.25±0.20 and 0.81±0.29, respectively. The levels of body temperature, white blood cells and hemoglobin before and after the operations were not statistically different (P>0.05) except for hysterectomy (P<0.05). Conclusion The ultrasonic scalpel can be safely applied for gynecologic operative laparoscopy and should be used widely.

基于逻辑回归分析构建超声刀使用风险管理模型与验证

目的:基于逻辑回归(LR)算法构建超声刀使用风险管理模型,提高超声刀风险管理质量。方法:基于LR算法构建超声刀使用风险管理模型并进行模型验证。选取2022—2023年上海市肺科医院临床在用的28台超声刀,以时间为节点,将2022年设备使用期间采用常规管理模式进行管理,2023年设备使用期间采用LR风险管理模型(简称风险管理)进行管理,采用自制评估量表对比两种管理模式的超声刀风险管理质量评分、风险预警评分以及参与设备使用管理人员体验评分。结果:采用风险管理模式的超声刀保养记录、使用状态记录、资料入档、保养牌悬挂和报废处理质量评分的平均分分别为(9.54±0.37)分、(9.67±0.34)分、(9.73±0.21)分、(9.18±0.35)分和(9.92±0.31)分,均高于常规管理模式,差异有统计学意义(t=55.666、32.235、49.511、40.311、23.122,P<0.05);采用风险管理的超声刀使用风险识别准确性、预警及时性和防控全面性风险预警评分的平均分分别为(9.66±1.20)分、(9.92±1.48)分和(9.87±1.04)分,均高于常规管理模式,差异有统计学意义(t=11.840、8.371、8.032,P<0.05);参与超声刀预防养护人员、维修人员和操作人员对采用风险管理模式的超声刀使用体验平均评分分别为(96.61±6.08)分、(95.07±5.19)分和(97.73±5.93)分,均高于常规管理模式,差异有统计学意义(t=4.991、4.156、4.870,P<0.05)。结论:基于LR算法构建超声刀风险管理模型应用于超声刀使用管理,可提高超声刀风险管理质量,规避风险隐患,提升超声刀临床使用的安全性与稳定性。

内镜下微创精准尿道拖入术治疗复杂性后尿道狭窄或闭锁(“大家泌尿网”观看手术视频)

尿道拖入术是治疗复杂性后尿道狭窄及闭锁的有效术式。传统尿道拖入术因创伤大、端端对合不精准等问题常难以达到理想的效果。本团队对传统尿道拖入术进行改良,应用输尿管镜于直视下行尿道端端精准对合,术中无需切开膀胱,全程使用超声刀,减少了术中出血及术后感染的发生,提高了手术成功率,极大地降低了狭窄复发率及术后并发症发生率,实现了微创精准的效果。较短的学习曲线使其可作为骨盆骨折后复杂性后尿道狭窄或闭锁的一种新的治疗方法。本文介绍了该术式具体操作步骤,结合临床数据对其手术疗效进行分析并详细说明其创新点和操作经验。

微创外科多自由度柔性超声手术刀研究进展

超声手术刀作为一种广泛应用的高效精准的能量器械,具有同时切割止血、较小热损伤、几乎无烟雾、自净能力强等优势,但是由于现有超声手术刀结构的约束,其运动自由度少,限制了其应用在机器人操作中的灵活性。经过科研人员在结构方面的不断优化和改进,在原有刚性超声手术刀的基础上,加入柔性结构,衍生出更加灵活的多自由度柔性超声手术刀。本文综述了刚性超声手术刀的发展以及柔性超声手术刀现有的设计方案,对于刚性超声刀的研究主要集中在结构的轻便以及工作性能的提高,对于柔性超声刀的设计分为将微型化的超声换能器放置在手柄端和放置在执行末端两类,分别分析这2种设计方案的具体结构,并讨论其优势和局限性。最后,对微创外科多自由度柔性超声刀未来的发展趋势提出展望。

普通电刀钳夹凝闭技术在兔甲状腺切除术中的应用效果及安全性

目的探讨普通电刀钳夹凝闭技术在兔甲状腺切除术中的应用效果及安全性。方法按照随机数字表法将12只新西兰兔分为钳夹凝闭组和超声刀组,每组6只。钳夹凝闭组兔行普通电刀钳夹凝闭技术离断甲状腺中部,超声刀组兔行超声刀电凝离断甲状腺中部。观察2组兔术后一般情况。取切除后甲状腺组织行苏木精-伊红(HE)染色,光学显微镜下观察热损伤后甲状腺组织病理学,并测定热损伤范围;分别于术后第1、3、7天,抽取2组兔的耳缘静脉血,应用酶联免疫吸附测定法检测血清中白细胞介素-6(IL-6)、C反应蛋白(CRP)水平;术后第7天,处死2组兔,取残余甲状腺,行HE染色,光学显微镜下观察病理学变化及炎症细胞浸润情况。结果2组兔术后均存活良好,术区愈合良好,残腔未见明显积液、凝血块,无术后出血、切口感染等并发症。光学显微镜下,甲状腺切缘表面可见明显损伤区域;损伤区域部分细胞结构受损,出现凝固性坏死,部分滤泡破裂,内容物呈固体浓缩和深染;滤泡旁细胞的胞质嗜酸性增加,核固缩、碎裂,甚至核溶解。超声刀组和钳夹凝闭组兔甲状腺组织的热损伤范围分别为(0.72±0.10)、(0.88±0.11)mm;钳夹凝闭组兔甲状腺组织的热损伤范围显著大于超声刀组(t=-2.740,P<0.05)。术后第1、3、7天,钳夹凝闭组与超声刀组兔血清中CRP、IL-6水平比较差异无统计学意义(P>0.05);2组兔术后第1、3、7天血清中CRP水平比较差异无统计学意义(P>0.05);2组兔术后第3、7天血清中IL-6水平显著高于术后第1天(P<0.05);术后第3天与第7天血清中IL-6水平比较差异无统计学意义(P>0.05)。2组兔的残余甲状腺断面均可见部分甲状腺腺体滤泡萎缩,胶质减少,滤泡上皮增生,间质纤维胶原化、增生,未见明显的炎症细胞浸润。结论在兔甲状腺切除术中应用普通电刀钳夹凝闭技术离断甲状腺较为安全;在预防热损伤方面,超声刀优于普通电刀钳夹凝闭技术,但普通电刀钳夹凝闭技术导致的甲状腺组织热损伤范围在安全操作范围内。

超声刀联合双极电凝治疗甲状腺结节的效果

目的分析甲状腺结节手术中实施超声刀联合双极电凝治疗的可行性。方法选取2021年1月至12月收治的50例需要实施手术治疗的甲状腺结节患者为研究对象,依据入院编号的奇偶性将其分为对照组与观察组,各25例。两组均行常规开放式超声刀甲状腺手术,对照组术中实施丝线结扎法止血,观察组术中实施双极电凝止血。比较两组的手术指标、术后并发症发生情况、炎症指标、治疗效果以及免疫功能指标。结果观察组的手术时间、切口长度、术后住院时间及术中止血耗时短于对照组,术中失血量少于对照组(P<0.05)。观察组的并发症总发生率明显低于对照组(P<0.05)。术后1 d,观察组的白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)水平低于对照组,白细胞介素-10(IL-10)水平高于对照组(P<0.05)。两组的治疗总有效率比较,差异无统计学意义(P>0.05)。术后3 d,观察组的CD4^(+)、CD4^(+)/CD8^(+)、自然杀伤(NK)细胞高于对照组,CD8^(+)、CD4^(+)CD25^(+)低于对照组(P<0.05)。结论超声刀联合双极电凝治疗甲状腺结节可以显著降低手术损伤和术后并发症发生率,但无法提升患者的治疗总有效率。

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.