Use of an ultrasonically activated scalpel for splenectomy in 10 dogs with naturally occurring splenic disease.
ABSTRACT To evaluate the safety and efficacy of an ultrasonically activated scalpel for performing splenectomy, with minimal ligation, in dogs.
Prospective clinical study.
Dogs (10) with naturally occurring splenic disease.
Between October 2003 and February 2004, splenectomy was performed using an ultrasonically activated scalpel and a double seal method, in 10 dogs with naturally occurring splenic disease. Time for splenectomy and number of ligatures required were recorded. Intraoperative hemostasis, device ease of use, postoperative hemorrhage, and short-term survival were evaluated.
Mean operative time for splenectomy, exclusive of celiotomy and closure, was 18 minutes (range, 8-25 minutes). The mean number of ligatures needed to perform splenectomy was 1 (range, 0-2 ligatures). One dog hemorrhaged from the splenic vein after ultrasonic scalpel transection of a vessel >5-mm diameter and required a ligature. The ultrasonic scalpel was easy to use, with a minimal learning curve. None of the dogs had postoperative abdominal hemorrhage; 9 dogs were discharged and 1 dog was euthanatized because of septicemia.
Ultrasonic activated scalpel may be used to achieve efficient and safe hemostasis of the splenic vascular pedicle in dogs with minimal need for vascular ligation.
Ultrasonic scalpels can be used to perform splenectomy in dogs with naturally occurring splenic disease.
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ABSTRACT: An ultrasonically activated scalpel was developed and used clinically to provide hemostatic cutting in laparoscopic surgery. Results of experimental work with the ultrasonic scalpel blades were compared with those of electrosurgery and lasers. Some features that distinguish this energy form may confer specific advantages in various surgical procedures.The Journal of the American Association of Gynecologic Laparoscopists 09/1996; 3(4):601-8.
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ABSTRACT: The objective of this study was to histologically clarify the difference of vascular wall damage when an ultrasonic scalpel is used in varied ways in the vicinity of a vessel. 1) The surface of sodium carbonate-containing jelly was manually brushed with the edge of a dissecting hook type Harmonic Scalpel (HS), and the thickness of the air bubble layer was measured to investigate the range to which the vibrations of the instrument reached. 2) The internal thoracic artery (ITA), radial artery (RA) and vein skeletonized were cut bluntly or brushed using HS ex vivo, and tissue damages were observed histologically. 3) The depth of thermal degeneration (TD) of residual stumps of ITAs skeletonized by HS using an output power level (level) of 2 and the quick touch method at the time of coronary arterial bypass grafting (CABG) were investigated histologically. 1) The mean thickness of the air bubble layers by single brushing was 3.7, 3.7 and 3.1 mm at level 4, 3 and 2, and no significant difference. When brushed 5 times, it was 6.9, 5.5 and 6.7 mm, respectively, showing marked increases compared with single brushing. 2) A: One side of the RA stump cut with a dissecting hook at level 2 was nicely occluded by a degenerated protein coagulum, but the contralateral had no coagulum. An ITA cut by a shear type blade at level 3 showed that both stumps were nicely occluded, but the vessel wall was introverted and fragmented. B: ITAs brushed 5 or 10 times at level 2 showed that TD occurred in tunica externa, the mean depth of 100 or 203 microm, and never exceeded the external elastic lamella. RAs brushed 10 times at level 2 and 3 showed that TD and air bubble generation occurred in the tunica externa, and the mean depth was 203 and 203 microm. However, TD exceeded the external lamella in some cases at level 3. Veins brushed 10 times at level 3 showed that TD spread to all layers. 3) The depth of TD in ITAs skeletonized clinically by HS was 400 to 530 microm, and apart from the external elastic lamella. 1) Though the air bubble layer was very thick in jelly, it was observed only in tunica externa ex vivo. 2) For coagulation and cut of small blood vessels, it is vital to press an HS blade edge onto the vessel so as to press equally both portions to be cut. There is a possibility of a fragmented and introverted vessel wall into the lumen. 3) By dissecting ITA and RA using HS at level 2 and the quick touch method, TD can be limited to the depth of the connective tissue of tunica externa.Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 11/2002; 8(5):291-7. · 0.47 Impact Factor
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ABSTRACT: Laparoscopic partial nephrectomy (LPN) remains a technically challenging procedure largely because of the lack of methods for obtaining consistent parenchymal hemostasis. The objective of this study was to determine if the extent of resection influences the ability of the harmonic scalpel to achieve hemostasis and to define the cases in which the harmonic scalpel is appropriate for LPN. Thirty LPNs were performed in a 25-kg domestic pig model. The blunt blade of the laparoscopic harmonic scalpel (LaparoSonic Coagulating Shears; Ethicon Endo-Surgery, Cincinnati, OH) at power level 5 was used to divide the parenchyma. Control of the renal hilar vessels was not obtained. Three standardized types of resections were performed: I = peripheral wedge biopsy; II = upper- or lower-pole nephrectomy; and III = heminephrectomy. Bleeding was graded on a scale from 0 to 4: 0 = no hemostasis; 1 = steady bleeding; 2 = moderate bleeding; 3 = parenchymal oozing; and 4 = dry. Hemostasis grades of 2 or less were clinically significant bleeding necessitating supplemental coagulation. The mean hemostasis scores showed a significant (P < 0.02) trend toward inadequate hemostasis with increasing extent of resection: 3.3 for Type I, 3.0 for Type II, and 2.4 for Type III. The percent of kidneys with grade 2 bleeding or worse was 9% for Type I surgery, 25% for Type II, and 57% for Type III. Successful hemostasis with the harmonic scalpel correlates with the extent of parenchymal resection in the porcine model. Most wedge excisions can be done with the harmonic scalpel alone, whereas larger resections necessitate supplemental coagulation. On the basis of this study, heminephrectomies with the harmonic scalpel are not recommended because of the high incidence of significant hemorrhage.Journal of Endourology 11/1998; 12(5):441-4. · 2.07 Impact Factor