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Ligating Clips and Staples
Published in Chih-Chang Chu, J. Anthony von Fraunhofer, Howard P. Greisler, Wound Closure Biomaterials and Devices, 2018
Ligation of blood vessels for hemostasis is a venerable procedure in surgery and the development of specialized ligating clips and staples has simplified and facilitated this procedure. Often, these devices may be used in preference to the traditional filamentary sutures. Further, the continued development and modification of clips, particularly the absorbable type, has stimulated their extensive use in gynecological and urological procedures, typically tubule ligation for female sterilization. The first ligating clips were manufactured from metals, for example the Cushing silver wire neurosurgery clip and the wide variety of tantalum, stainless steel, and composite metal-plastic spring clips used in general, GU, and OB/GYN surgery. The sometimes adverse tissue reactions induced by metals and their long-term residence in the body stimulated the search for alternative, specifically absorbable thermoplastic, clip materials. Two absorbable clips and an absorbable staple and dermal pin are currently in clinical use. The Absolok clip is fabricated from poly-p-dioxanone while the Lactomer clip, staple, and pin are fabricated from a 70:30 glycolic and lactic acid copolymer. These materials are radiolucent and exhibit predictable hydrolytic decomposition, but they are subject to stress relaxation, which necessitates the incorporation of locking mechanisms in the clip design to ensure security of closure. Although these clips will elicit a typical foreign body reaction, it should be of limited severity and duration. The degradation of these clips and staples is far more rapid under in vivo conditions than in vitro, while their exposure in vivo to bacterial infection indicated formation of a progressively thickening plaque-like layer on the surface which significantly reduced the rate of in vivo clip degradation. The residence time of these absorbable devices in the body would appear to be far longer than predicted. A promising new development has been the introduction of the pelviscopic loop ligature or PLL for a variety of gynecological and general procedures. This device appears to be a convenient and economical technique for a variety of ligation procedures.
Effect of energy-based devices on post-operative parathyroid function and blood calcium levels after total thyroidectomy
Published in Expert Review of Medical Devices, 2021
Eleftherios Spartalis, Alexios Giannakodimos, Afroditi Ziogou, Ilias Giannakodimos, Stavroula A. Paschou, Michael Spartalis, Dimitrios Schizas, Theodore Troupis
An extensive research of PubMed/Medline and Scopus databases was performed and 49 retrieved articles were analyzed. Twenty-three studies evaluated the use of Ultrasonic Shears, 17 focused on the use of Electrothermal Bipolar (Radiofrequency) System and 9 referred to both Energy-Based Devices. The collected data were reported on 19,344 patients, among whom 10,221 underwent surgery with EBDs and 9,123 with conventional hemostatic techniques. In both included groups there existed a greater number of female patients compared to male patients (6,642 females versus 1,778 males in the conventional group, 7,563 females versus 1,957 males in the EBD group). However, 10 sources did not provide sufficient data regarding sex ratio. Mean ages ranged between 37 to 79 years and 34 to 73 years in the EBD and conventional groups, respectively. Concerning the EBD group, 3,105 patients were treated with the Ultrasonic Shears while 2,692 with the Electrothermal Bipolar System. The hemostasis of the remaining 4,424 patients was achieved by either the Ultrasonic Shears or the Electrothermal Bipolar System, but no further segregation was reported in the corresponding articles. Concerning the conventional techniques clamp-and-tie, electrocautery, clips, stitches, knot-tying, suture ligation and mono- or bipolar coagulation were applied to the relevant group of patients. The aim of the thyroidectomies was the treatment of various thyroid diseases. Multinodular goiters, Grave’s disease, thyroiditis, carcinomas (papillary, differentiated) and adenomas comprised the pathological entities of the included patients. Groups of patients in the included studies were comparable. Age, gender ratio and preoperative characteristics were comparable among the patients of all groups (except for the study of Saint Marc et al.)[42–58].