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Laparoscopic Appendectomy
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Option for energy sources are: Use of a bipolar (common).Use of a harmonic scalpel.Use of guarded monopolar coagulation – monopolar cautery should be used in short frequent bursts to avoid cecal injury.Use of a clip at the base after dissection.
Haemorrhoidal Disease
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Austin George Acheson, Oliver Cheong Tsen Ng
The Harmonic scalpel (Ethicon) has been used for both open and closed haemorrhoidectomy procedures (Figure 11.16). It uses high-frequency ultrasound energy to cut and coagulate tissues simultaneously by disruption of protein hydrogen bonds within the tissue. It achieves this at a relatively low temperature (80°C), minimising lateral thermal injury and, similar to the Ligasure, should result in the discrete dissection of the haemorrhoidal tissue with less risk of bleeding and post-operative pain.
Transanal endoscopic microsurgery
Published in P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams, Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
If during the dissection bleeding occurs, the bleeding point is best controlled by compression with the tip of an instrument and then coagulated with the tip of the suction device or grasped with a forceps and coagulated. Bleeding most often occurs when dissection extends too deep into the perirectal fat or mesorectum where larger vessels are encountered. Hemostatic devices like the harmonic scalpel may not only reduce the blood loss but also shorten operating time. The authors do not however use them regularly.
Beneficial impact of microwave ablation-assisted laparoscopic hepatectomy in cirrhotic hepatocellular carcinoma patients: a propensity score matching analysis
Published in International Journal of Hyperthermia, 2019
Tianqiang Jin, Xiaolin Liu, Chaoliu Dai, Changjun Jia, Songlin Peng, Yang Zhao, Chao Wang, Heyue Zhang, Feng Xu
In the MLH group, the microwave ablation probe (ECO-100AI10, ECO Microwave System Co, Nanjing, China) was inserted percutaneously through an additional tiny incision in the abdominal wall, and then consecutively inserted and spaced 2 cm apart along the marked transection line. LUS was used during probe insertion to avoid injury to the large vessels and the bile duct. Upon achieving the optimal insertion angle and depth, an emission power of 60 W for 3 min (duration) was routinely adopted to attain complete precoagulation [22]. In order to control needle tract hemorrhage and prevent seeding metastases, the microwave ablation probe was pulled out slowly with the continuation of microwave energy. To achieve a complete coagulation belt, the time required for microwave ablation was directly associated with the tumor size, demarcation line length and lesion depth [17]. For large-sized tumors (up to 5 cm), the precoagulation process was performed alternatively with liver resection, thus forming a curved resection plane to better preserve the liver parenchyma. Following precoagulation, the liver parenchyma was divided using a Harmonic scalpel (HARMONIC SYNERGY® Blades, Ethicon Inc., Cornelia, GA) (Figure 2). LH was performed as detailed previously [23]. Briefly, parenchymal separation was achieved using a Harmonic scalpel or Ethicon EndoSurgery device in the LH group. Small branches of the Glisson pedicles in the resection plane were clipped using a Hem-o-lock clip® to ensure complete homeostasis and biliostasis [17,24]. Routine abdominal drainage was used during the operation.
Subxiphoid uniportal video-assisted thoracoscopic surgery for synchronous bilateral lung resection
Published in Postgraduate Medicine, 2018
Drawbacks of the technique include the following: (1) surgical procedures of this nature are relatively difficult and some difficulty was met. Surgical procedures of this nature are relatively difficult. The operating instruments were more prone to impeding one another’s movements and operative times for this group were somewhat prolonged. With the ongoing improvements in technique and instruments, this technique will become more skilled and substantially less time will likely be required. Another important issue during subxiphoid uniportal VATS approach was the difficulty in palpating small lung lesions through the subxiphoid incision. We used a preoperative CT-guided puncture positioning method to localize small nodules and to pinpoint lesions in patients with small lung lesion; (2) with vascular injury, the distance between subxiphoid entry and hilum may be problematic for hemostasis. Although we had not encountered massive bleeding in this study, we have made detailed plans in this area. If the vascular injury is relatively easy to be control, we will add an auxiliary operating hole at the four or five intercostal space for hemostasis, converting the operation into two-port VATS procedure. The conventional thoracotomy will be applied to the case of uncontrollable massive bleeding without any hesitate; and (3) the heart may be compressed or arrhythmias encountered when passing instruments into left chest. This might be the reason that the use of electrically activated dissection hook. We believed that if electrically activated instrumentation might be avoided during these kind of procedures by using the harmonic scalpel for all dissection maneuvers this problem might be eliminated.
Clinical effectiveness and versatility of a sealing hemostatic patch (HEMOPATCH) in multiple surgical specialties
Published in Expert Review of Medical Devices, 2018
Kevin M. Lewis, Shelly Ikeme, Tolu Olubunmi, Carl Erik Kuntze
Ruggiero et al. [44] in a single-center prospective observational study investigated the hemostatic efficacy and safety of HEMOPATCH in patients undergoing total thyroidectomies performed using a harmonic scalpel. Thirty patients were enrolled to receive HEMOPATCH and 30 to receive standard hemostatic treatment (gauze, ligature, electrocauterization). Apart from the type of thyroid disease, which differed slightly, the groups had similar demographic and baseline characteristics [44].