The Experts below are selected from a list of 5532 Experts worldwide ranked by ideXlab platform
John B Flege - One of the best experts on this subject based on the ideXlab platform.
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Thoracoscopic internal mammary artery harvest for MICABG using the Harmonic Scalpel.
The Annals of thoracic surgery, 1997Co-Authors: T. Ohtsuka, R K Wolf, P Wurnig, Loren F. Hiratzka, John B FlegeAbstract:Thoracoscopic internal mammary artery (IMA) harvest is technically demanding, particularly on the left side. We have devised a Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) technique to facilitate this procedure, and describe our clinical experience here. The Harmonic Scalpel functions with ultrasonic energy, producing less smoke and lower heat than regular electrocautery. A total of 27 (22 left and 5 right) pedicles of the IMA in 23 patients were harvested from the upper margin of the first rib or higher to the lower margin of the fifth rib thoracoscopically using the Harmonic Scalpel with a hook blade. In each case, the IMA harvest was completed thoracoscopically with only the Harmonic Scalpel, decreasing instrument transfers. Each vascular branch was coagulated without charring and was transected with excellent hemostasis. Smokeless views were provided. In the first 17 harvests, Doppler studies 3 months after the procedures demonstrated patent IMAs to the coronary circulation. The Harmonic Scalpel facilitates thoracoscopic IMA harvest and is expected to minimize hyperthermic damage of the IMA.
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thoracoscopic internal mammary artery harvest for micabg using the harmonic scalpel
The Annals of Thoracic Surgery, 1997Co-Authors: T. Ohtsuka, R K Wolf, P Wurnig, Loren F. Hiratzka, John B FlegeAbstract:Background. Thoracoscopic internal mammary artery (IMA) harvest is technically demanding, particularly on the left side. We have devised a Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) technique to facilitate this procedure, and describe our clinical experience here. Methods. The Harmonic Scalpel functions with ultrasonic energy, producing less smoke and lower heat than regular electrocautery. A total of 27 (22 left and 5 right) pedicles of the IMA in 23 patients were harvested from the upper margin of the first rib or higher to the lower margin of the fifth rib thoracoscopically using the Harmonic Scalpel with a hook blade. Results. In each case, the IMA harvest was completed thoracoscopically with only the Harmonic Scalpel, decreasing instrument transfers. Each vascular branch was coagulated without charring and was transected with excellent hemostasis. Smokeless views were provided. In the first 17 harvests, Doppler studies 3 months after the procedures demonstrated patent IMAs to the coronary circulation. Conclusions. The Harmonic Scalpel facilitates thoracoscopic IMA harvest and is expected to minimize hyperthermic damage of the IMA.
U Eichfeld - One of the best experts on this subject based on the ideXlab platform.
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determination of temperature elevation in tissue during the application of the harmonic scalpel
Ultrasound in Medicine and Biology, 2003Co-Authors: Christian Koch, Thomas Friedrich, F U Metternich, Andrea Tannapfel, Hanspeter Reimann, U EichfeldAbstract:Abstract The temperature elevation in tissue during the application of the harmonic scalpel (UltraCision®, operating frequency 55 kHz; Ethicon Endo-Surgery, Norderstedt, Germany) was determined using thermocouples of a specific design. In experiments with and without perfusion, two different scalpel blades were applied to three different kinds of pig tissue (lung parenchyma, tongue, parotid gland) in various configurations. Temperature elevations by more than 40°C were found at 1 mm distance from the blade, whereas at distances of more than 5 mm, perfusion removed the heat very efficiently. The differences in the heating potential of the two blades were small and, at a distance of 2 mm, the temperature elevation did not exceed 6°C at all. In histological investigations, the damaged area between blade and parenchyma was determined. No morphologic indications of thermal damage were found at a distance of more than 2 mm. It is concluded that, during application of the harmonic scalpel, a safety margin of 3 mm from sensitive structures should be kept. (E-mail: christian.koch@ptb.de)
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determination of temperature elevation in tissue during the application of the harmonic scalpel
Ultrasound in Medicine and Biology, 2003Co-Authors: Christian Koch, Thomas Friedrich, F U Metternich, Andrea Tannapfel, Hanspeter Reimann, U EichfeldAbstract:The temperature elevation in tissue during the application of the harmonic scalpel (UltraCision, operating frequency 55 kHz; Ethicon Endo-Surgery, Norderstedt, Germany) was determined using thermocouples of a specific design. In experiments with and without perfusion, two different scalpel blades were applied to three different kinds of pig tissue (lung parenchyma, tongue, parotid gland) in various configurations. Temperature elevations by more than 40 degrees C were found at 1 mm distance from the blade, whereas at distances of more than 5 mm, perfusion removed the heat very efficiently. The differences in the heating potential of the two blades were small and, at a distance of 2 mm, the temperature elevation did not exceed 6 degrees C at all. In histological investigations, the damaged area between blade and parenchyma was determined. No morphologic indications of thermal damage were found at a distance of more than 2 mm. It is concluded that, during application of the harmonic scalpel, a safety margin of 3 mm from sensitive structures should be kept.
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Evaluation of ultracision in lung metastatic Surgery.
The Annals of thoracic surgery, 2000Co-Authors: U Eichfeld, Andrea Tannapfel, Matthias Steinert, Thomas FriedrichAbstract:Abstract Background . There are very few studies on the histological outcome of lung metastatic Surgery using the Ultracision particularly in deeper areas of the lung. Methods . In a prospective study, we resected 24 lung metastases from 18 patients using the Ultrasonic scalpel (Ethicon Endo-Surgery, Norderstedt, Germany). We analyzed the risk of bleeding and air leakage as well as the histopathological features of the resection area. Results . There was no intraoperative bleeding and, in 72%, no intraoperative air leakage. The resection surface was closed with a suture. In 8 cases, the metastases were located deeply, near the hilus of the lobe which did not necessitate a lobectomy. Histologically, occluded blood vessels as well as occluded small bronchioli under 0.1 cm were observed. There was no evidence of deep tissue destruction. No postoperative complications occurred. Conclusions . Ultracision in metastatic lung Surgery is an appropriate method of treatment with minimum risk of bleeding or air leakage. This procedural approach allows for adequate resection of lung metastases while sparing a generous amount of healthy lung tissue.
Lea Rath-wolfson - One of the best experts on this subject based on the ideXlab platform.
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Perineal stapled prolapse resection (PSPR) in elderly patients for external rectal prolapse: early experience
Techniques in Coloproctology, 2014Co-Authors: Haim Krissi, Andrew P. Zbar, Eli Atar, S. Joubran, Lea Rath-wolfsonAbstract:Background Full-thickness rectal prolapse in frail elderly patients is often treated by a perineal approach with considerable attendant morbidity. We report our preliminary results of the perineal stapled prolapse resection (PSPR) technique for resection of full-thickness external rectal prolapse using a new reloadable Contour^® Transtar™ stapler (Ethicon Endo-Surgery) device. Methods Fourteen elderly high-risk patients with an external prolapse up to 10 cm in length were treated between April 2010 and October 2011, and operative factors, outcome and recurrence rates were assessed. Results There were no intraoperative difficulties and no perioperative morbidity. The median operating time was 35 min (range 25–45 min) with a median hospital stay of 3 days (range 3–5 days). Four patients developed early recurrence over a median follow-up of 32 months (range 25–41 months). Conclusions PSPR is safer, faster and easier to perform than other conventional perineal prolapse procedures and is suitable for elderly, high-risk patients for whom an abdominal approach under general anesthesia is not advisable.
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Perineal stapled prolapse resection (PSPR) in elderly patients for external rectal prolapse: early experience.
Techniques in coloproctology, 2014Co-Authors: Edward Ram, Haim Krissi, Andrew P. Zbar, Eli Atar, S. Joubran, Lea Rath-wolfsonAbstract:Full-thickness rectal prolapse in frail elderly patients is often treated by a perineal approach with considerable attendant morbidity. We report our preliminary results of the perineal stapled prolapse resection (PSPR) technique for resection of full-thickness external rectal prolapse using a new reloadable Contour® Transtar™ stapler (Ethicon Endo-Surgery) device. Fourteen elderly high-risk patients with an external prolapse up to 10 cm in length were treated between April 2010 and October 2011, and operative factors, outcome and recurrence rates were assessed. There were no intraoperative difficulties and no perioperative morbidity. The median operating time was 35 min (range 25–45 min) with a median hospital stay of 3 days (range 3–5 days). Four patients developed early recurrence over a median follow-up of 32 months (range 25–41 months). PSPR is safer, faster and easier to perform than other conventional perineal prolapse procedures and is suitable for elderly, high-risk patients for whom an abdominal approach under general anesthesia is not advisable.
Toshiya Ohtsuka - One of the best experts on this subject based on the ideXlab platform.
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Videoscopic supradiaphragmatic thoracic duct division using ultrasonic coagulator
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2002Co-Authors: Toshiya Ohtsuka, Makoto Tanaka, Jun Nakajima, Shinichi TakamotoAbstract:Three consecutive male patients underwent videoscopic supradiaphragmatic thoracic duct division using the Harmonic Scalpel with a hook blade (Ethicon Endo-Surgery, Cincinnati, OH, USA) for treatment of chyle leaks that developed after left upper lobectomy, graft replacement of a descending aortic aneurysm and thyroidectomy with concomitant partial sternal resection. The thoracic duct was exposed and divided using just the Harmonic Scalpel. The operations lasted 40, 20 and 18 min. No mortality, morbidity or recurrence occurred during follow-up periods of 27, 17 and 9 months. The Harmonic Scalpel with a hook blade can facilitate supradiaphragmatic exposure of the thoracic duct.
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Ultrasonic coagulator for video-assisted internal mammary artery harvest
Surgical endoscopy, 2000Co-Authors: Toshiya Ohtsuka, Shinichi Takamoto, Munemoto Endoh, Yutaka Kotsuka, Teruaki OkaAbstract:Background The Harmonic Scalpel (HS; Ethicon Endo-Surgery, Cincinnati, OH, USA) is an ultrasonic coagulator that generates less heat than electrocautery. We compared canine internal mammary arteries (IMAs) harvested using the HS or electrocautery and reviewed the early clinical outcome after thoracoscopic IMA takedown with the HS.
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Thoracoscopic Limited Pericardial Resection With an Ultrasonic Scalpel
The Annals of Thoracic Surgery, 1998Co-Authors: Toshiya Ohtsuka, P Wurnig, Randall K. Wolf, Steven E ParkAbstract:We employed an ultrasonic scalpel, the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH), for thoracoscopic limited pericardial resection in consecutive 10 patients with massive pericardial effusion or pericarditis. The mean operative time was 27 minutes for pericardial effusion. No dangerous arrhythmias were induced even in the patient with dense pericardial adhesions. There were no operation-related complications or deaths. The thoracoscopic ultrasonic scalpel technique can be an efficacious minimally invasive alternative for pericardial window.
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Video-assisted MICABG for the patient with right mammary carcinoma--a case report
The Japanese journal of thoracic and cardiovascular surgery : official publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka, 1998Co-Authors: Munemoto Endoh, Toshiya Ohtsuka, Yutaka Kotsuka, Shinichi TakamotoAbstract:A 69-year-old female with advanced right mammary carcinoma presented to us with diffuse stenosis of the proxymal left anterior descending artery (LAD). Right mastectomy had been suspended. The LAD was treated with minimally invasive CABG (MICABG) assisted with a thoracoscopic procedure. The left internal thoracic artery (LITA) was taken down through thoracoscopy from the upper margin of the 1st rib to the lower margin of the 5th rib using only the Harmonic Scalpel (Ethicon Endo-Surgery). Coronary anastomosis to the LAD was completed without cardiopulmonary bypass through a small thoracotomy on the anterior 4th intercostal space. The operation time was 4h 30 min and the blood loss was 120 ml. Post operative course was uneventful. Doppler study and angiography demonstrated patent LITA to the LAD. Right mastectomy was achieved 29 days after MICABG. MICABG can be a veneficial alternative method for the patient with malignant disease, allowing quick convalescence and early cancer operation. Thoracoscopy allows for sufficient LITA harvest up to the 1st rib or higher with the Harmonic Scalpel.
P Wurnig - One of the best experts on this subject based on the ideXlab platform.
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Thoracoscopic Limited Pericardial Resection With an Ultrasonic Scalpel
The Annals of Thoracic Surgery, 1998Co-Authors: Toshiya Ohtsuka, P Wurnig, Randall K. Wolf, Steven E ParkAbstract:We employed an ultrasonic scalpel, the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH), for thoracoscopic limited pericardial resection in consecutive 10 patients with massive pericardial effusion or pericarditis. The mean operative time was 27 minutes for pericardial effusion. No dangerous arrhythmias were induced even in the patient with dense pericardial adhesions. There were no operation-related complications or deaths. The thoracoscopic ultrasonic scalpel technique can be an efficacious minimally invasive alternative for pericardial window.
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Thoracoscopic internal mammary artery harvest for MICABG using the Harmonic Scalpel.
The Annals of thoracic surgery, 1997Co-Authors: T. Ohtsuka, R K Wolf, P Wurnig, Loren F. Hiratzka, John B FlegeAbstract:Thoracoscopic internal mammary artery (IMA) harvest is technically demanding, particularly on the left side. We have devised a Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) technique to facilitate this procedure, and describe our clinical experience here. The Harmonic Scalpel functions with ultrasonic energy, producing less smoke and lower heat than regular electrocautery. A total of 27 (22 left and 5 right) pedicles of the IMA in 23 patients were harvested from the upper margin of the first rib or higher to the lower margin of the fifth rib thoracoscopically using the Harmonic Scalpel with a hook blade. In each case, the IMA harvest was completed thoracoscopically with only the Harmonic Scalpel, decreasing instrument transfers. Each vascular branch was coagulated without charring and was transected with excellent hemostasis. Smokeless views were provided. In the first 17 harvests, Doppler studies 3 months after the procedures demonstrated patent IMAs to the coronary circulation. The Harmonic Scalpel facilitates thoracoscopic IMA harvest and is expected to minimize hyperthermic damage of the IMA.
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thoracoscopic internal mammary artery harvest for micabg using the harmonic scalpel
The Annals of Thoracic Surgery, 1997Co-Authors: T. Ohtsuka, R K Wolf, P Wurnig, Loren F. Hiratzka, John B FlegeAbstract:Background. Thoracoscopic internal mammary artery (IMA) harvest is technically demanding, particularly on the left side. We have devised a Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) technique to facilitate this procedure, and describe our clinical experience here. Methods. The Harmonic Scalpel functions with ultrasonic energy, producing less smoke and lower heat than regular electrocautery. A total of 27 (22 left and 5 right) pedicles of the IMA in 23 patients were harvested from the upper margin of the first rib or higher to the lower margin of the fifth rib thoracoscopically using the Harmonic Scalpel with a hook blade. Results. In each case, the IMA harvest was completed thoracoscopically with only the Harmonic Scalpel, decreasing instrument transfers. Each vascular branch was coagulated without charring and was transected with excellent hemostasis. Smokeless views were provided. In the first 17 harvests, Doppler studies 3 months after the procedures demonstrated patent IMAs to the coronary circulation. Conclusions. The Harmonic Scalpel facilitates thoracoscopic IMA harvest and is expected to minimize hyperthermic damage of the IMA.