The Experts below are selected from a list of 1380 Experts worldwide ranked by ideXlab platform
Rodrigo Gavina - One of the best experts on this subject based on the ideXlab platform.
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comparison of Ultrasonic Scalpel to electrocautery in patients undergoing endoscopic thoracic sympathectomy
The Annals of Thoracic Surgery, 2009Co-Authors: Benny Weksler, Mary Pollice, Zemilson B.b. Souza, Rodrigo GavinaAbstract:Background Sympathectomy is an effective treatment for hyperhidrosis. The Ultrasonic Scalpel and electrocautery have been used for the procedure, but the use of the Ultrasonic Scalpel has been promoted as superior to that of electrocautery. This study explored whether a reusable electrocautery probe was equally as effective and safe as the Ultrasonic Scalpel for sympathectomy. Methods We retrospectively analyzed 140 consecutive patients. The Ultrasonic Scalpel (HDH 05, Ethicon Endo-Surgery, Cincinnati, OH) was used in 70 patients (group 1) and a reusable 5-mm cautery hook (Edlo, Canoas, Brazil) was used in 70 patients (group 2). End points were improvement in symptoms (% improvement score), length of stay, return to work, and complications. Data were analyzed using two-tailed t test and the χ 2 ( p = 0.05 was significant). Data are mean ± standard deviation. Results Follow-up was 27.2 ± 8.4 months. Groups were similar in demographics, disease site, and level of sympathectomy. There was no significant difference in improvement score by site. The feet had the least improvement score (36.5% ± 32.3%), and the hands the highest improvement score (97.0% ± 11.3%). Length of stay was similar, 11.4 ± 5.9 (group 1) vs 10.1 ± 5.4 hours (group 2). Return to work in group 1 was 4.8 ± 2.7 vs 5.7 ± 3.6 days ( p = 0.09). Group 1 had 14 complications and group 2 had 7 ( p = 0.16). Conclusions We could not demonstrate a clear advantage in the use of the Ultrasonic Scalpel.
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Comparison of Ultrasonic Scalpel to electrocautery in patients undergoing endoscopic thoracic sympathectomy.
The Annals of thoracic surgery, 2009Co-Authors: Benny Weksler, Mary Pollice, Zemilson B.b. Souza, Rodrigo GavinaAbstract:Sympathectomy is an effective treatment for hyperhidrosis. The Ultrasonic Scalpel and electrocautery have been used for the procedure, but the use of the Ultrasonic Scalpel has been promoted as superior to that of electrocautery. This study explored whether a reusable electrocautery probe was equally as effective and safe as the Ultrasonic Scalpel for sympathectomy. We retrospectively analyzed 140 consecutive patients. The Ultrasonic Scalpel (HDH 05, Ethicon Endo-Surgery, Cincinnati, OH) was used in 70 patients (group 1) and a reusable 5-mm cautery hook (Edlo, Canoas, Brazil) was used in 70 patients (group 2). End points were improvement in symptoms (% improvement score), length of stay, return to work, and complications. Data were analyzed using two-tailed t test and the chi(2) (p = 0.05 was significant). Data are mean +/- standard deviation. Follow-up was 27.2 +/- 8.4 months. Groups were similar in demographics, disease site, and level of sympathectomy. There was no significant difference in improvement score by site. The feet had the least improvement score (36.5% +/- 32.3%), and the hands the highest improvement score (97.0% +/- 11.3%). Length of stay was similar, 11.4 +/- 5.9 (group 1) vs 10.1 +/- 5.4 hours (group 2). Return to work in group 1 was 4.8 +/- 2.7 vs 5.7 +/- 3.6 days (p = 0.09). Group 1 had 14 complications and group 2 had 7 (p = 0.16). We could not demonstrate a clear advantage in the use of the Ultrasonic Scalpel.
Irfan Ahmed - One of the best experts on this subject based on the ideXlab platform.
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A single-blind controlled study of electrocautery and Ultrasonic Scalpel smoke plumes in laparoscopic surgery
Surgical Endoscopy, 2012Co-Authors: J. Edward F. Fitzgerald, Momin Malik, Irfan AhmedAbstract:BackgroundSurgical smoke containing potentially carcinogenic and irritant chemicals is an inevitable consequence of intraoperative energized dissection. Different energized dissection methods have not been compared directly in human laparoscopic surgery or against commonly encountered pollutants. This study undertook an analysis of carcinogenic and irritant volatile hydrocarbon concentrations in electrocautery and Ultrasonic Scalpel plumes compared with cigarette smoke and urban city air control samples.MethodsOnce ethical approval was obtained, gas samples were aspirated from the peritoneal cavity after human laparoscopic intraabdominal surgery solely using either electrocautery or Ultrasonic Scalpels. All were adsorbed in Tenax tubes and concentrations of carcinogenic or irritant volatile hydrocarbons measured by gas chromatography. The results were compared with cigarette smoke and urban city air control samples. The analyzing laboratory was blinded to sample origin.ResultsA total of 10 patients consented to intraoperative gas sampling in which only one method of energized dissection was used. Six carcinogenic or irritant hydrocarbons (benzene, ethylbenzene, styrene, toluene, heptene, and methylpropene) were identified in one or more samples. With the exception of styrene ( P = 0.016), a nonsignificant trend toward lower hydrocarbon concentrations was observed with Ultrasonic Scalpel use. Ultrasonic Scalpel plumes had significantly lower hydrocarbon concentrations than cigarette smoke, with the exception of methylpropene ( P = 0.332 ). No significant difference was observed with city air. Electrocautery samples contained significantly lower hydrocarbon concentrations than cigarette smoke, with the exception of toluene ( P = 0.117) and methyl propene ( P = 0.914). Except for toluene ( P = 0.028), city air showed no significant difference.ConclusionsBoth electrocautery and Ultrasonic dissection are associated with significantly lower concentrations of the most commonly detected carcinogenic and irritant hydrocarbons than cigarette smoke. A nonsignificant trend toward lower hydrocarbon concentrations was seen with Ultrasonic Scalpel dissection compared with diathermy. The contamination levels in city air were largely comparable with those seen after Ultrasonic Scalpel use. Although hydrocarbon concentrations are low, cumulative exposures may increase health risks. Where concerns arise, Ultrasonic Scalpel dissection may be preferable.
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A single-blind controlled study of electrocautery and Ultrasonic Scalpel smoke plumes in laparoscopic surgery
Surgical Endoscopy, 2012Co-Authors: J. Edward F. Fitzgerald, Momin Malik, Irfan AhmedAbstract:BackgroundSurgical smoke containing potentially carcinogenic and irritant chemicals is an inevitable consequence of intraoperative energized dissection. Different energized dissection methods have not been compared directly in human laparoscopic surgery or against commonly encountered pollutants. This study undertook an analysis of carcinogenic and irritant volatile hydrocarbon concentrations in electrocautery and Ultrasonic Scalpel plumes compared with cigarette smoke and urban city air control samples.MethodsOnce ethical approval was obtained, gas samples were aspirated from the peritoneal cavity after human laparoscopic intraabdominal surgery solely using either electrocautery or Ultrasonic Scalpels. All were adsorbed in Tenax tubes and concentrations of carcinogenic or irritant volatile hydrocarbons measured by gas chromatography. The results were compared with cigarette smoke and urban city air control samples. The analyzing laboratory was blinded to sample origin.ResultsA total of 10 patients consented to intraoperative gas sampling in which only one method of energized dissection was used. Six carcinogenic or irritant hydrocarbons (benzene, ethylbenzene, styrene, toluene, heptene, and methylpropene) were identified in one or more samples. With the exception of styrene ( P = 0.016), a nonsignificant trend toward lower hydrocarbon concentrations was observed with Ultrasonic Scalpel use. Ultrasonic Scalpel plumes had significantly lower hydrocarbon concentrations than cigarette smoke, with the exception of methylpropene ( P = 0.332 ). No significant difference was observed with city air. Electrocautery samples contained significantly lower hydrocarbon concentrations than cigarette smoke, with the exception of toluene ( P = 0.117) and methyl propene ( P = 0.914). Except for toluene ( P = 0.028), city air showed no significant difference.ConclusionsBoth electrocautery and Ultrasonic dissection are associated with significantly lower concentrations of the most commonly detected carcinogenic and irritant hydrocarbons than cigarette smoke. A nonsignificant trend toward lower hydrocarbon concentrations was seen with Ultrasonic Scalpel dissection compared with diathermy. The contamination levels in city air were largely comparable with those seen after Ultrasonic Scalpel use. Although hydrocarbon concentrations are low, cumulative exposures may increase health risks. Where concerns arise, Ultrasonic Scalpel dissection may be preferable.
William W Hurd - One of the best experts on this subject based on the ideXlab platform.
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comparison of the Ultrasonic Scalpel to co2 laser and electrosurgery in terms of tissue injury and adhesion formation in a rabbit model
Fertility and Sterility, 1997Co-Authors: Mark T Schemmel, Hope K Haefner, Suzanne M Selvaggi, Jeffrey S Warren, Charles S Termin, William W HurdAbstract:Objective To determine the relative effect of an Ultrasonic Scalpel on reproductive tissue compared with CO 2 laser and electrosurgery. Design Prospective, randomized animal study. Setting University laboratory setting. Animals Sixteen New Zealand White rabbits. Intervention(s) A steel Scalpel, an Ultrasonic Scalpel, a CO 2 laser, or electrosurgery were used to perform an ovarian wedge resection and to remove the distal uterine horn. A 3-cm longitudinal incision also was made in the uterine horn. Main Outcome Measure(s) The number of 1-second bursts of needle-tip electrosurgery required for hemostasis, the depth and degree of coagulation necrosis, degree of fibrin deposition, and postoperative adhesion formation. Result(s) The amount of electrosurgery needed to achieve hemostasis was less for any of the four power techniques than for the steel Scalpel, with the exception of the Ultrasonic Scalpel at level 5 when used on the ovary. The depth (range: 0.30 to 0.38 mm) and the degree of coagulation necrosis was not different for any of the power techniques. The fibrin score was greatest for the Ultrasonic Scalpel at level 5 in both the ovarian tissue and the uterine tissue. There was no difference in adhesion scores for the power techniques and the steel Scalpel. Conclusion(s) The Ultrasonic Scalpel at level 3 is not different from either CO 2 laser or electrosurgery in terms of hemostatic properties, coagulation necrosis, or adhesion formation in the rabbit model. Fertil Steril ® 1997;67:382-6
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Comparison of the Ultrasonic Scalpel to CO2 laser and electrosurgery in terms of tissue injury and adhesion formation in a rabbit model
Fertility and sterility, 1997Co-Authors: Mark T Schemmel, Hope K Haefner, Suzanne M Selvaggi, Jeffrey S Warren, Charles S Termin, William W HurdAbstract:To determine the relative effect of an Ultrasonic Scalpel on reproductive tissue compared with CO2 laser and electrosurgery. Prospective, randomized animal study. University laboratory setting. Sixteen New Zealand White rabbits. A steel Scalpel, an Ultrasonic Scalpel, a CO2 laser, or electrosurgery were used to perform an ovarian wedge resection and to remove the distal uterine horn. A 3-cm longitudinal incision also was made in the uterine horn. The number of 1-second bursts of needle-tip electrosurgery required for hemostasis, the depth and degree of coagulation necrosis, degree of fibrin deposition, and postoperative adhesion formation. The amount of electrosurgery needed to achieve hemostasis was less for any of the four power techniques than for the steel Scalpel, with the exception of the Ultrasonic Scalpel at level 5 when used on the ovary. The depth (range: 0.30 to 0.38 mm) and the degree of coagulation necrosis was not different for any of the power techniques. The fibrin score was greatest for the Ultrasonic Scalpel at level 5 in both the ovarian tissue and the uterine tissue. There was no difference in adhesion scores for the power techniques and the steel Scalpel. The Ultrasonic Scalpel at level 3 is not different from either CO2 laser or electrosurgery in terms of hemostatic properties, coagulation necrosis, or adhesion formation in the rabbit model.
Christof Schmid - One of the best experts on this subject based on the ideXlab platform.
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skeletonization versus pedicle preparation of the radial artery with and without the Ultrasonic Scalpel
The Annals of Thoracic Surgery, 2004Co-Authors: A Rukosujew, A M Fabricius, G Drees, M Rothenburger, Andreas Hoffmeier, Hans H Scheld, Rudolf Reichelt, Tonny Djie Tiong Tjan, Christof SchmidAbstract:Abstract Background The radial artery (RA) is increasingly used for myocardial revascularization because of its presumed advantageous long-term patency rates. The vessel can be harvested as a pedicle or skeletonized. The aim of this study was to compare the skeletonization technique with pedicle preparation using either an Ultrasonic Scalpel or scissors. Methods Forty consecutive patients with coronary artery disease undergoing complete arterial revascularization were included in the study. In 20 patients the RAs were prepared using scissors and clips (group 1: skeletonization; group 2: pedicle). In another 20 patients the arteries harvested were prepared using an Ultrasonic Scalpel (group 3: skeletonization; group 4: pedicle). The RA was treated with papaverine to prevent spasm of the vessel during and after harvesting. Tissue specimens of each RA were taken to analyze endothelial morphology by scanning electron microscopy. After implantation of the RA, graft perfusion was measured with a flow probe. Results Harvesting the RA as a skeletonized vessel took more time as compared with pedicle preparation (group 1 vs group 2: 37.1 ± 3.5 minutes vs 24.4 ± 3.9 minutes; p p p p = 0.086). The length of the RA after skeletonization with scissors and clips was 20.8 ± 1.5 cm in contrast with 19.1 ± 0.9 cm ( p p = 0.062). Mean blood flow through the graft after establishing the proximal anastomosis was similar among all groups (groups 1, 2, 3, and 4: 50 ± 20.1 mL/min, 53.8 ± 24.3 mL/min, 56.3 ± 25.1 mL/min, and 51.8 ± 23 mL/min, respectively). Scanning electron microscopy demonstrated endothelial damage in all patients in groups 1, 2, and 3 and in 7 patients of group 4. Most endothelial lesions were minor except in group 3 in which 1 of 5 endothelial lesions were severe. Statistically significant differences was found between groups 1 and 2, and 3 and 4 with respect to the degree of endothelial damage ( p Conclusions Skeletonization using scissors and clips is more time consuming and technically more difficult, but yield significantly longer grafts. Skeletonization with an Ultrasonic Scalpel did not result in additional length and was more frequently associated with severe endothelial damage. Pedicle preparation using scissors or an Ultrasonic Scalpel is much simpler and faster, and does not jeopardize endothelial integrity.
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Skeletonization versus pedicle preparation of the radial artery with and without the Ultrasonic Scalpel.
The Annals of thoracic surgery, 2004Co-Authors: A Rukosujew, A M Fabricius, G Drees, M Rothenburger, Andreas Hoffmeier, Hans H Scheld, Rudolf Reichelt, Tonny Djie Tiong Tjan, Christof SchmidAbstract:The radial artery (RA) is increasingly used for myocardial revascularization because of its presumed advantageous long-term patency rates. The vessel can be harvested as a pedicle or skeletonized. The aim of this study was to compare the skeletonization technique with pedicle preparation using either an Ultrasonic Scalpel or scissors. Forty consecutive patients with coronary artery disease undergoing complete arterial revascularization were included in the study. In 20 patients the RAs were prepared using scissors and clips (group 1: skeletonization; group 2: pedicle). In another 20 patients the arteries harvested were prepared using an Ultrasonic Scalpel (group 3: skeletonization; group 4: pedicle). The RA was treated with papaverine to prevent spasm of the vessel during and after harvesting. Tissue specimens of each RA were taken to analyze endothelial morphology by scanning electron microscopy. After implantation of the RA, graft perfusion was measured with a flow probe. Harvesting the RA as a skeletonized vessel took more time as compared with pedicle preparation (group 1 vs group 2: 37.1 +/- 3.5 minutes vs 24.4 +/- 3.9 minutes; p < 0.001 and group 3 vs group 4: 31.1 +/- 3.5 minutes vs 25.6 +/- 3.7 minutes; p < 0.01). The number of hemostatic titanium clips was similarly higher in group 1 as opposed to group 2 (58.7 +/- 7.1 vs 38.7 +/- 7.1; p < 0.01). However, there was no difference between groups 3 and 4 (p = 0.086). The length of the RA after skeletonization with scissors and clips was 20.8 +/- 1.5 cm in contrast with 19.1 +/- 0.9 cm (p < 0.01) after dissection as a pedicle. In the groups using the Ultrasonic Scalpel, there was no difference in graft length (p = 0.062). Mean blood flow through the graft after establishing the proximal anastomosis was similar among all groups (groups 1, 2, 3, and 4: 50 +/- 20.1 mL/min, 53.8 +/- 24.3 mL/min, 56.3 +/- 25.1 mL/min, and 51.8 +/- 23 mL/min, respectively). Scanning electron microscopy demonstrated endothelial damage in all patients in groups 1, 2, and 3 and in 7 patients of group 4. Most endothelial lesions were minor except in group 3 in which 1 of 5 endothelial lesions were severe. Statistically significant differences was found between groups 1 and 2, and 3 and 4 with respect to the degree of endothelial damage (p < 0.01). Skeletonization using scissors and clips is more time consuming and technically more difficult, but yield significantly longer grafts. Skeletonization with an Ultrasonic Scalpel did not result in additional length and was more frequently associated with severe endothelial damage. Pedicle preparation using scissors or an Ultrasonic Scalpel is much simpler and faster, and does not jeopardize endothelial integrity.
Laura A Gallagher - One of the best experts on this subject based on the ideXlab platform.
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effects of steel Scalpel Ultrasonic Scalpel co2 laser and monopolar and bipolar electrosurgery on wound healing in guinea pig oral mucosa
Laryngoscope, 2003Co-Authors: Uttam K Sinha, Laura A GallagherAbstract:Objective The study's objective was to compare instrument performance and tissue healing when steel Scalpel, Ultrasonic Scalpel, monopolar or bipolar electrosurgical instruments, or CO2 laser was used in an animal oral surgery model. Study Design Prospective, blinded, randomized. Methods Adult guinea pigs (N = 70) were randomly assigned to 5 groups (14 animals per group) for excision of 2-cm, full-thickness oral mucosa using steel Scalpel, Ultrasonic Scalpel, monopolar or bipolar electrosurgical instruments, or CO2 laser. Postoperative pain was measured indirectly using weekly body weight changes. Animals from each group were killed on days 0, 7, 14, 21, and 28. Specimens were harvested for blinded histopathological study and tensile strength measurement. Instrument performance (hemostasis, tissue coagulation, tissue sticking) and wound healing (tissue re-epithelialization, degree of inflammation) were primary outcomes. Statistical analysis was performed using analysis of variance. Results The Ultrasonic Scalpel was the best tool in controlling hemostasis, tissue coagulation, and tissue sticking. Significantly higher body weight gain (P <.05) was noted at day 7 for monopolar and CO2 laser groups. Greatest tensile strength was seen in the steel Scalpel and Ultrasonic Scalpel groups at the end of 28 days. Tissue re-epithelialization was fastest for the steel Scalpel and Ultrasonic Scalpel groups (complete by day 7). Complete re-epithelialization of wounds of all treatment groups occurred by day 28. All groups had acute inflammation. Complete resolution of inflammation by day 14 took place in the steel Scalpel and Ultrasonic Scalpel groups only. Conclusion Use of the Ultrasonic Scalpel produced faster re-epithelialization and greater tensile strength than laser or electrosurgical instruments, with results comparable to those seen with the steel Scalpel.
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Effects of steel Scalpel, Ultrasonic Scalpel, CO2 laser, and monopolar and bipolar electrosurgery on wound healing in guinea pig oral mucosa.
The Laryngoscope, 2003Co-Authors: Uttam K Sinha, Laura A GallagherAbstract:The study's objective was to compare instrument performance and tissue healing when steel Scalpel, Ultrasonic Scalpel, monopolar or bipolar electrosurgical instruments, or CO2 laser was used in an animal oral surgery model. Prospective, blinded, randomized. Adult guinea pigs (N = 70) were randomly assigned to 5 groups (14 animals per group) for excision of 2-cm, full-thickness oral mucosa using steel Scalpel, Ultrasonic Scalpel, monopolar or bipolar electrosurgical instruments, or CO2 laser. Postoperative pain was measured indirectly using weekly body weight changes. Animals from each group were killed on days 0, 7, 14, 21, and 28. Specimens were harvested for blinded histopathological study and tensile strength measurement. Instrument performance (hemostasis, tissue coagulation, tissue sticking) and wound healing (tissue re-epithelialization, degree of inflammation) were primary outcomes. Statistical analysis was performed using analysis of variance. The Ultrasonic Scalpel was the best tool in controlling hemostasis, tissue coagulation, and tissue sticking. Significantly higher body weight gain ( P<.05) was noted at day 7 for monopolar and CO2 laser groups. Greatest tensile strength was seen in the steel Scalpel and Ultrasonic Scalpel groups at the end of 28 days. Tissue re-epithelialization was fastest for the steel Scalpel and Ultrasonic Scalpel groups (complete by day 7). Complete re-epithelialization of wounds of all treatment groups occurred by day 28. All groups had acute inflammation. Complete resolution of inflammation by day 14 took place in the steel Scalpel and Ultrasonic Scalpel groups only. Use of the Ultrasonic Scalpel produced faster re-epithelialization and greater tensile strength than laser or electrosurgical instruments, with results comparable to those seen with the steel Scalpel.
