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Andreas Manouras - One of the best experts on this subject based on the ideXlab platform.
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novel hemostatic devices in thyroid surgery electrothermal bipolar Vessel Sealing System and harmonic scalpel
Expert Review of Medical Devices, 2008Co-Authors: Andreas Manouras, Emmanuel Lagoudianakis, Haridimos Markogiannakis, Panagiotis Kekis, Bill FlemingAbstract:Accurate and efficient hemostasis is one of the first priorities of the thyroid surgeon to prevent or minimize complications, including injury to the laryngeal nerves or parathyroid glands, perioperative hemorrhage and the potentially life-threatening hematoma. Means to prevent and control intra- or postoperative bleeding therefore remain a topic of utmost importance. Although thyroidectomy is one of the most common surgical procedures, the safest, most efficient and cost-effective way to achieve hemostasis is debated by endocrine surgeons and otorhinolaryngologists. In our opinion, there is no substitute for meticulous surgical technique and hemostasis, while experience in such operations is essential for the best outcome with the fewest complications. Ties, suture-ligations, monopolar/bipolar diathermy, clips, and hemostatic agents/sealants or tissue adhesives have been used. Over the last 10 years, innovative hemostatic devices, such as the electrothermal bipolar Vessel Sealing System and ultrasonicall...
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novel hemostatic devices in thyroid surgery electrothermal bipolar Vessel Sealing System and harmonic scalpel
Expert Review of Medical Devices, 2008Co-Authors: Andreas Manouras, Emmanuel Lagoudianakis, Haridimos Markogiannakis, Panagiotis Kekis, Bill FlemingAbstract:Accurate and efficient hemostasis is one of the first priorities of the thyroid surgeon to prevent or minimize complications, including injury to the laryngeal nerves or parathyroid glands, perioperative hemorrhage and the potentially life-threatening hematoma. Means to prevent and control intra- or postoperative bleeding therefore remain a topic of utmost importance. Although thyroidectomy is one of the most common surgical procedures, the safest, most efficient and cost-effective way to achieve hemostasis is debated by endocrine surgeons and otorhinolaryngologists. In our opinion, there is no substitute for meticulous surgical technique and hemostasis, while experience in such operations is essential for the best outcome with the fewest complications. Ties, suture-ligations, monopolar/bipolar diathermy, clips, and hemostatic agents/sealants or tissue adhesives have been used. Over the last 10 years, innovative hemostatic devices, such as the electrothermal bipolar Vessel Sealing System and ultrasonically activated shears, have been developed and have been welcome adjuncts to the thyroid surgeon's armamentarium. In this review we aim to cover both novel and well-established traditional techniques of hemostasis in thyroid surgery, with specific focus on the bipolar Vessel sealer and harmonic scalpel.
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modified radical mastectomy with axillary dissection using the electrothermal bipolar Vessel Sealing System
Archives of Surgery, 2008Co-Authors: Andreas Manouras, Emmanuel Lagoudianakis, George M Filippakis, Haridimos Markogiannakis, Michael Genetzakis, Georgia Kafiri, Konstantinos Filis, George C ZografosAbstract:Hypothesis The use of the electrothermal bipolar Vessel Sealing System is feasible, safe, and effective in modified radical mastectomy with axillary dissection in terms of lymph Vessel Sealing, hemostasis, and perioperative complications. Design Prospective study. Setting University surgical department. Patients Between January 1, 2003, and December 31, 2003, 60 patients with locally advanced breast cancer (T2 or T3) admitted for modified radical mastectomy with axillary dissection were included in this study. The entire procedure was performed by the same surgical team using the electrothermal bipolar Vessel Sealing System. Main Outcome Measures Final outcome, operative time, hospitalization stay duration, intraoperative blood loss, postoperative mastectomy and axillary drainage volume and duration, and postoperative complications (seroma, bleeding, skin burn, hematoma, lymphedema, pneumothorax, and wound infection or necrosis). Results The mean (SD) intraoperative blood loss was 45 (12) mL, and the mean (SD) operative time was 105 (7) minutes. No postoperative bleeding, seroma, hematoma, lymphedema, or other complications occurred. The mean (SD) mastectomy and axillary drainage volumes were 20 (8) and 155 (35) mL, respectively, and the mean (SD) drainage durations were 1.3 (0.2) and 2.7 (0.5) days, respectively. The mean (SD) hospital stay was 3.7 (0.6) days. Conclusions In this first report (to our knowledge) of modified radical mastectomy with axillary dissection using the electrothermal bipolar Vessel Sealing System, the technique was feasible, safe, and effective. The device simplified the surgical procedure, while achieving efficient lymph Vessel Sealing and hemostasis. Compared with historical data regarding the conventional or harmonic scalpel, this technique seems to result in reduced operative time, perioperative blood loss, drainage volume and duration, and incidence of seroma or lymphedema. Prospective randomized controlled studies are necessary to evaluate the effect of this technique on perioperative complications.
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thyroid surgery comparison between the electrothermal bipolar Vessel Sealing System harmonic scalpel and classic suture ligation
American Journal of Surgery, 2008Co-Authors: Andreas Manouras, Emmanuel Lagoudianakis, Pantelis T Antonakis, Haridimos Markogiannakis, Panagiotis Kekis, Michael Genetzakis, Athanasios S Koutras, Panagiotis G Drimousis, Konstantinos Koutsoumanis, Ioannis BramisAbstract:Abstract Background This study was conducted to compare the outcome of total thyroidectomy using the electrothermal bipolar Vessel Sealing System, the harmonic scalpel, and the classic suture ligation technique. Methods This was a retrospective study of prospectively collected data from 382 consecutive total thyroidectomies from September 2004 to August 2006. Patients were divided into 3 groups: group SL patients (n = 90) underwent total thyroidectomy with the classic suture ligation technique, group L (n = 148) with the electrothermal bipolar Vessel sealer, and group U (n = 144) with the harmonic scalpel. The main outcomes measured were surgical and hospitalization time, intraoperative and postoperative bleeding, postoperative hypocalcemia, and superior and inferior laryngeal nerves injuries. Results The 3 groups were similar in terms of demographics, thyroid gland weight and pathology, perioperative complications, and hospital stay. Compared with the classic technique, surgical time was reduced significantly by about 20% when the bipolar Vessel sealer or harmonic scalpel was used (93.3 ± 12.5 vs 74.3 ± 14.2 and 73.8 ± 13.8 min, P = .001, and P = .001, respectively). Conclusions Both the bipolar Vessel sealer and harmonic scalpel are safe, useful, and time-saving alternatives to the traditional suture ligation technique for thyroid surgery. Because no differences were observed regarding these 2 devices, the choice should be made based on the surgeon’s preferences and experience.
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sutureless open low anterior resection with total mesorectal excision for rectal cancer with the use of the electrothermal bipolar Vessel Sealing System
Medical Science Monitor, 2007Co-Authors: Andreas Manouras, Emmanuel Lagoudianakis, George M Filippakis, Haridimos Markogiannakis, Michael Genetzakis, Georgia Kafiri, D Tsekouras, Nikolaos Pararas, Dimitrios Papanikolaou, Konstantinos ToutouzasAbstract:BACKGROUND: There is no report of electrothermal bipolar Vessel sealer utilization in rectal surgery. The objective here was to evaluate the results of the use of this device in open low anterior resection for rectal cancer regarding reduction of operative time, hemostasis, and postoperative complications compared with the conventional technique. An additional aim was to describe and standardize this operative technique. MATERIAL/METHODS: All open low anterior resections with total mesorectal excision for rectal cancer performed by the same surgical team from January 2003 to December 2003 were reviewed. Patients were divided in two groups: those operated with the classic technique (group A) and those with a bipolar Vessel sealer (group B). Main outcomes measured were operative and hospitalization time, intraoperative blood loss, postoperative drainage volume and duration, postoperative complications, perioperative blood transfusions, and final outcome. RESULTS: Forty-one patients were included (group A: 19, group B: 22). The groups were similar in demographics, TNM classification, number of lymph nodes dissected, complications, blood transfusions, hospital stay, and outcome. Comparing group B with group A, operative time (171+/-10 vs. 203+/-20 min, p=0.002), intraoperative blood loss (20+/-6 vs. 60+/-4 ml, p=0.04), drainage volume (70+/-8 vs. 120+/-10 ml, p=0.001), and drainage duration (1.7+/-0.3 vs. 2.6+/-0.2 days, p=0.01) were significantly reduced. CONCLUSIONS: The bipolar Vessel sealer is a safe and effective adjunct for low anterior resection. The device simplifies the procedure while achieving efficient hemostasis and results in reduced operative time, intraoperative blood loss, and drainage volume and duration.
C Conessa - One of the best experts on this subject based on the ideXlab platform.
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comparison of ligasure Vessel Sealing System harmonic scalpel and conventional hemostasis in total thyroidectomy
Otolaryngology-Head and Neck Surgery, 2009Co-Authors: Y Pons, Jerome Gauthier, Elsa Ukkolapons, Philippe Clement, Eric Roguet, Jeanluc Poncet, C ConessaAbstract:OBJECTIVE: The aim of the study was to compare the efficiency, safety, and cost of the different methods of hemostasis (conventional hemostasis versus LigaSure Vessel Sealing System [LVSS] versus h...
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comparison of ligasure Vessel Sealing System harmonic scalpel and conventional hemostasis in total thyroidectomy
Otolaryngology-Head and Neck Surgery, 2009Co-Authors: Y Pons, Jerome Gauthier, Elsa Ukkolapons, Philippe Clement, Eric Roguet, J L Poncet, C ConessaAbstract:OBJECTIVE: The aim of the study was to compare the efficiency, safety, and cost of the different methods of hemostasis (conventional hemostasis versus LigaSure Vessel Sealing System [LVSS] versus harmonic scalpel) currently available for thyroid surgery. STUDY DESIGN: Randomized, controlled trial. SETTING: The study was conducted from September 2007 to December 2008 in a university hospital. PATIENTS AND METHODS: Sixty patients (48 females and 12 males) underwent a total thyroidectomy for multinodular goiter. They were randomly assigned into three groups: group one (n = 20), conventional hemostasis; group two (n = 20), LigaSure; and group three (n = 20), harmonic scalpel. RESULTS: For group three, the mean operative time was 37 minutes shorter than group one (P < 0.001) and eight minutes shorter than group two (P = 0.04). The complications rate was similar among the three groups. The mean postoperative paracetamol consummation in group one was 1.4 g greater than in group two (P = 0.016) and 1.3 g greater than in group three (P = 0.02). The overall average operative cost was 11 and 85 dollars cheaper for groups two and three than for group one, respectively (P < 0.001). CONCLUSION: Total thyroidectomy using the harmonic scalpel was the fastest procedure because it was bloodless, and hemostasis and sectioning were controlled with a single instrument; it was, therefore, the most inexpensive procedure because of the reduction of operative time and staff cost. The operative safety was similar for all three procedures. In our series, the harmonic scalpel and the LVSS caused less pain than the conventional hemostasis.
Vassilios A Lachanas - One of the best experts on this subject based on the ideXlab platform.
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the use of the ligasure Vessel Sealing System in head and neck surgery a report on six years of experience and a review of the literature
B-ent, 2010Co-Authors: Emmanuel P Prokopakis, Vassilios A Lachanas, Alexios Vardouniotis, George A VelegrakisAbstract:The use of the Ligasure™ Vessel Sealing System in head and neck surgery: a report on six years of experience and a review of the literature. Background: The Ligasure Vessel Sealing System (LVSS) is a bipolar electrosurgical device with integrated active feedback control, Sealing Vessels up to 7 mm in diameter. It facilitates surgery by achieving the efficient haemostasis of blood Vessels encountered during dissection, and allowing the rapid and secure division of vascularised tissues, while minimising thermal injury to adjacent tissues. Objective: To report on our experience and review studies relating to the use of LVSS in Otolaryngology-Head and Neck Surgery. Type of review: Retrospective series. Search strategy and evaluation method: LVSS has been widely used in our department since 2002. All patient records relating to the use of LVSS were reviewed, and compared to surgical procedures done by our team without the use of LVSS, with special regard to operation time and post-operative complications. Furthermore, a Medline search and thorough review was conducted for all pertinent articles on LVSS in Otolaryngology-Head and Neck Surgery, and those articles were reviewed. Results: In our department, LVSS is used for thyroidectomy, laryngectomy, neck dissection, parotidectomy, tonsillectomy procedures, congenital cysts, thryroglossal cysts, and excisions of submandibular gland and parapharyngeal space tumours. LVSS provided sufficient haemostasis, operating time was shorter, and post-operative complications did not differ compared to similar surgical procedures performed without the LVSS. The Medline search revealed 16 studies published by other colleagues regarding the use of LVSS in Otolaryngology Head and Neck Surgery procedures (15 studies in thyroid and 1 study in parotid surgery). The results published were similar to ours. Conclusions: The use of LVSS in Otolaryngology-Head and Neck Surgery may have several advantages over standard methods. It is a reliable and safe device, providing sufficient haemostasis and reducing operating time.
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comparison of ligasure Vessel Sealing System harmonic scalpel and cold knife tonsillectomy
Otolaryngology-Head and Neck Surgery, 2007Co-Authors: Vassilios A Lachanas, John K Hajiioannou, George T Karatzias, Dimitrios Filios, Stylianos Koutsias, Charalambos MourgelasAbstract:OBJECTIVE: We sought to compare LigaSure Vessel Sealing System tonsillectomy (LT), Harmonic Scalpel tonsillectomy (HST), and cold knife tonsillectomy (CKT).STUDY DESIGN: We conducted a prospective ...
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comparison of ligasure Vessel Sealing System harmonic scalpel and cold knife tonsillectomy
Otolaryngology-Head and Neck Surgery, 2007Co-Authors: Vassilios A Lachanas, John K Hajiioannou, George T Karatzias, Dimitrios Filios, Stylianos Koutsias, Charalambos MourgelasAbstract:OBJECTIVE: We sought to compare LigaSure Vessel Sealing System tonsillectomy (LT), Harmonic Scalpel tonsillectomy (HST), and cold knife tonsillectomy (CKT). STUDY DESIGN: We conducted a prospective study on 161 adult patients undergoing tonsillectomy. Subjects were randomized to LT, HST, or CKT groups, and intraoperative bleeding, operative time, postoperative pain, and complication rates were assessed. RESULTS: The LT, HST, and CKT groups consisted of 50, 43, and 37 individuals, respectively. Intraoperative bleeding was significantly lower in the LT group, whereas bleeding in the HST group was significantly lower than that in the CKT group. Operative time and postoperative pain were significantly lower in the LT and HST groups. One primary hemorrhage occurred in the HST group, and one occurred in he CKT group. Secondary hemorrhage occurred in one, two, and one patients in the LT, HST, and CKT groups, respectively. CONCLUSION: LT and HST have shown comparable results regarding intraoperative blood loss, postoperative hemorrhage, and pain. Compared with CKT, both were associated with less intraoperative blood loss and pain.
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the use of the ligasure Vessel Sealing System in parotid gland surgery
Otolaryngology-Head and Neck Surgery, 2005Co-Authors: Emmanuel P Prokopakis, Vassilios A Lachanas, Emmanuel S Helidonis, George A VelegrakisAbstract:Objective To evaluate the role of the Ligasure™ Vessel Sealing System (LVSS; Valleylab, Boulder, CO) in parotid surgery. Study design A prospective study was conducted on 12 consecutive patients undergoing superficial parotidectomy, performed by using the LVSS device as the primary means of ligation. Inclusion criteria included parotid mass with no preoperative suspicion of malignancy, and no extension to the deep lobe of the parotid gland. Efficacy of hemostasis, cut-closure time, and postoperative complications were assessed. Results were compared with a historical control group, including cases on which the LVSS was not available. Results LVSS proved effective in providing ligation and hemostasis. There was a mean time gain of 52 minutes, compared with our historical control group. No postoperative bleeding, seroma, salivary fistula, or Frey syndrome were observed. One case of transient facial weakness occurred, which was completely resolved within 6 months. Conclusion LVSS is a safe device for parotid gland surgery, providing sufficient hemostasis and reducing operative time. EBM rating B-2.
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tonsillectomy using the ligasure Vessel Sealing System a preliminary report
International Journal of Pediatric Otorhinolaryngology, 2005Co-Authors: Emmanuel P Prokopakis, Vassilios A Lachanas, Antonios A Benakis, Emmanuel S Helidonis, George A VelegrakisAbstract:Summary Objective: To evaluate and introduce a new method of tonsillectomy with the use of Ligasure™ Vessel Sealing System (LVSS) in pediatric population. Method: A prospective study was conducted on children undergoing tonsillectomy with the use of LVSS. Indications included chronic tonsillitis, peritonsilar abscess history, and obstructive sleep apnea syndrome. Patients undergoing adenoidectomy, or any procedure together with tonsillectomy, and patients with bleeding disorders were excluded. Among the available headpieces, the ‘Precise’ instrument was used, both as haemostatic and dissection tool. Intraoperative bleeding, operative time, and complication rates, were evaluated. Results: Our series consisted of 83 children among 103 patients undergone LVSS tonsillectomy. There was no measurable bleeding during surgery in any of the cases. In 18 children limited peritonsilar edema was noticed. No postoperative hemorrhage or other complication occurred. Mean operative time was 16 min. Conclusions: LVSS was found quite effective and safe, providing sufficient haemostasis, minimal intraoperative blood loss, and safety against the variant Creutzfeld–Jakob disease transmission.
Panagiotis Kekis - One of the best experts on this subject based on the ideXlab platform.
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novel hemostatic devices in thyroid surgery electrothermal bipolar Vessel Sealing System and harmonic scalpel
Expert Review of Medical Devices, 2008Co-Authors: Andreas Manouras, Emmanuel Lagoudianakis, Haridimos Markogiannakis, Panagiotis Kekis, Bill FlemingAbstract:Accurate and efficient hemostasis is one of the first priorities of the thyroid surgeon to prevent or minimize complications, including injury to the laryngeal nerves or parathyroid glands, perioperative hemorrhage and the potentially life-threatening hematoma. Means to prevent and control intra- or postoperative bleeding therefore remain a topic of utmost importance. Although thyroidectomy is one of the most common surgical procedures, the safest, most efficient and cost-effective way to achieve hemostasis is debated by endocrine surgeons and otorhinolaryngologists. In our opinion, there is no substitute for meticulous surgical technique and hemostasis, while experience in such operations is essential for the best outcome with the fewest complications. Ties, suture-ligations, monopolar/bipolar diathermy, clips, and hemostatic agents/sealants or tissue adhesives have been used. Over the last 10 years, innovative hemostatic devices, such as the electrothermal bipolar Vessel Sealing System and ultrasonically activated shears, have been developed and have been welcome adjuncts to the thyroid surgeon's armamentarium. In this review we aim to cover both novel and well-established traditional techniques of hemostasis in thyroid surgery, with specific focus on the bipolar Vessel sealer and harmonic scalpel.
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novel hemostatic devices in thyroid surgery electrothermal bipolar Vessel Sealing System and harmonic scalpel
Expert Review of Medical Devices, 2008Co-Authors: Andreas Manouras, Emmanuel Lagoudianakis, Haridimos Markogiannakis, Panagiotis Kekis, Bill FlemingAbstract:Accurate and efficient hemostasis is one of the first priorities of the thyroid surgeon to prevent or minimize complications, including injury to the laryngeal nerves or parathyroid glands, perioperative hemorrhage and the potentially life-threatening hematoma. Means to prevent and control intra- or postoperative bleeding therefore remain a topic of utmost importance. Although thyroidectomy is one of the most common surgical procedures, the safest, most efficient and cost-effective way to achieve hemostasis is debated by endocrine surgeons and otorhinolaryngologists. In our opinion, there is no substitute for meticulous surgical technique and hemostasis, while experience in such operations is essential for the best outcome with the fewest complications. Ties, suture-ligations, monopolar/bipolar diathermy, clips, and hemostatic agents/sealants or tissue adhesives have been used. Over the last 10 years, innovative hemostatic devices, such as the electrothermal bipolar Vessel Sealing System and ultrasonicall...
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thyroid surgery comparison between the electrothermal bipolar Vessel Sealing System harmonic scalpel and classic suture ligation
American Journal of Surgery, 2008Co-Authors: Andreas Manouras, Emmanuel Lagoudianakis, Pantelis T Antonakis, Haridimos Markogiannakis, Panagiotis Kekis, Michael Genetzakis, Athanasios S Koutras, Panagiotis G Drimousis, Konstantinos Koutsoumanis, Ioannis BramisAbstract:Abstract Background This study was conducted to compare the outcome of total thyroidectomy using the electrothermal bipolar Vessel Sealing System, the harmonic scalpel, and the classic suture ligation technique. Methods This was a retrospective study of prospectively collected data from 382 consecutive total thyroidectomies from September 2004 to August 2006. Patients were divided into 3 groups: group SL patients (n = 90) underwent total thyroidectomy with the classic suture ligation technique, group L (n = 148) with the electrothermal bipolar Vessel sealer, and group U (n = 144) with the harmonic scalpel. The main outcomes measured were surgical and hospitalization time, intraoperative and postoperative bleeding, postoperative hypocalcemia, and superior and inferior laryngeal nerves injuries. Results The 3 groups were similar in terms of demographics, thyroid gland weight and pathology, perioperative complications, and hospital stay. Compared with the classic technique, surgical time was reduced significantly by about 20% when the bipolar Vessel sealer or harmonic scalpel was used (93.3 ± 12.5 vs 74.3 ± 14.2 and 73.8 ± 13.8 min, P = .001, and P = .001, respectively). Conclusions Both the bipolar Vessel sealer and harmonic scalpel are safe, useful, and time-saving alternatives to the traditional suture ligation technique for thyroid surgery. Because no differences were observed regarding these 2 devices, the choice should be made based on the surgeon’s preferences and experience.
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electrothermal bipolar Vessel Sealing System is a safe and time saving alternative to classic suture ligation in total thyroidectomy
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2005Co-Authors: Andreas Manouras, Emmanuel Lagoudianakis, Pantelis T Antonakis, George M Filippakis, Haridimos Markogiannakis, Panagiotis KekisAbstract:Background. Total thyroidectomy is associated with minimal morbidity. The electrothermal bipolar Vessel Sealing System is an adjunct to the surgical technique, recently made available to thyroid surgery. Methods. This is a prospective randomized trial of total thyroidectomies performed in single unit from July 2003 to May 2004. Patients were randomly assigned in two groups: group A (n = 90), total thyroidectomy with the classic suture ligation technique; and group B (n = 94), total thyroidectomy with the use of the electrothermal bipolar Vessel Sealing System. Results. Operative time was significantly reduced in group B by 14 minutes (mean difference, 14.3 ± 4.2 minutes, 95% CI, 5.88–22.6 minutes). No statistically significant differences were found in postoperative complications, postoperative serum calcium measurements, or hospital stay between the two groups. Conclusions. The electrothermal bipolar Vessel Sealing System is a safe and useful, time-saving adjunct for total thyroidectomy. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX–XXX, 2005
Haridimos Markogiannakis - One of the best experts on this subject based on the ideXlab platform.
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novel hemostatic devices in thyroid surgery electrothermal bipolar Vessel Sealing System and harmonic scalpel
Expert Review of Medical Devices, 2008Co-Authors: Andreas Manouras, Emmanuel Lagoudianakis, Haridimos Markogiannakis, Panagiotis Kekis, Bill FlemingAbstract:Accurate and efficient hemostasis is one of the first priorities of the thyroid surgeon to prevent or minimize complications, including injury to the laryngeal nerves or parathyroid glands, perioperative hemorrhage and the potentially life-threatening hematoma. Means to prevent and control intra- or postoperative bleeding therefore remain a topic of utmost importance. Although thyroidectomy is one of the most common surgical procedures, the safest, most efficient and cost-effective way to achieve hemostasis is debated by endocrine surgeons and otorhinolaryngologists. In our opinion, there is no substitute for meticulous surgical technique and hemostasis, while experience in such operations is essential for the best outcome with the fewest complications. Ties, suture-ligations, monopolar/bipolar diathermy, clips, and hemostatic agents/sealants or tissue adhesives have been used. Over the last 10 years, innovative hemostatic devices, such as the electrothermal bipolar Vessel Sealing System and ultrasonicall...
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novel hemostatic devices in thyroid surgery electrothermal bipolar Vessel Sealing System and harmonic scalpel
Expert Review of Medical Devices, 2008Co-Authors: Andreas Manouras, Emmanuel Lagoudianakis, Haridimos Markogiannakis, Panagiotis Kekis, Bill FlemingAbstract:Accurate and efficient hemostasis is one of the first priorities of the thyroid surgeon to prevent or minimize complications, including injury to the laryngeal nerves or parathyroid glands, perioperative hemorrhage and the potentially life-threatening hematoma. Means to prevent and control intra- or postoperative bleeding therefore remain a topic of utmost importance. Although thyroidectomy is one of the most common surgical procedures, the safest, most efficient and cost-effective way to achieve hemostasis is debated by endocrine surgeons and otorhinolaryngologists. In our opinion, there is no substitute for meticulous surgical technique and hemostasis, while experience in such operations is essential for the best outcome with the fewest complications. Ties, suture-ligations, monopolar/bipolar diathermy, clips, and hemostatic agents/sealants or tissue adhesives have been used. Over the last 10 years, innovative hemostatic devices, such as the electrothermal bipolar Vessel Sealing System and ultrasonically activated shears, have been developed and have been welcome adjuncts to the thyroid surgeon's armamentarium. In this review we aim to cover both novel and well-established traditional techniques of hemostasis in thyroid surgery, with specific focus on the bipolar Vessel sealer and harmonic scalpel.
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modified radical mastectomy with axillary dissection using the electrothermal bipolar Vessel Sealing System
Archives of Surgery, 2008Co-Authors: Andreas Manouras, Emmanuel Lagoudianakis, George M Filippakis, Haridimos Markogiannakis, Michael Genetzakis, Georgia Kafiri, Konstantinos Filis, George C ZografosAbstract:Hypothesis The use of the electrothermal bipolar Vessel Sealing System is feasible, safe, and effective in modified radical mastectomy with axillary dissection in terms of lymph Vessel Sealing, hemostasis, and perioperative complications. Design Prospective study. Setting University surgical department. Patients Between January 1, 2003, and December 31, 2003, 60 patients with locally advanced breast cancer (T2 or T3) admitted for modified radical mastectomy with axillary dissection were included in this study. The entire procedure was performed by the same surgical team using the electrothermal bipolar Vessel Sealing System. Main Outcome Measures Final outcome, operative time, hospitalization stay duration, intraoperative blood loss, postoperative mastectomy and axillary drainage volume and duration, and postoperative complications (seroma, bleeding, skin burn, hematoma, lymphedema, pneumothorax, and wound infection or necrosis). Results The mean (SD) intraoperative blood loss was 45 (12) mL, and the mean (SD) operative time was 105 (7) minutes. No postoperative bleeding, seroma, hematoma, lymphedema, or other complications occurred. The mean (SD) mastectomy and axillary drainage volumes were 20 (8) and 155 (35) mL, respectively, and the mean (SD) drainage durations were 1.3 (0.2) and 2.7 (0.5) days, respectively. The mean (SD) hospital stay was 3.7 (0.6) days. Conclusions In this first report (to our knowledge) of modified radical mastectomy with axillary dissection using the electrothermal bipolar Vessel Sealing System, the technique was feasible, safe, and effective. The device simplified the surgical procedure, while achieving efficient lymph Vessel Sealing and hemostasis. Compared with historical data regarding the conventional or harmonic scalpel, this technique seems to result in reduced operative time, perioperative blood loss, drainage volume and duration, and incidence of seroma or lymphedema. Prospective randomized controlled studies are necessary to evaluate the effect of this technique on perioperative complications.
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thyroid surgery comparison between the electrothermal bipolar Vessel Sealing System harmonic scalpel and classic suture ligation
American Journal of Surgery, 2008Co-Authors: Andreas Manouras, Emmanuel Lagoudianakis, Pantelis T Antonakis, Haridimos Markogiannakis, Panagiotis Kekis, Michael Genetzakis, Athanasios S Koutras, Panagiotis G Drimousis, Konstantinos Koutsoumanis, Ioannis BramisAbstract:Abstract Background This study was conducted to compare the outcome of total thyroidectomy using the electrothermal bipolar Vessel Sealing System, the harmonic scalpel, and the classic suture ligation technique. Methods This was a retrospective study of prospectively collected data from 382 consecutive total thyroidectomies from September 2004 to August 2006. Patients were divided into 3 groups: group SL patients (n = 90) underwent total thyroidectomy with the classic suture ligation technique, group L (n = 148) with the electrothermal bipolar Vessel sealer, and group U (n = 144) with the harmonic scalpel. The main outcomes measured were surgical and hospitalization time, intraoperative and postoperative bleeding, postoperative hypocalcemia, and superior and inferior laryngeal nerves injuries. Results The 3 groups were similar in terms of demographics, thyroid gland weight and pathology, perioperative complications, and hospital stay. Compared with the classic technique, surgical time was reduced significantly by about 20% when the bipolar Vessel sealer or harmonic scalpel was used (93.3 ± 12.5 vs 74.3 ± 14.2 and 73.8 ± 13.8 min, P = .001, and P = .001, respectively). Conclusions Both the bipolar Vessel sealer and harmonic scalpel are safe, useful, and time-saving alternatives to the traditional suture ligation technique for thyroid surgery. Because no differences were observed regarding these 2 devices, the choice should be made based on the surgeon’s preferences and experience.
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sutureless open low anterior resection with total mesorectal excision for rectal cancer with the use of the electrothermal bipolar Vessel Sealing System
Medical Science Monitor, 2007Co-Authors: Andreas Manouras, Emmanuel Lagoudianakis, George M Filippakis, Haridimos Markogiannakis, Michael Genetzakis, Georgia Kafiri, D Tsekouras, Nikolaos Pararas, Dimitrios Papanikolaou, Konstantinos ToutouzasAbstract:BACKGROUND: There is no report of electrothermal bipolar Vessel sealer utilization in rectal surgery. The objective here was to evaluate the results of the use of this device in open low anterior resection for rectal cancer regarding reduction of operative time, hemostasis, and postoperative complications compared with the conventional technique. An additional aim was to describe and standardize this operative technique. MATERIAL/METHODS: All open low anterior resections with total mesorectal excision for rectal cancer performed by the same surgical team from January 2003 to December 2003 were reviewed. Patients were divided in two groups: those operated with the classic technique (group A) and those with a bipolar Vessel sealer (group B). Main outcomes measured were operative and hospitalization time, intraoperative blood loss, postoperative drainage volume and duration, postoperative complications, perioperative blood transfusions, and final outcome. RESULTS: Forty-one patients were included (group A: 19, group B: 22). The groups were similar in demographics, TNM classification, number of lymph nodes dissected, complications, blood transfusions, hospital stay, and outcome. Comparing group B with group A, operative time (171+/-10 vs. 203+/-20 min, p=0.002), intraoperative blood loss (20+/-6 vs. 60+/-4 ml, p=0.04), drainage volume (70+/-8 vs. 120+/-10 ml, p=0.001), and drainage duration (1.7+/-0.3 vs. 2.6+/-0.2 days, p=0.01) were significantly reduced. CONCLUSIONS: The bipolar Vessel sealer is a safe and effective adjunct for low anterior resection. The device simplifies the procedure while achieving efficient hemostasis and results in reduced operative time, intraoperative blood loss, and drainage volume and duration.
