Research progress on the treatment of gingival pigmentation / 口腔疾病防治

@#Gingival pigmentation is a nonplaque gum disease. Patients are often afraid to communicate with others because of gum color problems, which affect the social and mental health of patients. The commonly used treatment methods for gingival pigmentation include scalpel excision, gingival grinding, laser therapy, cryosurgery and electrosurgery. In this paper, the progress of gingival pigmentation treatment was reviewed in terms of bleeding, pain, tissue healing and recoloring. The results showed that the clinical effect of laser treatment was better. Among them, the semiconductor laser had more advantages in reducing bleeding, pain and the restaining rate, while the Er:Cr:YSSG/Er:YAG laser performed better for promoting tissue healing. Clinicians can choose the best kind of laser to use according to the actual situation. For patients with thin gingival biotypes, floating gingival transplantation or substitute materials can be selected to restore the gingival morphology. With the in-depth study of melanin regulation mechanisms, various drugs, such as ascorbic acid, natural peptides, synthetic peptides and derivatives, may be the main research direction for the treatment of gingival pigmentation in the future.

Efficacy of endoscopic-assisted transaxillary breast augmentation with ultrasonic scalpel and electroscalpel / 中华医学美学美容杂志

Objective:To evaluate the clinical effects of the dissection of the implant pockets with ultrasonic scalpel or traditional electroscalpel through the axillary approach under endoscopic assistant.Methods:A total of 125 female patients with an average of 32.5 years, ranged from 21 to 44 years, underwent endoscopic-assisted transaxillary breast augmentation in the Department of Plastic Surgery, the Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, from January 2019 to December 2020, were analyzed retrospectively. The implant pockets were dissected with ultrasonic scalpel (ultrasonic scalpel group) in 64 patients or with traditional electroscalpel (electroscalpel group) in 61 patients. The operation time, operation speed, postoperative drainage, drainage tube removal time and hospital stay of the two groups were compared and analyzed statistically.Results:Compared with the electroscalpel group, the average operation time of the ultrasonic scalpel group 75(71-90) min was significantly shorter than that of the electroscalpel group 105(80-135) min ( t=4.10, P<0.001), the operation speed (3.27±0.44 ml/min) was faster than that of the electroscalpel group (2.52±0.72 ml/min) ( t=4.71, P<0.001), the postoperative drainage 130.5(98.8-193.3) ml was significantly less than that of the electroscalpel group 281.75(145.5-328.3) ml ( t=2.21, P<0.05), and the drainage tube removal time 3 (3-4) d and hospital stay 3 (3-4) d were remarkablely shorter than that of the electroscalpel group 4 (3-4) d, 5 (4-6) d ( t=3.58; t=4.06, P<0.05). Conclusions:The application of ultrasonic scalpel in endoscopic-assisted transaxillary breast augmentation is safe and reliable. In addtion to improving the surgical efficiency, ultrasonic scalpel can reduce blood loss, shorten the time of hospital stay and reduce complications, which is worthy of further promotion in clinical application.

Skeletonized bilateral internal mammary artery harvesting with harmonic scalpel in coronary artery bypass grafting / 中国胸心血管外科临床杂志

@#Objective    To summarize the use of harmonic scalpel to harvest bilateral internal mammary artery in coronary artery bypass grafting (CABG). Methods    The clinical data of 54 patients of bilateral skeletonized internal mammary artery harvesting for CABG in our hospital from January 2016 to May 2020 were analyzed retrospectively. There were 51 males and 3 females with a mean age of 62.37±9.56 years. Results    All patients went through the procedure unevently and discharged from hospital. The number of grafts was 4.07±0.85 per patient, the operation time was 267.21±47.00 min, mechanical ventilation time was 342.43±132.17 min and hospital stay was 12.21±4.43 d. Conclusion    It is safe and effective to use harmonic scalpel to harvest skeletonized bilateral internal mammary artery in CABG.

Thoracic Spine Stenosis: Does Ultrasonic Osteotome Improve Outcome in Comparison to Conventional Technique?

@#Introduction: To investigate the efficacy of Ultrasonic Bone Scalpel (UBS) in thoracic spinal stenosis (TSS) in comparison to traditional technique. Materials and methods: A total of 55 patients who had undergone conventional surgery (Group A) are compared with 45 patients of UBS (Group B) in TSS. The primary outcome measure of Modified Japanese Orthopaedic Association score (m JOA) with neurological complications and dural injury were assessed. Secondary outcome measures of total blood loss (TBL), time duration of surgery (ORT) and length of hospital stay (LHS) were analysed. Results: The pre-operative mJOA score 5.00(4.00-6.00) in the group A and 5.00(4.00-6.00) in the group B improved to 7.00(7.00-8.00) in the group A and 9.00(9.00-10.00) in the group B, respectively (P<0.001) at final average follow-up of 117.55 months for group A and 75.69 months in group B. More significant grade of myelopathy improvement and mJOA recovery rate (RR) were noted in group B. The TBL, ORT and LHS were more favourable in group B as compared to group A (p<0.0001). The group A had 9 (16.36%) neurological deficits compared to 2 (4.44%) in group B (p<0.001). Dural tears occurred in both groups (A=11, B=9). It was more frequent and not repairable in group A but without significant statistical difference. Conclusions: UBS can reduce neurological deficits and improve outcomes in TSS. Secondarily, reduced blood loss, lesser surgical time and reduced LHS are significant added advantages of this new technology.

A comparative study between harmonic scalpel hemostasis and conventional hemostasis in total thyroidectomy

Background: Thyroidectomy is the most commonly performed procedure in endocrine surgery. Since the thyroid gland is highly vascular, therefore, rapid and absolute hemostasis is extremely required. Conventional thyroidectomy is commonly used with acceptable outcomes, however, it is time‑consuming and resulted in significant intraoperative blood loss with the possible risk of postoperative hemorrhage, injury to parathyroid glands and laryngeal nerves. The advent of focus harmonic devices was encouraging for improving safety, effectiveness, and reduction of operative time, especially in thyroid surgery. Aim of this study: The purpose of this study was to analyze the effectiveness and surgical outcomes of using ultrasonic harmonic scalpel for thyroid surgery compared to conventional techniques.Methods: This was a prospective, randomized study in which 60 patients with various types of goiters presented for thyroidectomy. The patients were divided into two comparable groups. Group A (30 patients) included patients who had focus harmonic thyroidectomy and Group B (30 patients) included patients who underwent conventional thyroidectomy.Results: Focus harmonic thyroidectomy showed a significant reduction in operative time, intraoperative blood loss, volume of postoperative fluid drainage and meantime for hospital stay compared with conventional thyroidectomy. There were no significant differences in the incidence of postoperative hypocalcemia, seroma, hematoma, wound infection and laryngeal nerve injury between both groups.Conclusions: Focus harmonic thyroidectomy was a safe, effective, faster, and appealing alternative to conventional technique since it reduced the operative time, intraoperative blood loss, postoperative drainage and hospital stay with comparable postoperative complications.

Comparison of Diathermy versus Scalpel Skin Incision in Oncological Surgeries

Introduction: Surgical incisions are usually made with scalpel. Usage of scalpel usually results in skin bleeding which obscuresthe operating field resulting in wastage of operating time. Although diathermy is increasingly used for underlying tissue dissection,cutting, and hemostasis, its use for making skin incisions is not gaining favor.Aim: The aim of our study was to compare the value outcome of diathermy incisions versus scalpel incisions in abdominalsurgeries.Materials and Methods: This prospective comparative study was conducted to compare the outcome of diathermy incisionsversus scalpel incisions in oncological surgeries. Total of 80 patients who divided into Group A (scalpel incision) for 39 patientsand Group B (diathermy incision) for 41 patients. Treatment protocol and follow-up protocol were followed and the results werestatistically analyzed and discussed.Results: Out of 80 patients, 39 patients had scalpel incision and 41 patients had diathermy incision. In the scalpel group outof 39 patients, 21 patients were male and 18 patients were female, the mean duration of incision time in the scalpel group is116 sec, the mean value of incisional blood loss in the scalpel group is 1.9/ml, the mean operating time in the scalpel group is36.42 min, and the mean value of post-operative pain in day 1 is 6.42, day 2 is 5.18, and day 3 is 3.66. In the diathermy groupout of 41 patients, 26 patients were male and 15 patients were female, the mean duration of incision time in the diathermy groupis 88.52 sec, the mean value of incisional blood loss in the diathermy group is 1.4/ml, the mean operating time in the diathermygroup is 38.75 min, and the mean value of post-operative pain in day 1 is 5.12, day 2 is 3.88, and day is 2.01.Conclusion: The findings of the present study show that diathermy seems to provide some benefit with respect to post-operativewound pain, less incision time, and less incisional blood loss and has obvious safety advantages to the surgical team comparedwith scalpel.

Scalpel versus diathermy skin incision: a randomised clinical trial

Background: Scalpel skin incision produces a clean, incised wound with minimal tissue destruction. Cutting diathermy also produces an incised wound that heals as well as the one that is created by cold scalpel but with an added advantage of achieving quick hemostasis and saving operative time. The main thing of the present study is to verify and compare the usefulness of diathermy skin incision vs. scalpel skin incision in general surgical patients.Methods: The study was conducted in Medical College and Hospital, in 60 patients randomly selected for diathermy and scalpel incision, between 14-65 years age group, between January 2011-June 2012. Post operative pain, seroma, hematoma, discharge were observed and results were analyzed and compared for the two groups using Mann-Whitney U Test.Results: Diathermy group, with incision related time of 6.20±0.97 sec/cm, was significantly quicker (p=0.003) than scalpel incision, with incision time of 6.76±0.84 sec/cm. Postoperative pain scores, recorded daily over five days, showed insignificant difference between the two groups.Conclusions: We demonstrate that the diathermy provides efficient cutting of skin, with no superior wound-healing profile, comparable to that of the traditional scalpel blade.

Use of microwave scalpel in hepatectomy for hepatocellular carcinoma / 中华肝胆外科杂志

Objective To study the clinical use of microwave scalpel in hepatectomy for hepatocellular carcinoma without hepatic vascular inflow occlusion.Methods A retrospective study was conducted on the clinical data of 126 consecutive patients with hepatocellular carcinoma who were treated at the Department of Hepatobiliary Surgery of the Third Affiliated Hospital of Sun Yat-sen University from December 2015 to August 2018.The patients included 111 males and 15 females,with ages which ranged from 25 to 75 years.These patients were divided into two groups by the different surgical resection methods:the microwave scalpel hepatectomy (MSH) group which employed microwave scalpels to perform hepatectomy (n =42),and the ultrasound scalpel hepatectomy (USH) group which employed ultrasound scalpels (n =84).The perioperative conditions which included baseline data,amount of intraoperative bleeding,liver function after operation,and morbidity of postoperative complications were compared.Results There were no significant differences in the preoperative indexes which included tumor diameter,number of tumors,levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) between the 2 groups (all P ＞ 0.05).In the MSH group,the amount of intraoperative bleeding was 100.0 (100.0,200.0) ml,which was significantly lower than the 300.0 (100.0,400.0) ml in the USH group (P ＜ 0.05).Compared with the USH group,the levels of AST and ALT on postoperative day 1,3,7 after operation in the MSH group were significantly lower (all P ＜ 0.05),and the corresponding albumin levels were significantly higher than the USH group (P ＜0.05).The incidence of complications was 4.8％ (2/42) in the MSH group which was significantly lower than that of 20.2％ (17/84) in the USH group (P ＜ 0.05).Conclusion Microwave scalpel significantly reduced intraoperative bleeding and postoperative complications,and led to less liver functional injury.

A study on patterns of needle - stick injuries among gynaecologic and general surgeons in open surgery

Background: An estimated 3,84,000 percutaneous injuries are reported by HCW in hospitals in the United States each year, placing them at risk of exposure to HIV, HBV, or HCV. Suture needles have been identified as the most frequent cause of injury. They are involved in as many as 44% of such injuries. This study is designed to note the NSI in major gynaecological procedures and surgical procedures using conventional method (CM) versus (VS) use of HK.Methods: Study was conducted over a period of 12 months from January 2017 to December 2017. 60 patients were included in this study and were divided into 2 groups A and B with 30 patients in each group. Group A was major surgery performed by conventional method; Group B was major surgery performed by using harmonic knife. NSI in two groups were studied and analyzed.Results: Most of the operated patients were between 41-50 years age group. 16.6% procedures were emergency and 83.3% were elective. NSI in conventional surgery was 63.3% in the surgeon and 33.3% with harmonic knife. There were 13.3% NSI in first assistant in conventional surgery and 23.3% in harmonic scalpel group. No such injuries were reported by second assistant in either group. Injuries were more in non-dominant hand in either groups in the surgeon and first assistant.Conclusions: It is concluded that NSI are common in surgeons and first assistant. Such injuries are more in non-dominant hand and in procedures where there is little exposure like vaginal hysterectomy. Use of innovative technologies like harmonic scalpel may be useful.

Spinal Accessory Dysfunction Following Neck Dissection with Harmonic Scalpel V/S Electrocautery – A Single Centre Experience

Aims:This study is an effort towards comparing the efficacy of the Harmonic Focus and Electrosurgical technique with regard to nerve injury especially spinal accessory nerve and its morbidity postoperatively after neck dissection.Sample:Ninety patients of oral carcinoma who required neck dissection were included in the study.Study Design:This is a prospective study.Place and Duration of Study:Bhagwan Mahaveer Cancer Hospital & Research Centre, Jaipur, Rajasthan, India for a period of 17 months from November 2016 to March 2018.Methodology:Patients’ post-operative recovery was studied prospectively by using parameters pertaining to shoulder function and shoulder pain.Results:There were significant differences in the pain and abduction deformity at various time periods after surgery. However differences in the quality of life did not show significant difference at the end of 3 months. For up to one month pain scores were lower for Harmonic Focus and shoulder function was better through 3 months.Conclusion:Though the technique of neck dissection (harmonic v/s electro cautery) has significant impact on shoulder dysfunction, despite that in postoperative period shoulder function measured by way of shoulder pain and shoulder abduction recover almost fully during follow-up period without causing significant morbidity and with minimal effect on quality of life. There are few recommendations we would like to suggest that if incorporated, they might significantly affect the outcome and better results.

Clipless Laparoscopic Cholecystectomy: Our Experience

Background:Laparoscopic cholecystectomy (LC) is acceptedas the gold standart treatment of gallstones. Various methodshave been developed to close the cystic duct (CD) and cysticartery (CA), but titanium clip application is currently themost frequently used technique. High-tech electrosurgicalinstruments, such as Harmonic Scalpel (HS), have been usedboth for dissection of the cystic artery and Cystic duct. Thepresent study was conducted to observe and establish efficacyof clipless cholecystectomy, by use of harmonic scalpel as analternative, for division and sealing of cystic artery and cysticduct.Methods: This study was a hospital based, retrospectivestudy, conducted in Govt. Medical College, Srinagar, usingmedical records. A total of 114 patients included in the study,having been operated by a single surgeon over time period of5 years from February 2014 to january 2019.Results: In our study of 114 patients 82 (71.92%) werefemales and 32 (28.07%) were males with average age of41.4years (16-72 yr). No patient was converted to open withaverage operating time of 24.2 minutes (18-46 minutes). Meanhospital study was 1.42 days (1-8 days) with no mortality.Postoperative complications were found in 6 (5.2%) patientswith bile leak from duct of Lushka in 1 (0.8%) patient, portsite infection in 2 (1.7%) patients and fever in 3 (2.6%)patients.Gallbladder perforation intraoperatively was seen in7 (6.2%) patients.Conclusions:Use of harmonic scalpel is an excellent optionfor the cystic duct closure with less time consumption and lesscomplications

No scalpel vasectomy: a cross-sectional study of knowledge, attitude and practice of gynaecologists

Background: In spite of no scalpel vasectomy (NSV) being cheaper and safer, female sterilisations account for the majority of sterilisations performed worldwide. Research has focussed more on the “demand” and less on the “provider” side. Gynaecologists can be front-runners for the cause of population control in India. Hence, authors decided to estimate the knowledge of gynaecologists, their attitude and prevalent practice of NSV.Methods: Cross-sectional study. Interviewer-administered questionnaire used for face-to-face data collection from gynecologists registered with the Pune Obstetric and Gynecological Society.Results: Out of 447 gynecologists, 158 (35.3%) were males and 289 (64.7%) females. Mean age was 46.3 years ± 12.1 years, (range 24-80 years). Only 14 (3.1%) were trained in performing NSV. Only a minority knew about type of anaesthesia used (1.8%) and number of accesses needed (48.1%) for NSV. Only 40.7% and 18.1% knew about time to resume sexual activity and number of ejaculations to be covered by additional contraceptives after NSV respectively. More than half [258 (57.7%)] were willing to undergo training in NSV. Among those unwilling for training, female and older gynecologists (≥40 years) significantly outnumbered male and younger gynecologists (76.5% Vs. 23.5%; p=0.000 and 78.8% Vs. 21.2% respectively; p=0.000). Majority (79.9%) referred a couple willing for NSV to surgeons or urologists or advised female sterilization (17%).Conclusions: Knowledge of gynecologists about NSV was inadequate. Minority were trained in performing NSV. Male and younger gynecologists were willing to undergo training in NSV. Most preferred practices were referring couples elsewhere or advising female sterilization.

Barriers for low acceptance of no scalpel vasectomy among slum dwellers of Lucknow City

Background: Uttar Pradesh is the most populated state of the country having population of 199.581 million and total fertility rate of 3.3 (annual health survey [AHS] 2012�13) with high fertile trajectory. Currently, female sterilization accounts for about 18.4% and male sterilization for 0.3% of all sterilizations in Uttar Pradesh (AHS 2012�13). A strategy to promote men's involvement in effective birth control is needed to reduce the population growth. Since no scalpel vasectomy (NSV) is an easy method but still not being utilized; hence, the purpose of this research is to ascertain various factors of nonutilization of NSV. Objectives: The objective of the study is (i) to determine the barriers among married males for adopting NSV as a method of family planning, (ii) to determine the awareness about NSV, (iii) to suggest measures to increase uptake of NSV by the people. Methods: A cross-sectional study was carried out. A two-staged multistage random sampling technique was used. Lucknow is divided into eight Nagar Nigam zones. In the first stage, two urban slums from each geographical zone were selected randomly. In the second stage, from each selected slum a sample of 24 eligible households was selected at random to achieve the desired sample size. Results: It was observed that among the study participants maximum 89.2% perceived Sociocultural barriers, while 0.6% of the participants perceived service delivery barriers. However, 14% of the participants also perceived procedure-related barriers as the most important cause for not accepting NSV. Conclusion: Measures should be taken to remove these barriers, and increase uptake of NSV.

Outcomes of Congenital Talipes Equinovarus Treated with Ponseti Method

Introduction: Idiopathic clubfoot or congenital talipesequinovarus is characterized by an excessively turned-infoot and a high medial longitudinal arch is the commonestcongenital foot deformities having 1 in every 1000 childrenborn worldwide. Though described long back, there has beenan interest towards Ponseti method of conservative treatmentof clubfoot recently. Our study was aimed to assess theefficacy of Ponseti technique in correcting congenital talipesequinovarus deformity of foot.Material and methods: 65 patients were enrolled in the studyout of which 47 patients were available for final follow-up. Allpatients presenting with CTEV with age up to 2 years wereincluded and patients more than 2 years, operated cases andsyndromic clubfoot were excluded. We treated all patientswith Ponseti method of serial casting and tenotomy.Results: Out of the total 65 feet studied, 42 feet (64.62%)required tendo achilles tenotomy and 23 feet (35.38%) weretreated with casting alone and tenotomy was not required.In our study, there were 8 cases of relapes (12.31%).Out ofthese, 7 were idiopathic and 1 was syndromic. Out of these 8relapses, 2 required repeat tenotomy and 6 were treated withcasting as per ponseti technique. Complications due to plasterwere minimal in our study. Incidence of rocker bottom feet inour study is nil because of dedicated clubfoot manipulation inclubfoot clinic and patients were followed up regularly.Conclusion: To conclude, this study showed that clubfootdeformity can be managed successfully provided the techniqueand details of manipulation described by Ponseti are followedstrictly and patients can be followed up regularly by a team ofdedicated orthopedic surgeons.

Frenectomía lingual láser asistida como coadyuvante del tratamiento de ortopedia maxilar / Laser-assissted lingual frenectomy as a coadjuvant to maxillary orthopedic treatment

La aplicación del LÁSER (light amplification of stimulation emision of radiation) en las áreas de la medicina y la odontología viene demostrando una constante evolución, brindándonos alternativas a los tratamientos convencionales. Los láseres quirúrgicos de tejidos blandos muestran grandes ventajas comparados a los procedimientos habituales de corte, ya sea con bisturí frío o electrobisturí. La mínima necesidad de anestesia, la analgesia intra y postoperatoria, la coagulación inmediata, la cicatrización por segunda, el efecto bactericida, la ausencia de puntos de sutura, el confort postoperatorio, son algunas de las ventajas que hacen que la cirugía con láser sea una opción indiscutible que está ganando terreno entre los profesionales de la salud (AU)

The design and implementation of power control circuit of ultrasonic scalpel based on DSP / 中国医学装备

Objective:To independently develop a power control system of ultrasonic scalpel so as to reduce the energy consumption and maintain the normal temperature of ultrasonic scalpel.Methods:In this paper, the model of equivalent circuit of ultrasonic transducer nearby syntony was built up, and the hardware control system of ultrasonic scalpel based on digital signal processing (DSP) was designed.Results:Through testing the circuit and work performance of power control system, the series of parameters such as effective value and so on which were produced by this system could adjust frequency of power source in time and attain anticipative functional indicator, and it took the ultrasonic scalpel to work in syntonic situation.Conclusion:The tested indicators of power control system of ultrasonic scalpel based on the kernel design of DSP can attain anticipative requirement, and can take this system to work in syntonic situation.

A Study Of Harmonic Scalpel Assisted Haemorrhoidectomy At Tertiary Care Centre

Background:Conventional haemorrhoidectomy is still considered as gold standard therapy for grade III &IV haemorrhoids. The conventional haemorrhoidectomy can be made easier with the help of harmonic scalpel with associated less post-operative complications.This study evaluated in a randomized prospective manner the differences in; duration of hospital stay, postoperative complications, symptomatic recurrence and cost effectiveness between conventional and harmonic scalpel assisted haemorrhoidectomy. Methods: The prospective study was carried out in 60 patients of symptomatic grade III & IV haemorrhoids, presented during August 2015 to August 2017. Each group of 30 patients treated with harmonic scalpel assisted haemorrhoidectomy and conventional haemorrhoidectomy; followed up for 6 months for complications. Results: In present study, the severity of pain was significantly more following conventional haemorrhoidectomy than harmonic scalpel assisted haemorrhoidectomy. Urinary retention was more common with conventional haemorrhoidectomy. Anal incontinence had similar incidence in both the groups of haemorrhoidectomy. Two patients had anal stenosis after conventional haemorrhoidectomy as compared to none in the harmonic scalpel group. No recurrence noted in both the groups. Cost effectiveness of the procedure is measured in form of hospital stay and return to daily activity and harmonic scalpel group have advantage over the conventional haemorrhoidectomy group in terms of less hospital stay and early return to daily activity. Conclusion: Harmonic scalpel assisted haemorrhoidectomy appears to be a better procedure compared with conventional haemorrhoidectomy in terms of less post-operative complications and decreased hospital stay in symptomatic patients with grade III & IV haemorrhoids.

Diode Laser Assisted Vestibuloplasty: A Case Report

Inadequate vestibular depth due to the insufficient width of attached gingiva results in poor plaque control. Vestibuloplasty increases the vestibular depth and can be done utilizing diode laser to prevent the post-operative discomfort for the patient compared to the scalpel technique.

Comparison of the thermal damage of energy-based surgical devices during thyroid surgery / 中华内分泌外科杂志

Objective Energy based surgical devices such as high frequency electrotome,Harmonic scalpel and LigaSure are widely used in thyroid operations.This study is to demonstrate the difference of tissue thermal damage among different surgical instruments.Methods 12 beagle dogs were randomly divided into 3 groups,electrotome 15 W groups (group A),three-speed Harmonic scalpel (group B) and LigaSure middle gear group (group C).Patients of each group received energy instruments operating on their thyroid tissue which mimics traditional thyroidectomy.The temperatures of gland tissue during procedures were monitored by infrared thermal imager,and the operated thyroid tissues were histologically analyzed.Results The highest temperature was (83.9±8.2)℃ in the electrotome group,(70.7±7.5)℃ in three-speed Harmonic scalpel group,and (56.6±5.7)℃ in LigaSure group.The highest temperature among the three groups was statistically significant.The electrotome (15 W) caused more serious thermal damage to thyroid tissues than that caused by either the Harmonic scalpel or LigaSure (thermal damaged depth:(0.96±0.07) mm vs (0.74±0.07) mm,P＜0.01;(0.96±0.07) mm vs (0.72± 0.11) mm,P＜0.01).Nevertheless,the thermal damage had no significant differences between the Harmonic scalpel and LigaSure group (P=0.845).The thermal damage caused by the 15 W electrotome was significantly larger than that in the other two groups,and the difference had statistical significance (P＜0.01).Conclusion Compared to the high frequency electrotome,Harmonic scalpel and LigaSure lead less tissue thermal damage during thyroid surgeries,owing to less heat production.In that way,Harmonic scalpel and LigaSure are superior to electrotome in terms of safety.

Clinical application of harmonic scalpel in subxiphoid and subcostal arch approach for resection of anterior mediastinal lesion / 中国胸心血管外科临床杂志

@#Objective    To evaluate the clinical outcomes of harmonic scalpel in subxiphoid and subcostal arch approach for resection of anterior mediastinal lesion. Methods    We retrospectively analyzed the clinical data of 217 patients with anterior mediastinal lesion at the Department of Thoracic Surgery of Tangdu Hospital of the Fourth Military Medical University from June 2015 to June 2017, among whom 162 underwent thoracoscopic surgery via subxiphoid and subcostal arch approach with harmonic scalpel (a harmonic scalpel group, 95 males and 67 females at an average age of 46.2±18.7 years ranging from 22 to 72 years) and 55 with Ligasure (a Ligasure group, 29 males and 26 females at an average age of 47.7±12.9 years ranging from 31 to 68 years). Operation time, intraoperative blood loss, intraoperative conversion rate, postoperative hospital stay, patients satisfaction score, patients pain score and postoperative complications were compared between both groups. Results    All operations were accomplished successfully, and there was no death or conversion to thoracotomy. There was a statistical difference in operation time (58.6±34.8 min vs. 72.8±32.6 min, P=0.01), and intraoperative blood loss (36.2±18.7 ml vs. 41.9±12.9 ml, P=0.04). There was no statistical difference between the two groups in length of hospital stay (4.2±2.6 d vs. 4.5±1.9 d, P=0.36), pain score at postoperative day 1, 3 and 30 (8.3±0.9 vs. 8.5±0.6, P=0.13; 6.4±1.5 vs. 6.9±1.1, P=0.19; 1.3±0.7 vs. 1.4±0.9, P=0.40), patients’ satisfaction score (8.6±1.2 vs. 8.4±1.7, P=0.34), or incidence of postoperative complications (5.6% vs. 9.1%, P=0.35). Conclusion    Har-monic scalpel plays an important role in resection of anterior mediastinal lesion via subxiphoid and subcostal arch approach. All tissues are separated and blood vessels are dissected only by the harmonic scalpel, so it is very important for   us to handle the harmonic scalpel skillfully.