Comparison of the vessel sealer Extend® with harmonic ACE® in robotic bilateral axillary-breast approach thyroid surgery.

BACKGROUND: Harmonic ACE® (Harmonic) Curved Shears are frequently used for vessel sealing in patients undergoing robotic thyroidectomy. Unlike other robotic devices with articulation, the Harmonic device can only move in a straight-forward direction without articulation. The recently introduced Vessel Sealer Extend® (VSE) provides bipolar sealing and cutting with articulation movement. This study compared the VSE and Harmonic devices in robotic bilateral axillary-breast approach (BABA) thyroid surgery. METHODS: From December 2018 to March 2019, 35 consecutive patients underwent robotic BABA thyroidectomy, 20 using the VSE and 15 using the Harmonic device. Patient characteristics, pathologic results, and clinical outcomes, including complications, were evaluated. RESULTS: The characteristics of patients in the two groups were similar. Surgical time from robot docking to completion of lobectomy was longer in the VSE than in the Harmonic group (45.00±9.52 vs. 39.72±12.76 min; P=0.170). The number of camera cleanings during lobectomy was significantly lower in the VSE group (0.55±0.51 vs. 1.93±1.71; P=0.002). Intraoperative blood loss (53.00±43.29 vs. 28.67±41.03 mL; P=0.102), hospital stay after surgery (3.55±0.95 vs. 3.67±0.90 days; P=0.715), and pain scores on the first (2.85±0.37 vs. 2.93±0.26; P=0.458) and second (2.55±0.51 vs. 2.60±0.51; P=0.775) postoperative days were similar in the VSE and Harmonic groups. No patient experienced vocal cord palsy or postoperative bleeding. CONCLUSIONS: VSE can be safely applied to robotic BABA thyroid surgery.

Communications Between the Facial Nerve and the Vestibulocochlear Nerve, the Glossopharyngeal Nerve, and the Cervical Plexus.

The aim of this review is to elucidate the communications between the facial nerves or facial nerve and neighboring nerves: the vestibulocochlear nerve, the glossopharyngeal nerve, and the cervical plexus.In a PubMed search, 832 articles were searched using the terms "facial nerve and communication." Sixty-two abstracts were read and 16 full-text articles were reviewed. Among them, 8 articles were analyzed.The frequency of communication between the facial nerve and the vestibulocochlear nerve was the highest (82.3%) and the frequency of communication between the facial nerve and the glossopharyngeal nerve was the lowest (20%). The frequency of communication between the facial nerve and the cervical plexus was 65.2 ± 43.5%. The frequency of communication between the cervical branch and the marginal mandibular branch of the facial nerve was 24.7 ± 1.7%.Surgeons should be aware of the nerve communications, which are important during clinical examinations and surgical procedures of the facial nerves such as those communications involved in facial reconstructive surgery, neck dissection, and various nerve transfer procedures.

Communications Between the Trigeminal Nerve and the Facial Nerve in the Face: A Systematic Review.

The aim of the article is to elucidate the communications between the trigeminal nerve and facial nerve in the face. In a PubMed search, 328 studies were found using the terms 'trigeminal nerve, facial nerve, and communication.' The abstracts were read and 39 full-text articles were reviewed. Among them, 11 articles were analyzed. In the studies using dissection, the maxillary branch (V2) had the highest frequency (95.0% ±â€Š8.0%) of communication with the facial nerve, followed by the mandibular branch (V3) (76.7% ±â€Š38.5%). The ophthalmic branch (V1) had the lowest frequency of communication (33.8% ±â€Š19.5%). In a Sihler stain, all of the maxillary branches and mandibular branches had communications with the facial nerve and 85.7% (12/14 hemifaces) of the ophthalmic branches had communications. The frequency of communications between the trigeminal nerve and facial nerve were significantly higher (P = 0.00, t-test) in the studies using a Sihler stain (94.7% ±â€Š1.1%) than the studies using dissection (76.9 ±â€Š35.8). The reason for the significantly higher frequency of trigeminal-facial communication in the studies using a Sihler stain is because of the limitation of the Sihler stain itself. This technique cannot differentiate the motor nerves from sensory nerves at the periphery, and a crossover can be misinterpreted as communication near to nerve terminal.