• Grasping range
• Steam spread area
• Thermal effect
• Ultrasonic activating device
• Vessel sealing system
• WET condition

• Animals
• Swine
• Temperature
• Carotid Artery, Common/surgery
• Hot Temperature
• Steam

• Bipolar device
• Economic analysis
• HTA
• High-energy device
• Monopolar device
• Multidimensional evaluation

• Humans
• Technology Assessment, Biomedical/methods
• Hospitals
• Italy
• Pancreatectomy
• Cost-Benefit Analysis

• C
• C6
• C63
• Electrosurgery
• I
• I1
• I19
• Monte Carlo simulation
• advanced bipolar devices
• advanced energy devices
• budget impact analysis
• ultrasonic scalpel

• Humans
• Electrosurgery
• Ultrasonics
• Budgets
• Hospitals
• Operating Rooms

• Colorectal surgery
• Energy devices
• Harmonic
• Ligasure
• Network meta-analysis
• Operative outcomes
• Systematic review
• Thunderbeat

• Blood Loss, Surgical
• Colorectal Surgery/adverse effects
• Humans
• Length of Stay
• Network Meta-Analysis
• Operative Time
• Postoperative Complications/etiology

• Humans
• Pancreatectomy
• Pancreatic Fistula/etiology
• Pancreaticoduodenectomy/adverse effects
• Postoperative Complications/etiology
• Retrospective Studies
• Risk Factors

• Budget-impact analysis
• COVID-19
• I00
• I10
• I11
• advanced bipolar devices
• dispersive electrode
• patient return electrode
• quadruple aim
• smoke evacuation
• triple aim
• ultrasonic

• Budgets
• Cost-Benefit Analysis
• Electrosurgery/economics
• Electrosurgery/instrumentation
• Financial Management, Hospital/economics
• Humans
• Length of Stay
• Models, Economic
• Operative Time
• Surgical Procedures, Operative/classification
• Surgical Procedures, Operative/economics
• Technology Assessment, Biomedical

The energy-based LigaSure device is widely utilized to facilitate dissection and hemostasis during various open and endoscopic procedures. Previous studies have demonstrated that this device can reduce intraoperative blood loss in various surgical settings. The present study aimed to report our experience with LigaSure and the advantages of using this device during transaxillary submuscular pocket dissection over those of a monopolar electrocautery dissector in patients undergoing breast augmentation.

A total of 156 patients who underwent transaxillary breast augmentation between November 2019 and May 2020 were retrospectively reviewed. Submuscular pocket dissection using LigaSure was performed in 92 patients and a conventional technique using a monopolar electrocautery dissector was performed in the remaining 64 patients. A bloodless breast pocket was defined as a clear operating field with little or no blood staining at any stage of the procedure. All endoscopic procedures were recorded to determine whether bloodless pockets had been established. The amount of postoperative drainage at 1 day after surgery was also assessed to compare between the LigaSure and conventional groups.

Bloodless breast pockets were successfully established in 83 patients (90.2%) in the LigaSure group and in 38 patients (59.4%) in the conventional group (P < 0.001). Postoperative drainage amount at 1 day following surgery was significantly lower in the LigaSure group than in the conventional group (P < 0.001).

Our findings indicate that the LigaSure system is a safe and effective alternative in breast augmentation requiring transaxillary submuscular dissection.

Ultrasonically activated shears (UAS) have been applied in open gastric surgeries with no or little evidence. It was previously reported about the surgical outcome and effectiveness of UAS based on a randomized controlled trial of 256 patients with gastric cancer. We aimed to clarify the long-term oncological safety of the use of UAS in the aspect of overall survival and recurrence.

Gastric cancer patients who underwent gastrectomy with D2 lymph node dissection were enrolled and randomly assigned to either the conventional surgery group (n=125) or the UAS group (n=128). Survival, recurrence and long-term postoperative complications were compared between the two groups. The median follow-up period was 56 months.

Gastric cancer-related death was higher in patients of the UAS group compared with the conventional group (P=0.019). Overall survival rates stratified by stage were not significantly different between the two groups (P=0.170). Disease-free survival rates stratified by stage and recurrence-free survival rates of gastric cancer were similar between the conventional group and the UAS group (P=0.313 and 0.199, respectively). The postoperative complication rate was not significantly different between the groups (P=1.000).

It is suggested that the use of UAS in gastrectomy for gastric cancer showed oncologically acceptable safety compared with conventional electric instruments even in long-term period.

• Stomach cancer
• gastrectomy
• oncological safety
• ultrasonically activated shears (UAS)

As compared to conventional techniques, recent meta-analyses have reported cost savings with Harmonic devices; however, only in thyroidectomy. Thus, the aim of this study was to evaluate the costs associated with Harmonic devices versus conventional techniques across a range of surgical procedures.

A systematic search of MEDLINE, EMBASE, and Cochrane Library was conducted from inception to October 01, 2016 without language restrictions to identify randomized controlled trials comparing Harmonic devices to conventional techniques and reporting procedure costs (operating time plus operating equipment/consumables/device costs). Costs were pooled using the ratio of geometric means, and a random effects model was applied. Sensitivity analyses varying statistical methods, number of included studies, and cost outcomes were completed to test the robustness of the results.

Thirteen studies met the inclusion criteria. A total of 561 and 540 participants had procedures performed with Harmonic devices and conventional methods, respectively, with procedures including gastrectomy, thyroidectomy, colectomy, cholecystectomy, Nissen fundoplication, and pancreaticoduodenectomy. As compared to conventional methods, Harmonic devices reduced total procedure costs by 8.7% (p=0.029), resulting in an absolute reduction of US$227.77 from mean conventional technique costs, derived primarily from a reduction in operating time costs. When operating time costs, excluding operating equipment/consumables/device costs, were analyzed, costs were reduced by $544 per procedure with the use of Harmonic devices. The results from all sensitivity analyses demonstrated cost reductions with Harmonic devices.

This systematic review and meta-analysis showed that despite a higher device cost, Harmonic devices provide a statistically significant reduction in procedure costs, derived primarily from a reduction in operating time costs, across surgical procedures. In addition to functionality benefits, Harmonic devices may represent a potentially cost saving method to reduce overall hospital resource use. Future research should focus on potential costs and benefits from use of Harmonic devices in procedures not covered here.

• Harmonic
• costs
• efficiency
• meta-analysis
• operating time
• surgery
• ultrasonic

• colorectal neoplasms
• diverticular disease
• laparoscopic surgery
• surgical hemostasis
• vessel sealing

• Blood transfusions
• Confounding
• Gastrectomy
• Gastric cancer
• Meta-analysis
• Surgery

• AMSTAR
• GRADE
• Harmonic scalpel
• Meta-analysis
• Surgical oncology
• Systematic review

• Humans
• Neoplasms/surgery
• Operative Time
• Prognosis
• Surgical Instruments
• Surgical Oncology/instrumentation

• Ethicon

Ferromagnetic heating is a new electrosurgery energy modality that has proven effective in hemostatic tissue dissection as well as sealing and dividing blood vessels and vascularized tissue. The purpose of this study was to evaluate a ferromagnetic-based laparoscopic vessel sealing device with respect to sealing and dividing vessels and vascularized tissue and to compare performance against current vessel sealing technologies.

A laparoscopic vessel sealing device, Laparoscopic FMsealer (LFM), was studied for efficacy in sealing and dividing blood vessels and comparative studies against predicate ultrasonic, Harmonic Ace+(US), and/or bipolar, LigaSure 5 mm Blunt Tip and/or Maryland (BP), devices in vivo using a swine model and in vitro for comparison of seal burst pressure and reliability. Mann-Whitney and Student t test were used for statistical comparisons.

In division of 10 cm swine small bowel mesentery in vivo, the laparoscopic FMsealer [12.4±1.8 sec (mean±SD)], was faster compared with US (26.8±2.5 s) and BP (30.0±2.7 s), P<0.05 LFM versus US and BP. Blinded histologic evaluation of 5 mm vessel seals in vivo showed seal lateral thermal spread to be superior in LFM (1678±433 μm) and BP (1796±337 μm) versus US (2032±387 μm), P<0.001. In vitro, seal burst strength and success of sealing 2 to 4 mm arteries were as follows (mean±SD mm Hg, % success burst strength >240 mm Hg): LFM (1079±494 mm Hg, 98.1% success) versus BP (1012±463, 99.0%), P=NS. For 5 to 7 mm arteries: LFM (1098±502 mm Hg, 95.3% success) versus BP (715±440, 91.8%), P<0.001 in burst strength and P=NS in % success. Five 60 kg female swine underwent 21-day survival studies following ligation of vessels ranging from 1 to 7 mm in diameter (n=186 total vessels). Primary seal was successful in 97%, 99% including salvage seals. There was no evidence of postoperative bleeding at sealed vessels at 21-day necropsy.

The Laparoscopic FMsealer is an effective tool for sealing and dividing blood vessels and vascularized tissue and compares favorably to current technologies in clinically relevant end points.

Background. Laparoscopic surgery has become more widely used, but peritoneal dissemination and port-site metastasis have been reported to occur in these surgeries. One reason for these problems is the ultrasonically activated scalpel (UAS) used for laparoscopic surgery. This study aimed to investigate the viability of airborne cells released during cancer dissection using a UAS. Methods. Flank tumors measuring about 2 cm were induced in male NOD-Cg-Rag1^tm1MomIL2rg^tm1wjl/SzJ mice by subcutaneous injection of 1 × 10⁶ HepG2 cells. Dissection was performed with UAS (in high or low power modes) and PowerStar bipolar scissors. The mist of released tissue was collected in cell culture medium. The viability of the cellular material was assessed with trypan blue exclusion cell counting, counting after immunofluorescence staining, and flow cytometric analysis. Results. Large quantities of cellular debris were trapped in the tissue dispersed by both devices. In all experiments, there were significantly more viable cells produced by the UAS in high power mode. By using suction at the excision site, the number of viable cancer cells was reduced. Conclusions. This study demonstrates that viable cancer cells can be released into the nearby environment during tumor ablation with a UAS.

• Appendectomy
• Children
• Lateral thermal damage
• LigaSure
• MiSeal
• Thermal injury
• Ultracision

• Adolescent
• Appendectomy/adverse effects
• Appendectomy/instrumentation
• Appendicitis/surgery
• Appendix/injuries
• Appendix/surgery
• Child
• Child, Preschool
• Dissection/adverse effects
• Dissection/instrumentation
• Female
• Hemostasis, Surgical/adverse effects
• Hemostasis, Surgical/instrumentation
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/instrumentation
• Male
• Postoperative Complications/etiology
• Treatment Outcome

• Bipolar
• Energy source
• Laparoscopy
• Ultrasonic

Despite hemostat use, uncontrolled surgical bleeding is prevalent. Drawbacks of current hemostats include limitations with efficacy on first attempt and suboptimal ease-of-use. Evarrest^® is a novel fibrin sealant patch that has demonstrated high hemostatic efficacy compared with standard of care across bleeding severities. The objective of this study was to conduct a hospital cost analysis of the fibrin sealant patch versus standard of care in soft tissue and hepatic surgical bleeding.

The analysis quantified the 30-day costs of each comparator from a hospital perspective. Published US unit costs were applied to resource use (ie, initial treatment, retreatment, operating time, hospitalization, transfusion, and ventilator) reported in four trials. A “surgical” analysis included resources clinically related to the hemostatic benefit of the fibrin sealant patch, whereas a “hospital” analysis included all resources reported in the trials. An exploratory subgroup analysis focused solely on coagulopathic patients defined by abnormal blood test results.

The surgical analysis predicted cost savings of $54 per patient with the fibrin sealant patch compared with standard of care (net cost impact: −$54 per patient; sensitivity range: −$1,320 to $1,213). The hospital analysis predicted further cost savings with the fibrin sealant patch (net cost impact of −$2,846 per patient; sensitivity range: −$1,483 to −$5,575). Subgroup analyses suggest that the fibrin sealant patch may provide dramatic cost savings in the coagulopathic subgroup of $3,233 (surgical) and $9,287 (hospital) per patient. Results were most sensitive to operating time and product units.

In soft tissue and hepatic problematic surgical bleeding, the fibrin sealant patch may result in important hospital cost savings.

• coagulopathic
• cost
• fibrin sealant patch
• health economics
• hepatic bleeding
• hospital
• soft tissue bleeding
• surgical bleeding

• Colectomy
• Diverticulitis
• Energized vessel sealing systems
• Inferior mesenteric artery
• Laparoscopy
• Mechanical ligature

• Electrosurgical device
• Enseal
• Harmonic Scalpel
• LigaSure
• electrothermal bipolar vessel sealers
• surgery
• surgical equipment
• ultrasonic shears

• Electrosurgery/instrumentation
• General Surgery/instrumentation
• Humans
• Ultrasonics/instrumentation

The ultrasonic Harmonic scalpel has demonstrated clinical and surgical benefits in dissection and coagulation. To evaluate its use in gastrectomy, we conducted a systematic review and meta-analysis of randomized controlled trials comparing the Harmonic scalpel to conventional techniques in gastrectomy for patients with gastric cancer. International databases were searched without language restrictions for comparisons in open or laparoscopic gastrectomy and lymphadenectomy. The meta-analysis used a random-effects model for all outcomes; continuous variables were analyzed for mean differences and dichotomous variables were analyzed for risk ratios. Sensitivity analyses were conducted for study quality, type of conventional technique, and imputation of study results. Ten studies (N = 935) met the inclusion criteria. Compared with conventional hemostatic techniques, the Harmonic scalpel demonstrated significant reductions in operating time (−27.5 min; P < 0.001), intraoperative blood loss (−93.2 mL; P < 0.001), and drainage volume (−138.8 mL; P < 0.001). Results were numerically higher for conventional techniques for hospital length of stay, complication risk, and transfusions but did not reach statistical significance. Results remained robust to sensitivity analyses. This meta-analysis demonstrates the clear advantages of using the Harmonic scalpel compared to conventional techniques, with improvements demonstrated across several outcome measures for patients undergoing gastrectomy and lymphadenectomy.

• Adult
• Blood Loss, Surgical
• Electrocoagulation/adverse effects
• Electrocoagulation/methods
• Female
• Gastrectomy/adverse effects
• Gastrectomy/methods
• Humans
• Lymph Node Excision/methods
• Male
• Middle Aged
• Operative Time
• Postoperative Complications/epidemiology
• Prospective Studies
• Sex Factors
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Ultrasonic Surgical Procedures/adverse effects
• Ultrasonic Surgical Procedures/methods

• LigaSure
• conventional hemostasis
• cost-analysis
• electrothermal bipolar vessel sealing technology
• laparoscopic surgery
• ultrasonic dissector

• Adult
• Aged
• Blood Loss, Surgical/prevention & control
• Electrosurgery/instrumentation
• Female
• Hemostasis, Surgical/instrumentation
• Hemostasis, Surgical/methods
• Hepatectomy/instrumentation
• Hepatectomy/methods
• Humans
• Liver/blood supply
• Liver/surgery
• Liver Transplantation
• Male
• Middle Aged
• Treatment Outcome

• Laparoscopic appendicectomy
• mesoappendix

Laparoscopic surgery for colorectal disease has become widespread as a minimally invasive treatment. This is important because the increasing availability of new devices allows us to perform procedures with a reduced length of surgery and decreased blood loss. We herein report the results of a literature review of energy sources for laparoscopic colorectal surgery, focused especially on 6 studies comparing ultrasonic coagulating shears (UCS) and other instruments. We also describe our laparoscopic dissection techniques using UCS for colorectal cancer. The short-term outcomes of surgeries using UCS and Ligasure for laparoscopic colorectal surgery were superior to conventional electrosurgery. Some authors have reported that the length of surgery or blood loss when Ligasure was used for laparoscopic colorectal surgery is less than when UCS was used. On the other hand, a recent study demonstrated that there were no significant differences between the short-term outcomes of UCS and Ligasure for laparoscopic colorectal surgery. It is therefore suggested that the choice of technique used should be made according to the surgeon’s preference. We also describe our laparoscopic dissection techniques using UCS (Harmonic ACE) for colorectal cancer with regard to the retroperitoneum dissection, dissection technique, dissection technique around the feeding artery, and various other dissection techniques. We therefore review the outcomes of using various energy sources for laparoscopic colorectal surgery and describe our laparoscopic dissection techniques with UCS (Harmonic ACE) for colorectal cancer.

• Laparoscopic surgery
• Ultrasonic coagulating shears
• Harmonic Scalpel
• Ligasure
• Colon and rectum
• Dissection technique

• Blood Loss, Surgical
• Colectomy/adverse effects
• Colectomy/instrumentation
• Colectomy/methods
• Electrocoagulation/adverse effects
• Electrocoagulation/instrumentation
• Humans
• Laparoscopy/methods
• Ultrasonic Therapy/adverse effects
• Ultrasonic Therapy/instrumentation

• Adenocarcinoma/pathology
• Adenocarcinoma/surgery
• Carcinoma, Squamous Cell/pathology
• Carcinoma, Squamous Cell/surgery
• Electrocoagulation
• Female
• Follow-Up Studies
• Humans
• Hysterectomy
• Incidence
• Lymph Node Excision
• Lymphocele/etiology
• Lymphocele/prevention & control
• Middle Aged
• Neoplasm Staging
• Pelvis/pathology
• Pelvis/surgery
• Peritoneum/surgery
• Postoperative Complications
• Prognosis
• Retrospective Studies
• Uterine Cervical Neoplasms/pathology
• Uterine Cervical Neoplasms/surgery