Use of the harmonic scalpel versus conventional haemostatic techniques in patients with Grave disease undergoing total thyroidectomy: a prospective randomised controlled trial

INTRODUCTION: Thyrotoxicosis is often considered to be the most difficult thyroid operation because of the high vascularisation and the risk of bleeding. The conventional haemostatic technique in thyroidectomy today include knot tying and electrocoagulation. The introduction of the harmonic scalpel (HS) has led to further research if the use of the HS has any benefits in thyroid surgery. To our knowledge, no previous study has evaluated the HS dissection technique in a homogenous group of patients with Graves' disease undergoing total thyroidectomy. MATERIALS AND METHODS: Fifty-one patients (39 women and 12 men) with the pre-operative diagnosis of Graves' disease treated at two endocrine centers were randomised to total thyroidectomy with the use of the HS or with conventional haemostatic techniques. RESULTS: Twenty-seven patients were randomised to the harmonic group and 24 to the conventional group. The operating time was shorter in the HS group (median, 121 min; range, 84-213 min) compared to the conventional group (median, 172 min; range, 66-268 min; p = 0.011). CONCLUSION: The use of the HS was associated with a significant reduction in operating time compared to the use of the conventional haemostatic techniques in patients with Graves' disease undergoing total thyroidectomy.     

超声刀在小切口机械悬吊腔镜辅助下甲状腺手术中的应用体会

目的观察超声刀在小切口机械悬吊腔镜辅助下甲状腺手术（Miccoli手术）应用的效果。方法对28例甲状腺疾病患者在Miccoli手术中使用超声刀。结果28例完成Miccoli手术,平均出血量8m1（5—10m1）,术后切口引流仅有少量渗湿,纱布（覆盖切口纱布为8层）渗湿面积平均2cm^2（1～5cm^2）,无神经损伤,无甲状旁腺损伤。结论超声刀能保证Miccoli手术顺利完成,止血效果可靠,使用方便,安全。     

超声刀在小切口甲状腺手术中的应用

目的探讨应用超声刀在小切口甲状腺手术中效果。方法对我科于2006年1月～2007年4月,106例良性甲状腺疾患(Ⅱ°)采用颈部小切口及超声刀下施行甲状腺次全切除术进行回顾性分析。结果手术平均时间50min(40～90min),术中平均出血量20ml(5～40ml),术后24h平均切口引流量20ml(10～40ml),术后1例出现口角麻木、低钙血症者。术后平均住院时间4d(3～5d)。结论超声刀在甲状腺中应用能减少手术时间、术中出血,手术并发症少,术后恢复快,手术切口小,而且具有美容效果。     

Haemorrhoidectomy using harmonic scalpel: An initial report

Objective : The objective of this study was to evaluate the surgical outcomes of haemorrhoidectomy using harmonic scalpel. Method : From June to August 1999, 12 patients suffering from third degree piles were admitted for harmonic scalpel haemorrhoidectomy. The whole operation was performed entirely with the harmonic scalpel with the power set at level 3. The pedicles were coagulated with the harmonic scalpel rather than transfixed. Postoperatively, pethidine injection was given intramuscularly on demand for pain control. The postoperative pain score (0–10) from the first to the fifth postoperative day was assessed. Patients were followed up at 4, 8 and 12 weeks, and complications were recorded. Results : Twelve patients with a median age of 48 years were studied. The median operation time was 15 min (range: 12–20), with a median blood loss of 15 mL (range: 2–25). The median postoperative stay was 2 days (range: 2–4). The median pain score was maximal at postoperative day one (score: 3). The pain score rapidly dropped over the next 2 days, and became zero by postoperative day 4. Only two patients required pethidine injections on the first postoperative day. Conclusion : Preliminary evidence suggests harmonic scalpel haemorrhoidectomy is safe and expedious; it is associated with less pain compared with conventional scissors dissection, and is a good alternative to diathermy excision.      

国产超声刀在普外科开放手术中的临床应用：附视频

目的探讨国产超声刀在普外科开放手术应用中的有效性及安全性。方法将2008年9月至2010年2月60例行开放手术的患者,随机分为试验组和对照组,各30例。试验组运用国产BBT超声手术系统,对照组运用美国强生超声刀,观察并比较两组患者组织切割时间、血管凝同时间、术中出血量、术后住院天数、术后腹腔引流管引流量等指标。结果试验组和对照组之间术中出血量无明显差异[（89．50±27．65）mlvs5（95．23±22．95）ml,P=-0．298],而且术后住院时间【（17.3±8．8）dvs（16．1±9．9）d,P=0．6041及术后腹腔引流[（180．6±61．0）ml口s（174．9±44．4）ml,P=0．674]在两组之间差异均无统计学意义;但与对照组相比,试验组的组织切割平均时间[（6．95±1．41）s vs（4．32±1．11）s,P〈O．05]和血管凝同时间[（6．00±0.314）s vs（2．68±0．123）s,P〈0．001]要长。结论国产BBT超声手术系统安全有效,符合临床使用的要求,可以在临床推广运用。     

超声刀与高频电刀在腹腔镜胆道探查术中的对比研究

目的:对比研究超声刀(ultrasonic harmonic scalpel,UHS)与高频电刀(high-frequency mono-polar electronic scalpel,HMES)在腹腔镜胆道探查术(laparoscopic common bile duct exploration,LCBDE)中的应用价值。方法:回顾分析216例LCBDE患者的临床资料,其中98例术中应用UHS(A组),118例术中应用HMES(B组);对比分析两组手术时间、术中出血量、中转开腹率、术后胆漏率、术后出血量及住院时间;检测两组患者术前及术后第1天、第3天、第5天ALT、AST、TBIL、DBIL、GGT、ALP水平。结果:两组患者手术时间、术中出血量、中转开腹率、术后胆漏率、术后出血量及住院时间差异均无统计学意义(P>0.05);肝功能检测显示,与术前比较,A组术后第1天,B组术后第1天、第3天ALT、AST明显升高(P<0.05),第5天两组均恢复至正常水平;术后第3天两组间差异有统计学意义(P<0.05)。两组患者术后第3天、第5天TBIL、DBIL水平较术前及术后第1天显著降低,术后第5天较第3天显著下降(P<0.05);术后第5天两组ALP、GGT较术前显著下降,两组间相比差异无统计学意义(P>0.05)。结论:LCBDE术中应用UHS、HMES均是安全、有效的,可有效解除胆道梗阻。     

甲状腺手术中使用超声刀对喉返神经的保护作用

目的比较超声刀行甲状腺手术与传统甲状腺手术对喉返神经的保护作用。方法263例患者采用超声刀行甲状腺手术,228例采用传统方法行甲状腺手术．对比两种手术方法对喉返神经的保护、术后喉返神经损伤并发症发生情况,评估超声刀在预防喉返神经损伤方面的优缺点。结果263例甲状腺手术使用超声刀,2例因热损伤出现暂时性声嘶,均在3个月内恢复：传统方法出现声嘶并发症7例,其中3例术中被缝扎,松解后均在术后1周内缓解,3例术后3个月至半年发音恢复正常,1例术后出现声嘶超过1年以上未好转。结论超声刀行甲状腺手术可减少术中出血,有利于喉返神经行程的辨认。     

超声刀在经脐单孔腹腔镜胆囊切除术中的应用

目的探讨超声刀在经脐单孔腹腔镜胆囊切除术(transumbilical single port laparoscopic cholecystectomy TUS-PLC)中的应用效果。方法 2011年1月～2012年12月,使用超声刀及普通器械完成43例经脐单孔腹腔镜胆囊切除术,对临床数据进行分析。结果手术均获成功,无中转常规腹腔镜手术或开腹手术,手术过程顺利,术野清晰,手术时间18～38 min,平均29 min,术中出血<5 ml,术后无出血、胆漏等并发症发生。结论使用超声刀完成经脐单孔腹腔镜胆囊切除术,安全可行,且降低了手术难度,缩短了手术时间。     

超声刀在经脐单孔腹腔镜手术中的应用价值

目的探讨经脐单孔腹腔镜手术过程中超声刀的应用价值。方法2009年5月至2009年12月共完成经脐单孔腹腔镜手术42例,男22例,女20例,年龄17～73岁,其中经脐单孔腹腔镜阑尾切除术21例,经脐单孔腹腔镜肠粘连松解术8例,经脐单孔腹腔镜胆囊切除术13例。在42例经脐单孔腹腔镜手术中,使用超声刀和可弯曲的加长腹腔镜器械完成操作。结果全部患者手术均获成功,无中转常规腹腔镜手术或开腹手术,手术过程顺利,术野清晰,手术出血量均〈30ml,无术后继发出血和其他并发症发生。结论使用超声刀和相应手术器械完成经脐单孔腹腔镜手术安全可行,具有瘢痕隐蔽、组织损伤小等优点,深化了腹腔镜手术的微创理念,值得推广。     

Minimally invasive video-assisted thyreoidectomy (MIVAT) with and without use of harmonic scalpel—a randomized study

BACKGROUND AND AIMS: Minimally invasive video-assisted thyroidectomy (MIVAT) has been used for the removal of small thyroid nodules to improve cosmetic results and diminish pain. The aim of this study was to compare the outcomes of the MIVAT operations with and without the use of an ultrasonic harmonic scalpel (HS). PATIENTS AND METHODS: Seventy-six patients with a solitary thyroid nodule below 30 mm in diameter were randomized to two groups of 38 patients each. Unilateral thyroid lobectomy was performed in each patient. In the clip-ligation group (CL-G), during MIVAT, the superior thyroid vessels were clipped and bipolar coagulation was used to secure smaller vessels, whereas in the harmonic scalpel group (HS-G), HS was used to dissect and divide all the thyroid vessels. The statistical analysis included the mean operative time, blood loss, postoperative morbidity, scar length, cosmetic satisfaction at 1 and 6 months following surgery, and cost-effectiveness. RESULTS: HS-G vs CL-G operations were shorter (31.4 +/- 7.7 vs 47.5 +/- 13.2 min; p < 0.001), the mean blood loss was smaller (12.9 +/- 5.7 vs 32.8 +/- 13.0 ml; p < 0.001), the mean scar length at 1 month following surgery was shorter (15.6 +/- 1.4 vs 21.5 +/- 1.9 mm; p < 0.001), and greater cosmetic satisfaction was achieved at 1 month after surgery (88.9 +/- 9.7 vs 81.9 +/- 5.4 pts; p < 0.001), but the difference became nonsignificant at 6 months postoperatively. MIVAT with HS was 20-30 euros more expensive. No major complications were observed in both groups. CONCLUSIONS: HS in the MIVAT operations is safe and facilitates dissection, allowing for a significant decrease in operative time. Other benefits, such as lower blood loss, a scar a few millimeters shorter, or a slightly better early cosmetic result, are offered at slightly increased costs.     

超声刀在直肠癌经腹会阴联合根治性手术会阴部操作中的应用

目的:探讨低位直肠癌经腹会阴联合根治术在会阴部操作中使用超声刀与使用电刀的差异.方法:2007年6月至2009年10月收治低位直肠癌患者35例,其中19例使用强生公司豪韵GEN04超声切割止血系统手术(超声刀组),另16例使用电刀作为对照(电刀组).两组患者年龄、性别、肿瘤Dukes分期、大体类型、组织学分化程度等差异...     

Hepatic resection using the harmonic scalpel

We describe herein our technique of performing extensive resection of the liver by blunt dissection in combination with excision using a harmonic scalpel. A ball coagulator was inserted at 3-cm intervals along the proposed cutting line in the liver, and the liver parenchyma between these holes was then cut using coagulation shears. Regardless of the condition of the liver, good coagulation and cutting were achieved using the harmonic scalpel without vascular occlusion when dividing the shallow layer of the liver, and no complications in association with the harmonic scalpel, such as postoperative bleeding, bile leakage, or abscess formation at the cut margins, occurred. In the deep layer below the main trunk of the hepatic vein, blunt dissection was used, since it was difficult to achieve sufficient control of bleeding from large vessels using the harmonic scalpel alone. Therefore, when used in combination with other techniques, the harmonic scalpel appears to be an effective device for liver surgery that minimizes bleeding and decreases the vascular clamping time. Received: October 14, 1999 / Accepted: May 30, 2000     

应用超声刀行乳腺癌腋窝淋巴结清扫近期疗效观察

目的 研究应用超声刀行乳腺癌腋窝淋巴结清扫的安全性及近期疗效。方法 回顾性分析2009年9月至2010年12月,北京大学第一医院乳腺疾病中心应用HARMONIC超声刀配备FOCUS刀头行乳腺癌腋窝淋巴结清扫手术30例的临床资料（研究组）,并选择同期、相同术者完成的以高频单极电刀行腋窝淋巴清扫手术病例为对照组,进行对比观察。结果 研究组的平均腋窝引流时间短于对照组（11.4 vs. 15.7d,P=0.029）,而手术时间、术中出血、淋巴结清扫数量以及淋巴引流总量等方面二者差异无统计学意义。结论 与高频单极电刀相比,应用超声刀行乳腺癌腋窝淋巴结清扫安全可靠并可以缩短术后腋窝引流时间及住院天数。     

腹腔镜逆行阑尾切除术中超声刀与电刀作用的比较研究

目的：腹腔镜逆行阑尾切除术中超声刀与电刀的作用进行对照比较分析,探讨超声刀的优越性。方法回顾分析总结2007-2013年逆行阑尾切除术中使用超声刀的38例及使用电刀的44例临床资料进行对比分析。结果平均手术时间超声刀组为（43.05±3.65）min,电刀组为（47.25±6.36）min,与电刀组相比超声刀组手术时间显著下降（P 〈0.01）。出血量分别为（3.51±1.05）ml、（10.05±2.33）ml,超声刀组显著低于电刀组（P 〈0.01）。超声刀组无开腹病例,术后无肠梗阻发生,电刀组开腹7例,术后肠梗阻3例,两组间差异有统计学意义（P 〈0.01）。结论超声刀在腹腔镜逆行阑尾切除中具有创伤小、手术时间短、并发症少等优点,切割止血、手术操作安全性方面超声刀应用效果优于电刀。     

头灯放大镜辅助下Focus超声刀甲状腺切除术和传统手术的比较

目的 探索头灯放大镜辅助下Focus超声刀甲状腺切除术相对于传统手术的优势和技术要点。方法 自2009年9月至2011年5月在头灯放大镜辅助下采用Focus超声刀为主要手术切割工具完成甲状腺切除术211例。采用病例-对照研究的方法,选取2008年6月至2009年8月传统手术方法行甲状腺切除术230例为对照组。比较两组一般临床参数、切口长度、手术时间、术中出血量、术后引流情况、并发症、术后住院天数等指标。结果 两组临床参数相近,有可比性。相对于传统手术组,Focus超声刀组平均切口长度小、手术时间短、术中出血量和术后引流量少,差异有统计学意义。微创手术组88.2%无需放置引流管,常规手术组均放置引流胶管。两组手术并发症率和术后住院天数相近,差异无统计学意义。结论 头灯放大镜辅助下Focus超声刀甲状腺切除术切口小、手术时间短、术中出血少、术后引流量少,不增加并发症率,符合微创外科原则。     

The ultrasonic harmonic scalpel for circumcision: experimental evaluation using dogs

Male circumcision is one of the most commonly performed operations worldwide, and many novel techniques have been developed for better postoperative outcomes. The purpose of this study was to explore the feasibility of applying the ultracision harmonic scalpel (UHS) for circumcision by using dogs. Sixteen adult male dogs were divided into two groups: the UHS group and the control group. The dogs were circumcised with either the UHS or a conventional scalpel. The UHS circumcision procedure and the effects were imaged 1 week after surgery. The two groups were compared with respect to the operative time and volume of blood loss. Postoperative complications, including oedema, infection, bleeding of the incision and wound dehiscence, were recorded for both groups. The mean operative time for the UHS group was only 5.1 min compared with the 35.5 min of the conventional group. The mean blood loss was less than 2 ml for the UHS group and 15 ml for the conventional group. There was only one case of mild oedema in the UHS group, but the postoperative complications in the conventional group included two cases of mild oedema, one infection of the incision and one case of bleeding of the incision. In conclusion, circumcision using UHS is a novel technique to treat patients with phimosis and excessive foreskin, and this method has a short operative time, less blood loss and fewer complications than the conventional scalpel method. This small animal study provides a basis for embarking on a larger-scale clinical trial of the UHS.