When was the harmonic scalpel introduced

The indications for tonsillectomy are numerous. The most widely accepted include: recurrent infections; obstructive sleep apnoea; peritonsillar abscess with recurrent tonsillitis; malignancy or suspected malignancy; and tonsillitis that has caused febrile seizures.

Until the late s, tonsillectomies were performed by cold surgical dissection, where the tonsil is removed from its capsular plane by blunt and sharp dissection. In the s, many surgeons found that hot electrocautery was safe, easy to perform, and offered good control of intraoperative haemorrhage. In fact, monopolar electrocautery dissection is one of the most common procedures in use today. Innovation and research continue to lead to improvements in the efficacy, safety, and cost of tonsillectomy.

One such innovation is the ultrasonic harmonic scalpel, which was introduced in Ethicon Endo-Surgery and which is becoming increasingly popular as a tonsillectomy device. The harmonic scalpel has been shown to be a valuable tool for numerous surgical procedures, including cholecystectomy, bowel resection, and adhesiolysis.

The instrument minimizes lateral thermal tissue damage. There is almost no need for instrument changes. The reasons for the increasing popularity of the harmonic scalpel are its purported associations with less postoperative pain and an earlier return to oral intake and regular activities. Compiled and edited by John Sandham. Venous ablation is a technique for the treatment of venous reflux in legs using diathermy or laser equipment.

Venous stasis is a common condition in which the flow of blood from the legs to the What do healthcare organisations need to do with their medical equipment management policy to meet the regulations and Up until the mid s, The NHS had traditionally focussed on medical equipment maintenance excluding procurement planning, user training, and quality records.

It was during the 80s that staff in These processes will check that equipment meets safety standards, meets A hyfrecator is a low power medical electro-surgical diathermy. To understand hyfrecation, the properties of electricity must be Department of Electronics, Back Register Active Threads. Back Delegates. Active tips of the ultrasonic coagulating shears. All employ a rigid active lower blade through which the vibrating energy is transmitted.

The movable upper jaw is used to compress the vessel against the lower blade, thus allowing transfer of the vibrational energy. The top 2 devices have straight blades. The bottom device has a curved blade facilitating perpendicular placement across vessels.

A "double ligation technique" to divide the inferior thyroid vein. A, The device is applied across the vein near the thyroid for approximately 3 seconds until the vessel is sealed, but not yet divided. B, The device is then moved along the vessel several millimeters away from the thyroid, and the vessel is sealed and divided. C, The cut vessel end is seen with an additional segment sealed adjacent to the thyroid.

This double ligation technique minimizes the chance of vessel hemorrhage. Scatterplot showing the operative times in the 4 different arms of the study. Each case is represented by a circle. The use of the harmonic scalpel saved an average of 26 minutes in lobectomy and 29 minutes in thyroidectomy procedures compared with conventional knot tying. Scatterplot showing the relationship between operative time and the maximum diameter of the thyroid specimen for lobectomy procedures.

The harmonic scalpel cases had a tendency for lower operative times compared with the conventional technique at similar thyroid sizes. Scatterplot showing the relationship between operative time and the maximum diameter of the thyroid specimen for total thyroidectomy procedures.

Arch Surg. Hypothesis The technique of thyroidectomy has undergone little change in several decades. The harmonic scalpel, using ultrasonic frictional heating to ligate vessels, is widely used in laparoscopic surgery, but there is little experience in open thyroidectomy.

We hypothesized that the use of the harmonic scalpel could lead to a significant reduction in operative time as compared with knot tying in thyroid surgery. Patients One hundred seventy-one consecutive patients undergoing lobectomy or total thyroidectomy by one surgeon A. Results The 2 groups were similar regarding age and sex.

There were no intraoperative complications. There was no difference between the 2 techniques regarding the amount of blood loss for different procedures. There was no effect of tumor size on operative time Pearson correlation factors: 0. Conclusions The use of the harmonic scalpel for the control of thyroid vessels during thyroid surgery is safe, and it shortens the operative time by almost 30 minutes compared with the conventional technique for both unilateral lobectomy or total thyroidectomy procedures.

It is a device that uses high-frequency mechanical energy to cut and coagulate tissues at the same time. It has been proven to decrease operation time and complications in studies of abdominal solid organ surgery, 2 - 5 adrenalectomy, 6 and thoracic surgery, 7 , 8 as well as many other procedures.

Thyroid surgery initially started in the 12th century with the use of setons, hot irons, and caustric powers often with fatal results. A major advance was the introduction of ether anesthesia, antisepsis, and artery forceps to practice. By , the principles of safe and efficient thyroid surgery had been established.

The only debate and change have been with regard to the choice of a certain type of operation ie, lobectomy, total thyroidectomy, or subtotal thyroidectomy for a given diagnosis. Some alternative methods in thyroid surgery that have been tried during the last decade include endoscopic surgery, nerve stimulations, and even hypnosis for anesthesia; however, none has been widely accepted. Thyroidectomy is, in essence, devascularization of the thyroid by double ligating and dividing the branches of the thyroid vessels followed by excision of the gland, as is true for all resectional surgical procedures.

The unique feature of this operation is that the thyroid gland has one of the richest blood supplies among the organs, with numerous blood vessels and plexuses entering the parenchyma. These need to be controlled with ligatures. The ligation and division of these vessels is time consuming. Reduction of the time spent with the conventional clamp-tie technique can significantly reduce the operative time in this procedure. Since time spent in the operating room is expensive, 17 this will both decrease the operation time and the operative costs.

In this sense, we hypothesized that the use of the harmonic scalpel could lead to a significant reduction of the operative time in thyroid surgery and report the results of an initial case-controlled study comparing the use of conventional suture tying vs the harmonic scalpel in patients undergoing lobectomy or total thyroidectomy.

Between February and December , patients underwent various thyroid surgical procedures performed by one surgeon A. Those patients undergoing either lobectomy or total thyroidectomy form the subject of this study for practical considerations. The choice between the type of surgery for a given patient depended on the availability of the equipment.

We started using the harmonic scalpel for thyroid procedures in April All patients had routine preoperative workup for their disease and the same anesthetic and hospital care regardless of the surgical technique employed.

All patients were admitted on the morning of the scheduled operation and had a hour hospital stay. All procedures were performed using endotracheal general anesthesia. The patients were positioned and draped in the conventional manner. A 4- to 6-cm incision depending on the size of the thyroid was made over the level of the thyroid isthmus. Subplatysmal flaps were developed, and the strap muscles were separated in the midline and laterally reflected. The inferior, middle, and superior thyroid vessels were then divided either with the harmonic scalpel or with conventional knot tying Figure 3.

The thyroid lobe was then medially rotated, and the vessels in the ligament of Berry, with the nerve under direct vision, were clamped and tied in both groups. The same steps are repeated for removal of the contralateral lobe. Finally, the wound was irrigated and closed using interrupted polyglactin sutures to approximate the strap muscles and the platysmal layer.

The skin was closed using Michel clips, which were removed on postoperative day 1. Patients with previous neck surgery, those with extrathyroidal invasion of malignant tumors of the thyroid, and those undergoing an accompanying additional procedure ie, parathyroidectomy, lymph node dissection were not considered for analysis. No additional time was spent in any case for waiting for the frozen-section pathology report.

To investigate the effect of histopathology on surgery time, histopathology was divided into 2 major categories: focal pathologies, comprising benign and malignant thyroid tumors; and diffuse pathologies, including goiter, thyroiditis, and Graves disease.

Subtotal thyroidectomies were also considered under total thyroidectomy cases for practical reasons. All patients were followed up with office visits 2 weeks after surgery.

The 2 groups were similar regarding age and sex. For the total thyroidectomy procedure, there was no difference between groups regarding the distribution of focal vs diffuse pathologies.

There was no effect of tumor size on operative time Pearson correlation factor: 0. Hemostasis is of utmost importance in thyroid surgery to control and divide the numerous vessels before excision of the gland. Traditional surgery involves hand-tied ligatures to control the 2 ends of a vessel before division. Although many sophisticated means of achieving vessel control eg, bipolar electrocautery, lasers, clips, and staples found widespread applications in many other types of procedures, the only modification of the thyroidectomy technique during the past decades included the use of monopolar electrocautery for dissection due to various technical, anatomical, and practical reasons.

Clips work for large vessels and are subject to dislodgment; whereas staples are wasted and costly for multiple single-vessel applications. Lasers are hindered by the risk of injury to many vital structures such as the recurrent nerves in the operative field, and bipolar electrocautery does not give the surgeon the freedom of applicability at different angles.

The development of ultrasonically activated coagulating shears in the early s has provided an alternative to other methods of controlling blood vessels. The device divides tissue by using high-frequency 55 Hz ultrasonic energy transmitted between the instrument blades. With our initial experience from laparoscopic surgery, we started using the harmonic scalpel in for thyroid surgery. We have so far assessed its use in more than patients undergoing various thyroid and parathyroid procedures, including lobectomy; subtotal, total, or completion thyroidectomy; neck dissections; and parathyroidectomy.

To the best of our knowledge, in this article, we report the largest experience in the literature about the use of the harmonic scalpel in thyroid surgery. We showed that the use of the harmonic scalpel for the control of thyroid vessels during thyroid surgery is safe, and that it shortens the operative time by almost 30 minutes compared with the conventional technique for both unilateral lobectomy or total thyroidectomy procedures despite the larger size of the thyroid removed with the harmonic scalpel.