Comparison of two ultrasonic coagulating shears in sealing pulmonary vessels

Devanathan Raghavan,1 John A Howington,2 Duan Broughton,1 Cortney E Henderson,1 Jeffrey W Clymer1 1Preclinical Research, Ethicon Endo-Surgery, Cincinnati, OH, USA; 2NorthShore University HealthSystem, Chicago, IL, USA Abstract: Ultrasonic cutting and coagulating devices have been used successfully in thoracic applications such as pulmonary resection or artery harvesting, but few studies have evaluated their use in sealing pulmonary vessels. In this study we compared two commercially available devices, Harmonic Ace+ (HAR, Ethicon Endo-Surgery, Inc., Cincinnati OH, USA) and SonoSurg (SS, Olympus America, Center Valley, PA, USA), in a canine preclinical model. There were three sections to the study: acute, survival, and ex vivo (burst pressure). Hemostasis of sealed pulmonary arteries and veins was assessed for the initial application and during a simulated hypertensive crisis, both immediately after vessel sealing and after a survival period of 30 days. Other intraoperative measures were also evaluated, including transection time, tissue sticking, tissue tags, and char on the seal. Histological evaluation was performed both after initial sealing and after the survival period. Burst pressure of sealed vessels was measured ex vivo. For both devices, hemostasis was excellent, including those measurements made under simulated hypertensive crisis. There were no differences in any of the intraoperative measures or thermal damage evaluated histologically. Wound healing was normal. The burst pressures for ex vivo vessels sealed by HAR (median 619.2 mmHg) were significantly higher than those of SS (350.3 mmHg, P = 0.022). Both devices displayed acceptable characteristics in sealing canine pulmonary arteries and veins. The only difference observed was that HAR produced burst pressures 76.8% greater than SS, which may lead to a lower percentage of failures in the region of physiological interest. Use of ultrasonic devices in thoracic applications provides a high rate of initial hemostasis, supraphysiological burst pressures, and durable seals that heal normally. Keywords: ultrasonic sealing, thoracic, pulmonary vessels, burst pressure, hemostasi

Microdecompression for lumbar synovial cysts: an independent assessment of long term outcomes

<p>Abstract</p> <p>Background</p> <p>Outcomes of surgical intervention for lumbar synovial cysts have been evaluated in the short and intermediate term. Concerns regarding cyst recurrence, the development of late instability at the involved level, and instability/stenosis at adjacent levels (when concomitant) fusion is performed suggest that long term follow-up is needed. This study aims to fill that void.</p> <p>Methods</p> <p>Forty-six patients operated by a single surgeon not involved in the study were followed up long term at an average of 9.7 years (range 5 to 22 years) post-operatively. All patients underwent decompression (+/- concomitant arthrodesis in the presence of associated degenerative spondylolisthesis) using the operative microscope for magnification/illumination. Outcomes were assessed using a customized questionnaire evaluating: relief of pain/claudicant symptoms, numbness/parasthesias, and weakness; as well as late onset low back pain, new radicular symptoms, need for additional surgery, and patient satisfaction. Outcomes in patients with or without fusion were compared as well.</p> <p>Results</p> <p>87% of patients noted resolution of their pre-operative pain, numbness, and weakness. 28% of patients developed late onset low back pain. 17% developed late onset radicular symptoms in a new nerve root distribution. 15% required subsequent additional surgery. 89% of patients were satisfied with the surgical outcome. No differences were found for any outcome measure between patients undergoing concomitant fusion and those undergoing decompression alone using the two-sample t-test.</p> <p>Conclusion</p> <p>This study provides outcome data at an average of nearly ten years post-operative. This information should allow surgeons to provide realistic expectations for their patients regarding outcomes and should enhance the informed consent and surgical decision-making process.</p