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Objective To study the clinical use of microwave scalpel in hepatectomy for hepatocellular carcinoma without hepatic vascular inflow occlusion.Methods A retrospective study was conducted on the clinical data of 126 consecutive patients with hepatocellular carcinoma who were treated at the Department of Hepatobiliary Surgery of the Third Affiliated Hospital of Sun Yat-sen University from December 2015 to August 2018.The patients included 111 males and 15 females,with ages which ranged from 25 to 75 years.These patients were divided into two groups by the different surgical resection methods:the microwave scalpel hepatectomy (MSH) group which employed microwave scalpels to perform hepatectomy (n =42),and the ultrasound scalpel hepatectomy (USH) group which employed ultrasound scalpels (n =84).The perioperative conditions which included baseline data,amount of intraoperative bleeding,liver function after operation,and morbidity of postoperative complications were compared.Results There were no significant differences in the preoperative indexes which included tumor diameter,number of tumors,levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) between the 2 groups (all P ＞ 0.05).In the MSH group,the amount of intraoperative bleeding was 100.0 (100.0,200.0) ml,which was significantly lower than the 300.0 (100.0,400.0) ml in the USH group (P ＜ 0.05).Compared with the USH group,the levels of AST and ALT on postoperative day 1,3,7 after operation in the MSH group were significantly lower (all P ＜ 0.05),and the corresponding albumin levels were significantly higher than the USH group (P ＜0.05).The incidence of complications was 4.8％ (2/42) in the MSH group which was significantly lower than that of 20.2％ (17/84) in the USH group (P ＜ 0.05).Conclusion Microwave scalpel significantly reduced intraoperative bleeding and postoperative complications,and led to less liver functional injury.
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@#Objective To compare the differences in the application of ultrasound scalpel and coagulation hook in thoracoscopic anterior mediastinal tumor surgery and to analyze the respective advantages and indications of the two commonly used energy instruments. Methods The clinical data of 85 patients undergoing thoracoscopic anterior mediastinal tumor surgery in West China Hospital of Sichuan University between June and November in 2017 were prospectively analyzed. There were 45 males and 40 females at age of 50.45 (18–75) years. The patients were divided into three groups including a ultrasound scalpel group (59 patients), a coagulation hook group (17 patients) and a mixed group (9 patients) according to the using time of energy devices. The clinical effect among the three groups were compared. Results No significant difference was found among the three groups in operation time, blood loss, average duration of chest tube drainage or volume of drainage (P>0.05). No significant complications occurred in all groups during operation or after operation. The proportion of subxiphoid approach in the ultrasound scalpel group was higher than that in the other two groups (49/59 vs. 7/17 vs. 5/9, P<0.01). The maximum diameter of the tumor (4.58±2.19 cm vs. 4.05±1.07 cm vs. 3.00±1.45 cm, P<0.05) and the resected tissue weight (103.67±74.78 g vs. 61.17±31.97 g vs. 61.86±34.13 g, P<0.05) were also significantly greater than that in the coagulation hook group or the mixed group. Conclusion Ultrasound scalpel has good safety and reliability in the thoracoscopic anterior mediastinal tumor surgery, and is more suitable for operation in a narrow space.
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Objective To explore the feasibility of high-frequency electric welding systemin cholecyste-ctomy when compared with ultrasound scalpel , Ligasure and traditional scalpel. Methods Ninety-six rabbits were enrolled in the study and divided into high-frequency electric welding system group , ultrasound scalpel group , Ligasure group and traditional scalpel group. The working temperature was recorded. Eight rabbits of each group were killed to observe the occlusion at 1st, 4th, 7th day postoperatively. Tissues were collected for observation under HE staining. Results High-frequency electric welding system group excelled in operative time , bleeding, working temperature, granulation tissue and inflammatory reaction. No significant difference was found in preope-rative and postoperative liver function test. Conclusion High-frequency electric welding system in cholecyste-ctomy has similar effect as ultrasound scalpel and Ligasure.
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Objective To discuss the feasibility and safety of total mesorectal excision under laparoscopy by ultrasonic scalpel for rectal carcinoma. Methods The data of 83 patients with rectal carcinoma who received gastrointestinal surgery under laparoscopy in our hospital from March 2011 to September 2013 were analyzed. According to the method of total mesorectal excision,they were divided into ultrasound knife group of 44 cases and a high-frequency electric knife group of 39 cases. The differences of the intraoperative and postoperative related index between two groups were compared and the postoperative complications were analyzed. Results All gastrointestinal operations under laparoscopy were completed successfully. The operation time(221. 6 ± 48. 7) min and the peri-operative bleeding (64. 2 ± 39. 5) mL of ultra-sound knife group were significantly lower than the operation time(284. 3 ± 52. 4) min and the peri-operative bleeding (98. 7 ± 49. 3) mL of high frequency electric knife group (P0. 05). The volume of harmful gas included CO and acryloni-trileis at the 15min,30min,45min during the operation of ultrasound knife group were significantly lower than that of high frequency electric knife group (P0. 05). Conclu-sion Treatment of laparoscopic surgery for rectal cancer by ultrasonic scalpel in total mesorectal excision has the advantages of less operation time,intraoperative blood loss and less harmful gases,which is effective and safe.
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Objective To study the effect of the ultrasound scalpel and electric knife in axillary lymph node dissection in modified radical mastectomy for breast cancer.Methods The clinical data of 429 patients with modified radical mastectomy for breast cancer were analyzed retrospectively.The axillary lymph node dissection in 178 cases were performed with the ultrasound scalpel (ultrasound scalpel group) and 251 cases were done with the electric knife(electric knife group).The blood loss,operative time,extubation time,the total amount of drainage,the incidence of seroma were compared.Results Two groups were successfully operated,no axillary vessels and long thoracic nerve,chest nerve injury.The blood loss,operative time,extubation time,the total amount of drainage in ultrasound scalpel group were significantly better than those in electric knife group [(98.0 ± 10.2) ml vs.(152.0 ± 11.5) ml,(125.0 ±9.6) min vs.(155.0 ± 12.3) min,(6.0 ± 2.1) d vs.(9.0 ± 4.3) d,(227.0 ± 10.6) ml vs.(319.0 ± 15.8) ml,P＜ 0.05 or ＜ 0.01].The incidence of seroma was no significant difference between two groups (P ＞ 0.05).Conclusions Using ultrasound scalpel in axillary lymph node dissection for breast cancer can significantly reduce operative time,and is consistent with less blood loss,less extubation time and the total amount of drainage.