The New HARMONIC ACE®+7 Shears: A Game Changer in Ultrasonic Hemostasis.

The latest version of HARMONIC®, the HARMONIC ACE®+7 Shears by Ethicon US, LLC, is now commercially available. While earlier models also had easy-to-use handles and a fine, non-stick tip, the HARMONIC ACE®+7 Shears adds a new hemostasis feature. The "7" in HARMONIC ACE®+7 stands for the device's ability to coagulate and divide 7-mm vessels. This is accomplished via an Advanced Hemostasis Mode and button located on both sides of the handle. The HARMONIC ACE®+7 will prove itself the leader in the ultrasonic energy field.

Laparoscopic Morcellation and Tissue Spillage Containment Using the LI Endofield™ Bag.

There are many times during laparoscopic surgery that a surgeon, whether gynecologist or general surgeon, must work in an environment where spillage of tissue or organ contents should be avoided. In gynecologic surgery, this involves management of ovarian cysts as well as containment of tissue fragments during morcellation of uteri or fibroids. Unfortunately, many laparoscopic containment bags on the market today are not large enough to remain open on their own during the entire procedure. The LI Endofield™ and LI Endofield™ TV bag offer a solution and provide an adjustable and suturable "field bag." Surgeons can work in an adjustable "field," are able to see through the bag, and can remove it at the end of the procedure. With the recent FDA cautions on power morcellation, our team only morcellates fibroids and uteri using one of these bags.

Use of the ENSEAL® G2 tissue sealer in gynecologic surgery.

Minimally invasive surgery (MIS) has become the standard of care for a variety of surgical conditions, and reliable vessel sealing and precise cutting are essential. A variety of tissue-sealing devices have been used successfully to decrease operating time and control bleeding during hysterectomy and other MIS gynecologic procedures. One development involves the next generation of advanced bipolar devices by ETHICON (Ethicon Endo-Surgery Inc., Cincinnati, OH), called ENSEAL® G2 Tissue Sealers. Tip improvements to the ENSEAL® have included stronger jaws and a welded positive electrode in the stationary jaw, thus enabling the new ENSEAL® G2 Tissue Sealer to provide reliable vessel sealing and precise cutting all in the same instrument. The patented I-BLADE® forces the jaws of the device together as it advances, resulting in high, uniform compression along the entire length of the jaws. The temperature-regulating Positive Temperature Coefficient (PTC) material in the jaws is designed to minimize sticking, and the offset electrode configuration is designed to minimize thermal spread. The ergonomics provided by the ENSEAL® G2 Tissue Sealer offer significant improvement over previous devices and may make this a much more cost-effective choice for benign gynecologic procedures.

Laparoscopic Management of Ovarian Cysts with Controlled Tissue Sealing - The "Cross Bag" Technique.

When ovarian preservation is desired, a minimally invasive laparoscopic surgical procedure using a "cross bag" technique is effective to consistently manage and remove ovarian cysts of concern. In addition to the standard preoperative preparation of patients, a bowel prep is critical, especially if the mass is large or the patient obese. Visualization of all internal structures is achieved using a multi-screen HD system and 5-mm laparoscope. Over 100 cases have been performed using the "cross bag" technique with no spillage of cysts.

IFN-gamma pretreatment augments immune complex-induced matrix metalloproteinase-1 expression in U937 histiocytes.

We reported recently that immune complexes (ICs) induced matrix metalloproteinase-1 (MMP-1) expression in U937 histiocytes. The present study was undertaken to determine the effect of pretreatment of U937 cells with interferon-gamma (IFN-gamma) on IC-induced MMP-1 expression. Our flow cytometry studies showed that IFN-gamma upregulated the surface expression of FcgammaRI, but not FcgammaRII. Results also showed that pretreatment of the cells with IFN-gamma augmented LDL-containing IC (LDL-IC)-induced MMP-1 secretion in a dose- and time-dependent manner. Furthermore, Northern blot analysis revealed that IFN-gamma pretreatment led to a marked increase in MMP-1 mRNA. Finally, we demonstrated that PD98059 was able to block LDL-IC-induced MMP-1 secretion, regardless of whether the cells were pretreated with IFN-gamma or not, suggesting that IFN-gamma pretreatment did not alter the essential role of the ERK signaling pathway in LDL-IC-induced MMP-1 expression. In conclusion, the present study has demonstrated that IFN-gamma pretreatment augments LDL-IC-induced MMP-1 expression in U937 cells, thus elucidating an immune mechanism potentially involved in plaque destabilization.