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1.
Chirurgia (Bucur) ; 114(5): 668-673, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31689175

RESUMO

Background: The desire for perfect haemostasis has led the medical equipment industry to produce ideal instruments for safe thyroidectomy. Thus, haemostasis and sealing instruments such as the LigaSureTM Small Jaw, ThunderbeatTM Open Fine Jaw and HarmonicTM Focus have been indicated for thyroid surgery. Aim: The purpose of this study is to present the initial results of using these three surgical instruments for performing monobloc thyroidectomy. Material and Methods: We performed a prospective study between January 2014 and July 2019 in which we included all the patients operated by same surgeon using those 3 sealing devices. Thyroidectomies were performed using LigaSureTM Small Jaw (group 1), the ThunderbeatTM Open Fine Jaw (group 2) and HarmonicTM Focus (group 3). The groups were statistically compared in term of duration of surgery and hospitalisation, early postoperative complications as well as voice alteration or acute respiratory failure. Results: No significant differences were observed among groups in terms of patient demographics, pathological diagnoses, postoperative complications, length of hospitalization, and clinical outcomes. Operating time was shorter in group 1. Conclusions: New surgical instruments have beneficial properties, including shortening the operative time, maintaining a clean operating field, and minimising smoke released during the operation.


Assuntos
Hemostasia Cirúrgica/instrumentação , Glândula Tireoide/cirurgia , Tireoidectomia/instrumentação , Tireoidectomia/métodos , Humanos , Estudos Prospectivos , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/instrumentação
2.
Medicine (Baltimore) ; 98(45): e17910, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702668

RESUMO

To evaluate the safety and efficacy of total percutaneous closure of the femoral artery access site after veno-arterial extracorporeal membrane oxygenation (VA-ECMO) with the Perclose ProGlide device.This retrospective observational study during an almost 2-year period included 21 patients who underwent VA-ECMO in whom the femoral artery puncture site was closed percutaneously with Perclose ProGlide devices. Technical success was defined as successful arterial closure of the common femoral artery, without the need for additional surgical or endovascular procedures. Access site complications were recorded at 24 hours and 30 days after arterial closure, such as major bleeding requiring transfusion or surgical intervention, minor bleeding, groin infection, pseudoaneurysm, and lymphocele.Technical success was achieved in 20 patients (95.2%). One patient required surgical repair for an access site pseudoaneurysm. Eighteen femoral arteries were closed with 2 devices each, while 3 patients required the use of a third device for femoral artery access site closure to achieve adequate hemostasis. No arterial thrombosis, arterial dissection, arterial stenosis, groin infection, or arteriovenous fistula occurred during the periprocedural period (within 24 hours of arterial closure) or during 30-day follow-up.Percutaneous closure with the Perclose ProGlide device is a feasible procedure for closing femoral arterial access sites after VA-ECMO, with a low incidence of access site complications.


Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Artéria Femoral/cirurgia , Hemostasia Cirúrgica/instrumentação , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Punções/efeitos adversos , Estudos Retrospectivos
3.
World Neurosurg ; 132: 99-102, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479785

RESUMO

BACKGROUND: Hemostasis valves are commonly used in neurointerventions. We propose a novel concept for fixing hemostasis valves to the operating table during procedures. Moreover, we report our preliminary in vitro experience using these new devices created using a 3-dimensional printer. METHODS: The hemostasis valve holder (HVH) comprises 2 components: an inner fixer and an outer socket. It was designed to be suitable for use with all rotational hemostasis valves commercially available. HVH contains magnets at the bottom that facilitate its attachment to a thin steel board beneath a sterilized drape on the working table. We evaluated the HVH's efficacy via in vitro experiments involving stent placement by a single operator. RESULTS: HVH allowed easy attachment to and detachment from the rotational hemostasis valve. Moreover, the use of multiple HVHs facilitated operators to concentrate on the procedure because they continuously prevented the unexpected movement of devices at several points. Use of HVHs enables stent placement to be performed even by a single operator. We observed that forming a loop of the stent delivery catheter between 2 HVHs enhanced the device control. CONCLUSIONS: HVHs should be more useful than conventional methods, particularly in cases requiring fine complementary control of both a microcatheter and microguidewire.


Assuntos
Procedimentos Endovasculares/instrumentação , Desenho de Equipamento , Hemostasia Cirúrgica/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Humanos , Impressão Tridimensional , Instrumentos Cirúrgicos
4.
Vet Clin North Am Exot Anim Pract ; 22(3): 471-487, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31395326

RESUMO

Surgery can be challenging in exotic pets owing to their small size and blood volume, and their increased anesthetic risk compared with small animals. Various devices are available to facilitate suturing, cutting, and hemostasis in the human and veterinary fields. These surgical equipment improve the simplicity, rapidity, and effectiveness of surgery. Vessel-sealing devices, radiosurgery, lasers, and ultrasound devices are commonly used because of their ease of use and increase in surgical efficiency. Other surgical devices are available (eg, stapling devices) but are not discussed in this article.


Assuntos
Animais Exóticos , Equipamentos Cirúrgicos/veterinária , Animais , Biópsia/instrumentação , Biópsia/veterinária , Castração/instrumentação , Castração/veterinária , Desenho de Equipamento , Hemostasia Cirúrgica/instrumentação , Hemostasia Cirúrgica/veterinária , Humanos , Terapia a Laser/instrumentação , Terapia a Laser/veterinária , Lasers/normas , Fígado/patologia , Fígado/cirurgia , Pancreatectomia/instrumentação , Pancreatectomia/veterinária , Radiocirurgia/instrumentação , Radiocirurgia/veterinária , Esplenectomia/instrumentação , Esplenectomia/veterinária , Equipamentos Cirúrgicos/tendências , Procedimentos Cirúrgicos Ultrassônicos/instrumentação , Procedimentos Cirúrgicos Ultrassônicos/veterinária , Procedimentos Cirúrgicos Vasculares/instrumentação
5.
J Card Surg ; 34(9): 849-853, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31348840

RESUMO

BACKGROUND: Postoperative bleeding complications are associated with less favorable outcomes in cardiac surgery and contribute to excessive overall healthcare costs. HEMOBLAST (Biom'up, Lyon, France) (HB) is a novel ready-to-use hemostatic powder that consists of porcine collagen, bovine chondroitin sulfate, and human pooled plasma thrombin that may help reduce surgical bleeding. AIMS: The aim of this study was to describe the techniques of application for this new combination powder-based hemostat, HB, and demonstrate its use employing photographs of application methods during cardiac procedures. MATERIALS AND METHODS: The initial 24 procedures in which HB was used at our institution included: left ventricular assist device (LVAD) insertions, lung transplants, heart transplants, aortic valve replacements, coronary artery bypass grafting, and mitral valve repair. RESULTS: Hemostasis was achieved in all cases and there were no instances of mediastinitis, sternal infections, allergic reactions, or 30-day mortality. DISCUSSION: This report describes the best methods of application of HB including use for treatment of mediastinal bleeding in a re-operative procedure in a patient on antiplatelet agents and sternal bleeding during an LVAD insertion. Proper application can facilitate excellent hemostasis using this powder. CONCLUSION: HB is a novel powder-based multiple component hemostatic agent that promotes focal or large area hemostasis. We have presented the techniques of use that are important to the successful application of HB to facilitate hemostasis.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Hemostasia Cirúrgica/instrumentação , Hemostáticos/farmacologia , Hemorragia Pós-Operatória/cirurgia , Idoso , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
Gastroenterology ; 157(5): 1213-1221.e4, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31362007

RESUMO

BACKGROUND & AIMS: It is not clear whether closure of mucosal defects with clips after colonic endoscopic mucosal resection (EMR) prevents delayed bleeding, although it seems to have no protective effects when risk is low. We performed a randomized trial to evaluate the efficacy of complete clip closure of large (≥2 cm) nonpedunculated colorectal lesions after EMR in patients with an estimated average or high risk of delayed bleeding. METHODS: We performed a single-blind trial at 11 hospitals in Spain from May 2016 through June 2018, including 235 consecutive patients who underwent EMR for large nonpedunculated colorectal lesions with an average or high risk of delayed bleeding (based on Spanish Endoscopy Society Endoscopic Resection Group score). Participants were randomly assigned to groups that received closure of the scar with 11-mm through-the-scope clips (treated, n = 119) or no clip (control, n = 116). The primary outcome was proportion of patients in each group with delayed bleeding, defined as evident hematochezia that required medical intervention within 15 days after colonoscopy. RESULTS: In the clip group, complete closure was achieved in 68 (57%) cases, with partial closure in 33 (28%) cases and failure to close in 18 (15%) cases. Delayed bleeding occurred in 14 (12.1%) patients in the control group and in 6 (5%) patients in the clip group (absolute risk difference, reduction of 7% in the clip group; 95% confidence interval, -14.7% to 0.3%). After completion of the clip closure, there was only 1 (1.5%) case of delayed bleeding (absolute risk difference, reduction of 10.6%; 95% confidence interval, -4.3% to 17.9%). CONCLUSIONS: In a randomized trial of patients with large nonpedunculated colorectal lesions undergoing EMR, we found that clip closure of mucosal defects in patients with a risk of bleeding can be a challenge, but also reduces delayed bleeding. Prevention of delayed bleeding required complete clip closure. ClinicalTrials.gov ID: NCT02765022.


Assuntos
Adenocarcinoma/cirurgia , Pólipos Adenomatosos/cirurgia , Pólipos do Colo/cirurgia , Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa/efeitos adversos , Hemorragia Gastrointestinal/prevenção & controle , Hemostasia Cirúrgica/instrumentação , Hemorragia Pós-Operatória/prevenção & controle , Instrumentos Cirúrgicos , Adenocarcinoma/patologia , Pólipos Adenomatosos/patologia , Idoso , Idoso de 80 Anos ou mais , Pólipos do Colo/patologia , Neoplasias Colorretais/patologia , Desenho de Equipamento , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Medição de Risco , Fatores de Risco , Método Simples-Cego , Espanha , Fatores de Tempo , Resultado do Tratamento
7.
Otolaryngol Head Neck Surg ; 161(5): 770-778, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31331260

RESUMO

OBJECTIVE: Alternative energy devices have become a popular alternative to conventional hemostasis in thyroid surgery. These devices have been shown to reduce operative time and thermal nerve injury. As hemostasis is paramount in thyroid surgery, we sought to examine the relative efficacy of 2 alternate energy devices compared to conventional hemostasis in preventing postoperative hematoma following total thyroidectomy. DATA SOURCES: Ovid MEDLINE, EMBASE, PubMed, and Cochrane Central Register of Controlled Trials. REVIEW METHODS: A systematic literature search was performed for all relevant English-language studies published between 1946 and July 2018. Two authors independently extracted data and analyzed articles for quality using the National Institute of Health Quality Assessment Scale. Our primary outcome of interest was hematoma requiring reoperation. RESULTS: A total of 348 studies were screened, with 23 meeting the inclusion criteria. We found no significant difference in postoperative hematoma rates using alternate energy devices compared to conventional hemostasis (P = .370, .317). Network meta-analysis echoed the results of conventional meta-analysis, demonstrating no significant difference in hematoma rates. CONCLUSIONS: We found no significant difference in postoperative hematoma rates following total thyroidectomy for any indication with the use of alternate energy devices compared to conventional hemostatic techniques. This suggests that hematoma occurrence does not necessarily need to be considered when choosing between these hemostatic devices. This information may help guide surgeons' decisions regarding choice of hemostatic technique during thyroid surgery.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Hematoma/epidemiologia , Hemostasia Cirúrgica/instrumentação , Hemorragia Pós-Operatória/epidemiologia , Tireoidectomia/efeitos adversos , Tireoidectomia/instrumentação , Hematoma/prevenção & controle , Humanos , Incidência , Hemorragia Pós-Operatória/prevenção & controle
9.
J Plast Surg Hand Surg ; 53(5): 295-300, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31062994

RESUMO

Background: Seromas are the most common complication of latissimus dorsi flap breast reconstruction. Electrocautery for flap elevation can cause seromas and injure the lymph or vessels of the surrounding tissues. Positive effects of the LigaSure Small Jaw (Medtronic [formerly Covidien], Minneapolis, MN, USA) sealing device were examined. Methods: Forty-three latissimus dorsi flap breast reconstruction patients were included. Twenty-three underwent surgery with electrocautery and 21 underwent surgery with LigaSure. The seroma formation rate, total drain volume, drainage indwelling periods at the breast site and donor site, operative time, and hospital stay duration were retrospectively compared. Associations between patient characteristics and these variables were analyzed. Results: Seroma incidence rates were 9/23 (39.1%) and 3/21 (14.3%) for the control and experimental groups. One control group patient underwent surgical treatment; the rest underwent conservative treatment. A significant difference in latissimus dorsi flap elevation time was found between the control and experimental groups (105.6 minutes and 77.1 minutes; p = .026). A significant difference in the drainage indwelling periods of the latissimus dorsi donor site was found (13.1 days and 11 days; p = .006). Excised breast mass weight, latissimus dorsi flap weight, breast drain total volume/indwelling period, and latissimus dorsi drain volume/indwelling period showed statistically significant associations. Radiation and chemotherapy were not significantly associated with any variables. Conclusion: The LigaSure device for latissimus dorsi flap breast reconstruction can reduce seromas, operative time, and hospital stay. It is a reliable and useful surgical sealing device that does not cause injury to the surrounding tissues.


Assuntos
Hemostasia Cirúrgica/instrumentação , Mamoplastia , Complicações Pós-Operatórias/prevenção & controle , Seroma/prevenção & controle , Músculos Superficiais do Dorso/transplante , Retalhos Cirúrgicos , Estudos de Casos e Controles , Feminino , Humanos , Tempo de Internação , Mastectomia , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Seroma/etiologia
10.
Eur J Orthop Surg Traumatol ; 29(6): 1337-1345, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30993522

RESUMO

Methods of controlling hemorrhage in penetrating abdominal injuries are varied, ranging from electrocautery, ligation, laparotomy sponge packing, angiography, hemostatic agents, and direct manual pressure. Unfortunately, traditional methods are sometimes unsuccessful due to the location or nature of the hemorrhage, and manual pressure cannot be held indefinitely. We describe a novel damage control technique for hemorrhage control in these situations, followed by three cases where an external fixator vascular compressor (EFVC) was used to hold continual pressure. Three patients are presented to a Level 1 trauma center following multiple ballistic injuries, all requiring emergent exploratory laparotomy. The first had a two-pin iliac crest EFVC placed during repeat exploratory laparotomy to control bleeding. The second patient had a supra-acetabular EFVC placed during initial exploratory laparotomy after emergent embolization failed to control bleeding from the L3 vertebral body. The third patient had a two-pin iliac crest EFVC placed at initial exploratory laparotomy due to uncontrollable bleeding from the sacral venous plexus and internal iliac veins. Of the three patients, two stabilized and survived, while one passed away due to multi-organ failure. We describe a novel damage control technique that may be a useful means of temporarily stemming intraabdominal bleeding that is otherwise recalcitrant to traditional hemostatic methods. Additionally, we provided a limited case series of patients who have undergone this technique to illustrate its utility and versatility. This technique is simple, fast, effective, and adaptable to a variety of circumstances that may be encountered in patients with intraabdominal bleeding recalcitrant to conventional hemorrhage control.


Assuntos
Traumatismos Abdominais , Fixadores Externos , Hemorragia , Hemostasia Cirúrgica , Ferimentos Penetrantes/complicações , Traumatismos Abdominais/complicações , Traumatismos Abdominais/cirurgia , Adolescente , Adulto , Desenho de Equipamento , Hemorragia/etiologia , Hemorragia/terapia , Hemostasia Cirúrgica/instrumentação , Hemostasia Cirúrgica/métodos , Humanos , Escala de Gravidade do Ferimento , Laparotomia/métodos , Masculino , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/cirurgia , Resultado do Tratamento
13.
J Inj Violence Res ; 11(1): 29-34, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30635996

RESUMO

BACKGROUND: Craniomaxillofacial (CMF) injuries are very common in both civilian and military settings. Nearly half of all civilian trauma incidents include a scalp laceration and historical rates of CMF battle injuries increased from 16%-21% to 42.2%. The scalp is highly vascular tissue and uncontrolled bleeding can lead to hypotension, shock and death. Therefore, enabling on-scene providers, both military and civilian, to immediately manage scalp and face lacerations, in a manner that allows them to still function in a tactical way, offers operational advantages. This case series examines how effectively a wound-clamp (iTClamp) controlled bleeding from CMF injuries pre-hospital environment. METHODS: The use of the iTClamp for CMF (scalp and face laceration) was extracted from iTrauma Care's post market surveillance database. Data was reviewed and a descriptive analysis was applied. RESULTS: 216 civilian cases of iTClamp use were reported to iTrauma Care. Of the 216 cases, 37% (n=80) were for control of CMF hemorrhage (94% scalp and 6% face). Falls (n=24) and MVC (n=25) accounted for 61% of the mechanism of injury. Blunt accounted for 66% (n=53), penetrating 16% (n=13) and unknown 18% (n=14). Adequate hemorrhage control was reported in 87.5% (n=70) of cases, three respondents reported inadequate hemorrhage control and in seven cases hemorrhage control was not reported. Direct pressure and packing was abandoned in favor of the iTClamp in 27.5% (n=22) of cases. CONCLUSIONS: CMF injuries are common in both civilian and military settings. Current options like direct manual pressure (DMP) often do not work well, are formidable to maintain on long transports and Raney clips are a historical suggestion. The iTClamp offers a new option for control of external hemorrhage from open wounds within compressible zones.


Assuntos
Serviços Médicos de Emergência , Hemorragia/etiologia , Hemorragia/cirurgia , Hemostasia Cirúrgica/instrumentação , Traumatismos Maxilofaciais/complicações , Traumatismos Maxilofaciais/cirurgia , Couro Cabeludo/lesões , Acidentes por Quedas , Acidentes de Trânsito , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Traumatismos Cranianos Fechados/cirurgia , Traumatismos Cranianos Penetrantes/cirurgia , Humanos , Lacerações/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pressão , Estudos Retrospectivos , Vigilância de Evento Sentinela , Adulto Jovem
14.
Surg Today ; 49(7): 580-586, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30684049

RESUMO

PURPOSE: In recent years, several reports have noted that the specific coagulation mode called "soft coagulation" with modern electrosurgical tools offers superior hemostasis. The "suction ball coagulation" (SBC) device, which can achieve hemostasis using a soft coagulation mode and simultaneous suction, has been developed as a next step. This study aimed to evaluate the hemostatic effects of SBC in comparison to a conventional soft coagulation device (non-SBC) in video-assisted thoracoscopic surgery (VATS) for patients with non-small cell lung cancer (NSCLC). METHODS: This study retrospectively analyzed 351 patients who underwent complete VATS lobectomy for NSCLC. A propensity score analysis generated matched pairs from the patients in the SBC and non-SBC groups (119 patients each). RESULTS: After propensity score matching, the bleeding volume during surgery in the SBC group (27.0 g) was significantly less than that in the non-SBC group (42.0 g, p < 0.001). No significant difference was seen in the frequency of postoperative complications. A logistic regression analysis identified the non-use of SBC as an independent risk factor for greater intraoperative blood loss during complete VATS lobectomy (odds ratio 3.14, p < 0.001). CONCLUSIONS: SBC was safe for complete VATS lobectomy in patients with NSCLC, and the use of this device was associated with significantly decreased intraoperative blood loss.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Eletrocoagulação/instrumentação , Hemostasia Cirúrgica/instrumentação , Neoplasias Pulmonares/cirurgia , Pneumonectomia/instrumentação , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Idoso , Eletrocoagulação/métodos , Feminino , Hemostasia Cirúrgica/métodos , Humanos , Modelos Logísticos , Masculino , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
16.
World Neurosurg ; 121: 222-226, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30292660

RESUMO

OBJECTIVE: The primary training in any surgical practice starts with tissue handling and effective hemostasis. Neurosurgical procedures start with an incision in the scalp and require summative use of mechanical hemostats and bipolar coagulation to achieve hemostasis. Though Raney clips are the most popular and effective in maintaining hemostasis, their high cost and nonreusability become deterrents for routine use in resource-stricken environments. METHODS: We have compared stationery binder clips of different sizes with Raney clips on the parameters of effectiveness, availability, and cost. Binder clips were also used in intraoperative settings for scalp hemostasis. The comparative efficacy, additional usage of cautery, and need for sterilization are also discussed. RESULTS: We describe our experience with simple stationery metal binder clips in maintaining effective hemostasis in a cost-effective manner. The 25-mm size binder clip exerts same force as a Raney clip without any tissue injury. Practical application revealed effective scalp hemostasis up to blood pressure of 150 mm Hg. CONCLUSIONS: Stationery binder clips are a cost-effective, ready-to-use alternative for standard Raney clips.


Assuntos
Hemostasia Cirúrgica/instrumentação , Couro Cabeludo/cirurgia , Instrumentos Cirúrgicos , Adulto , Cauterização , Craniotomia/economia , Craniotomia/instrumentação , Países em Desenvolvimento , Hemostasia Cirúrgica/economia , Humanos , Invenções , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde , Esterilização , Instrumentos Cirúrgicos/economia , Adulto Jovem
17.
J Minim Invasive Gynecol ; 26(2): 362, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29705060

RESUMO

STUDY OBJECTIVE: To demonstrate the proper use of vessel-sealing devices during vaginal hysterectomy. DESIGN: Educational video (Canadian Task Force classification level III). SETTING: University hospital. INTERVENTION: The video reviews the principles on the use of energy in minimally invasive surgery. We focus on how vessel-sealing devices function and the benefits of their use in difficult vaginal hysterectomy. The video explains the 2 major types of complications, inadequate vessel sealing and undesired thermal injury, and demonstrates techniques to avoid these complications. MEASUREMENTS AND MAIN RESULTS: Laboratory, intraoperative, and cadaveric recordings demonstrate proper use and the complications that may arise in the setting of improper use. CONCLUSION: Vessel-sealing devices may be a useful tool for surgeons performing vaginal hysterectomy. This video demonstrates their use and underlines the importance of understanding the principles of energy devices and their proper usage in surgery.


Assuntos
Histerectomia Vaginal/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Feminino , Hemostasia Cirúrgica/instrumentação , Humanos , Histerectomia Vaginal/métodos , Instrumentos Cirúrgicos
20.
Gastrointest Endosc ; 89(1): 77-86.e1, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30056253

RESUMO

BACKGROUND AND AIMS: Many new through-the-scope clips are available, and physicians often select clips based on physical characteristics and/or cost. However, functional profiles may be equally important and have not been methodically assessed. We evaluated 5 commercially available clips: Resolution 360, Instinct, Quick Clip Pro, Dura Clip, and SureClip. METHODS: We rigorously compared clips on multiple characteristics, including rotatability, overshoot, open/close precision, and tensile/closure strength. Clips were tested in 4 different endoscope configurations: (1) straight, (2) duodenal sweep, (3) full retroflexion, and (4) across the duodenoscope elevator. RESULTS: For rotatability, the Resolution 360 was the fastest due to its unique functionality in allowing primary MD control in rotation (P < .05). The Resolution 360, SureClip, and Dura Clip were able to rotate through the prescribed sequence across all scope configurations. For overshoot, the SureClip and Resolution 360 had the least overshoot for the straight configuration at 0%. All clips had >75% overshoot at more strained configurations. For open/close precision, the SureClip and Dura Clip showed precise opening/closing with the ability to stop at any point. The remaining clips exhibited abrupt opening with more controlled closure. For tensile strength, the Quick Clip Pro generated the highest peak force as would be required in lateral tissue manipulation (4.8 lb, P < .005). For closure strength, the Instinct overall showed the most gel compression, and along with the Resolution 360, showed 100% deployment success for all gel tissue thicknesses (up to 10 mm). CONCLUSIONS: Each clip has a unique physical and functional profile, which may be a factor in selection depending on the clinical circumstance.


Assuntos
Endoscopia do Sistema Digestório/instrumentação , Hemostasia Cirúrgica/instrumentação , Instrumentos Cirúrgicos , Endoscópios Gastrointestinais , Desenho de Equipamento , Humanos , Teste de Materiais , Resistência à Tração
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