Comparison of experimental nerve injury caused by ultrasonically activated scalpel and electrosurgery
Background: Iatrogenic nerve injury caused by heat from dissection instruments is a significant problem in many areas of surgery. The aim of the present study was to compare the risk of nerve injury for three different dissection instruments: monopolar and bipolar electrosurgery (ES) and an ultrason...
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| Published in | British journal of surgery Vol. 92; no. 6; pp. 772 - 777 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Chichester, UK
John Wiley & Sons, Ltd
01.06.2005
Wiley |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0007-1323 1365-2168 1365-2168 |
| DOI | 10.1002/bjs.4948 |
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| Abstract | Background:
Iatrogenic nerve injury caused by heat from dissection instruments is a significant problem in many areas of surgery. The aim of the present study was to compare the risk of nerve injury for three different dissection instruments: monopolar and bipolar electrosurgery (ES) and an ultrasonically activated (US) instrument.
Methods:
The biceps femoris muscle was cut in a standard manner just adjacent to the sciatic nerve using monopolar ES, bipolar ES or US shears. A total of 73 functional experiments were conducted in which the nerve was isolated, divided proximally, and stimulated supramaximally in 37 anaesthetized rats. The electromyographic (EMG) potential was recorded distally before and after each experiment. Nerve dysfunction was defined as more than 10 per cent loss of the evoked EMG potential. Fifty‐nine nerves were examined histologically after dissection with the different instruments. The extent of heat damage was determined in four nerves that were divided with ES bipolar scissors and five that were divided with US shears.
Results:
Reduction in the EMG potential was significantly more frequent in the monopolar ES group than in the US group. Morphological examination also showed significantly less nerve damage in the US group.
Conclusion:
US instruments may be safer than ES for dissection close to nerves. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Ultrasound does less damage |
|---|---|
| AbstractList | Iatrogenic nerve injury caused by heat from dissection instruments is a significant problem in many areas of surgery. The aim of the present study was to compare the risk of nerve injury for three different dissection instruments: monopolar and bipolar electrosurgery (ES) and an ultrasonically activated (US) instrument.BACKGROUNDIatrogenic nerve injury caused by heat from dissection instruments is a significant problem in many areas of surgery. The aim of the present study was to compare the risk of nerve injury for three different dissection instruments: monopolar and bipolar electrosurgery (ES) and an ultrasonically activated (US) instrument.The biceps femoris muscle was cut in a standard manner just adjacent to the sciatic nerve using monopolar ES, bipolar ES or US shears. A total of 73 functional experiments were conducted in which the nerve was isolated, divided proximally, and stimulated supramaximally in 37 anaesthetized rats. The electromyographic (EMG) potential was recorded distally before and after each experiment. Nerve dysfunction was defined as more than 10 per cent loss of the evoked EMG potential. Fifty-nine nerves were examined histologically after dissection with the different instruments. The extent of heat damage was determined in four nerves that were divided with ES bipolar scissors and five that were divided with US shears.METHODSThe biceps femoris muscle was cut in a standard manner just adjacent to the sciatic nerve using monopolar ES, bipolar ES or US shears. A total of 73 functional experiments were conducted in which the nerve was isolated, divided proximally, and stimulated supramaximally in 37 anaesthetized rats. The electromyographic (EMG) potential was recorded distally before and after each experiment. Nerve dysfunction was defined as more than 10 per cent loss of the evoked EMG potential. Fifty-nine nerves were examined histologically after dissection with the different instruments. The extent of heat damage was determined in four nerves that were divided with ES bipolar scissors and five that were divided with US shears.Reduction in the EMG potential was significantly more frequent in the monopolar ES group than in the US group. Morphological examination also showed significantly less nerve damage in the US group.RESULTSReduction in the EMG potential was significantly more frequent in the monopolar ES group than in the US group. Morphological examination also showed significantly less nerve damage in the US group.US instruments may be safer than ES for dissection close to nerves.CONCLUSIONUS instruments may be safer than ES for dissection close to nerves. Background: Iatrogenic nerve injury caused by heat from dissection instruments is a significant problem in many areas of surgery. The aim of the present study was to compare the risk of nerve injury for three different dissection instruments: monopolar and bipolar electrosurgery (ES) and an ultrasonically activated (US) instrument. Methods: The biceps femoris muscle was cut in a standard manner just adjacent to the sciatic nerve using monopolar ES, bipolar ES or US shears. A total of 73 functional experiments were conducted in which the nerve was isolated, divided proximally, and stimulated supramaximally in 37 anaesthetized rats. The electromyographic (EMG) potential was recorded distally before and after each experiment. Nerve dysfunction was defined as more than 10 per cent loss of the evoked EMG potential. Fifty‐nine nerves were examined histologically after dissection with the different instruments. The extent of heat damage was determined in four nerves that were divided with ES bipolar scissors and five that were divided with US shears. Results: Reduction in the EMG potential was significantly more frequent in the monopolar ES group than in the US group. Morphological examination also showed significantly less nerve damage in the US group. Conclusion: US instruments may be safer than ES for dissection close to nerves. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Ultrasound does less damage Iatrogenic nerve injury caused by heat from dissection instruments is a significant problem in many areas of surgery. The aim of the present study was to compare the risk of nerve injury for three different dissection instruments: monopolar and bipolar electrosurgery (ES) and an ultrasonically activated (US) instrument. The biceps femoris muscle was cut in a standard manner just adjacent to the sciatic nerve using monopolar ES, bipolar ES or US shears. A total of 73 functional experiments were conducted in which the nerve was isolated, divided proximally, and stimulated supramaximally in 37 anaesthetized rats. The electromyographic (EMG) potential was recorded distally before and after each experiment. Nerve dysfunction was defined as more than 10 per cent loss of the evoked EMG potential. Fifty-nine nerves were examined histologically after dissection with the different instruments. The extent of heat damage was determined in four nerves that were divided with ES bipolar scissors and five that were divided with US shears. Reduction in the EMG potential was significantly more frequent in the monopolar ES group than in the US group. Morphological examination also showed significantly less nerve damage in the US group. US instruments may be safer than ES for dissection close to nerves. BACKGROUND: Iatrogenic nerve injury caused by heat from dissection instruments is a significant problem in many areas of surgery. The aim of the present study was to compare the risk of nerve injury for three different dissection instruments: monopolar and bipolar electrosurgery (ES) and an ultrasonically activated (US) instrument. METHODS: The biceps femoris muscle was cut in a standard manner just adjacent to the sciatic nerve using monopolar ES, bipolar ES or US shears. A total of 73 functional experiments were conducted in which the nerve was isolated, divided proximally, and stimulated supramaximally in 37 anaesthetized rats. The electromyographic (EMG) potential was recorded distally before and after each experiment. Nerve dysfunction was defined as more than 10 per cent loss of the evoked EMG potential. Fifty-nine nerves were examined histologically after dissection with the different instruments. The extent of heat damage was determined in four nerves that were divided with ES bipolar scissors and five that were divided with US shears. RESULTS: Reduction in the EMG potential was significantly more frequent in the monopolar ES group than in the US group. Morphological examination also showed significantly less nerve damage in the US group. CONCLUSION: US instruments may be safer than ES for dissection close to nerves. Background: Iatrogenic nerve injury caused by heat from dissection instruments is a significant problem in many areas of surgery. The aim of the present study was to compare the risk of nerve injury for three different dissection instruments: monopolar and bipolar electrosurgery (ES) and an ultrasonically activated (US) instrument. Methods: The biceps femoris muscle was cut in a standard manner just adjacent to the sciatic nerve using monopolar ES, bipolar ES or US shears. A total of 73 functional experiments were conducted in which the nerve was isolated, divided proximally, and stimulated supramaximally in 37 anaesthetized rats. The electromyographic (EMG) potential was recorded distally before and after each experiment. Nerve dysfunction was defined as more than 10 per cent loss of the evoked EMG potential. Fifty-nine nerves were examined histologically after dissection with the different instruments. The extent of heat damage was determined in four nerves that were divided with ES bipolar scissors and five that were divided with US shears. Results: Reduction in the EMG potential was significantly more frequent in the monopolar ES group than in the US group. Morphological examination also showed significantly less nerve damage in the US group. Conclusion: US instruments may be safer than ES for dissection close to nerves. Copyright © 2005 British Journal of Surgery Society Ltd. |
| Author | Jiang, C. H. Carlander, J. Nordborg, C. Lindström, S. Velin, Å. K. Johansson, K. |
| Author_xml | – sequence: 1 givenname: J. surname: Carlander fullname: Carlander, J. email: Johan.Carlander@ltvastmanland.se organization: Department of Surgery, Centrallasarettet, Västerås, Sweden – sequence: 2 givenname: K. surname: Johansson fullname: Johansson, K. organization: Department of Surgery, Västervik, Sweden – sequence: 3 givenname: S. surname: Lindström fullname: Lindström, S. organization: Institute for Biomedicine and Surgery, University Hospital Linköping, Linköping, Sweden – sequence: 4 givenname: Å. K. surname: Velin fullname: Velin, Å. K. organization: Institute for Biomedicine and Surgery, University Hospital Linköping, Linköping, Sweden – sequence: 5 givenname: C. H. surname: Jiang fullname: Jiang, C. H. organization: Institute for Biomedicine and Surgery, University Hospital Linköping, Linköping, Sweden – sequence: 6 givenname: C. surname: Nordborg fullname: Nordborg, C. organization: Department of Pathology, Sahlgrenska University Hospital, Göteborg, Sweden |
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| Keywords | Medicine Nerve Scalpel Treatment Surgery Electrosurgery Lesion Experimental study Comparative study |
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| References | Birch DW, Park A, Shuhaibar H. Acute thermal injury to the canine jejunal free flap: electrocautery versus ultrasonic dissection. Am Surg 1999; 65: 334-337. Feil W. Technology and clinical application of ultrasonic dissection. Min Invas Ther Allied Technol 2002; 11: 215-223. Reeve T, Thompson NW. Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg 2000; 24: 971-975. Koch C, Friedrich T, Metternich F, Tannapfel A, Reimann H-P, Eichfeld U. Determination of temperature elevation in tissue during the application of the harmonic scalpel. Ultrasound Med Biol 2003; 29: 301-309. Amaral JF. Depth of thermal injury: ultrasonically activated scalpel vs electrosurgery. Surg Endosc 1995; 9: 226-231. Amaral JF. The experimental development of an ultrasonically activated scalpel for laparoscopic use. Surg Laparosc Endosc 1994; 4: 92-99. Mulhall JP, Slovick R, Hotaling J, Aviv N, Valenzuela R, Waters WB et al. Erectile dysfunction after radical prostatectomy: hemodynamic profiles and their correlation with the recovery of erectile function. J Urol 2002; 167: 1371-1375. Tasmuth T, von Smitten K, Hietanen P, Kataja M, Kalso E. Pain and other symptoms after different treatment modalities of breast cancer. Ann Oncol 1995; 6: 453-459. Quah HM, Jayne DG, Eu KW, Seow-Choen F. Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer. Br J Surg 2002; 89: 1551-1556. Kinoshita T, Kanehira E, Omura K, Kawakami K, Watanabe Y. Experimental study on heat production by a 23·5-kHz ultrasonically activated device for endoscopic surgery. Surg Endosc 1999; 13: 621-625. Owaki T, Nakano S, Arimura K, Aikou T. The ultrasonic coagulating and cutting system injures nerve function. Endoscopy 2002; 34: 575-579. Feil W. Schliddrüsen resection mit Ultracision. Acta Chirurgica Austriaca 1997; Suppl. 130: 23. 1999; 13 1997 1995; 9 1999; 65 2003; 29 2000; 24 2002; 89 1995; 6 2002; 34 1994; 4 2002; 167 2002; 11 16106489 - Br J Surg. 2005 Sep;92(9):1180 |
| References_xml | – reference: Amaral JF. The experimental development of an ultrasonically activated scalpel for laparoscopic use. Surg Laparosc Endosc 1994; 4: 92-99. – reference: Quah HM, Jayne DG, Eu KW, Seow-Choen F. Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer. Br J Surg 2002; 89: 1551-1556. – reference: Tasmuth T, von Smitten K, Hietanen P, Kataja M, Kalso E. Pain and other symptoms after different treatment modalities of breast cancer. Ann Oncol 1995; 6: 453-459. – reference: Feil W. Schliddrüsen resection mit Ultracision. Acta Chirurgica Austriaca 1997; Suppl. 130: 23. – reference: Reeve T, Thompson NW. Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg 2000; 24: 971-975. – reference: Feil W. Technology and clinical application of ultrasonic dissection. Min Invas Ther Allied Technol 2002; 11: 215-223. – reference: Owaki T, Nakano S, Arimura K, Aikou T. The ultrasonic coagulating and cutting system injures nerve function. Endoscopy 2002; 34: 575-579. – reference: Mulhall JP, Slovick R, Hotaling J, Aviv N, Valenzuela R, Waters WB et al. Erectile dysfunction after radical prostatectomy: hemodynamic profiles and their correlation with the recovery of erectile function. J Urol 2002; 167: 1371-1375. – reference: Koch C, Friedrich T, Metternich F, Tannapfel A, Reimann H-P, Eichfeld U. Determination of temperature elevation in tissue during the application of the harmonic scalpel. Ultrasound Med Biol 2003; 29: 301-309. – reference: Amaral JF. Depth of thermal injury: ultrasonically activated scalpel vs electrosurgery. Surg Endosc 1995; 9: 226-231. – reference: Birch DW, Park A, Shuhaibar H. Acute thermal injury to the canine jejunal free flap: electrocautery versus ultrasonic dissection. Am Surg 1999; 65: 334-337. – reference: Kinoshita T, Kanehira E, Omura K, Kawakami K, Watanabe Y. Experimental study on heat production by a 23·5-kHz ultrasonically activated device for endoscopic surgery. Surg Endosc 1999; 13: 621-625. – volume: 89 start-page: 1551 year: 2002 end-page: 1556 article-title: Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer publication-title: Br J Surg – volume: 34 start-page: 575 year: 2002 end-page: 579 article-title: The ultrasonic coagulating and cutting system injures nerve function publication-title: Endoscopy – volume: 11 start-page: 215 year: 2002 end-page: 223 article-title: Technology and clinical application of ultrasonic dissection publication-title: Min Invas Ther Allied Technol – volume: 9 start-page: 226 year: 1995 end-page: 231 article-title: Depth of thermal injury: ultrasonically activated scalpel electrosurgery publication-title: Surg Endosc – volume: 6 start-page: 453 year: 1995 end-page: 459 article-title: Pain and other symptoms after different treatment modalities of breast cancer publication-title: Ann Oncol – volume: 24 start-page: 971 year: 2000 end-page: 975 article-title: Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient publication-title: World J Surg – start-page: 23 issue: Suppl. 130 year: 1997 article-title: Schliddrüsen resection mit Ultracision publication-title: Acta Chirurgica Austriaca – volume: 167 start-page: 1371 year: 2002 end-page: 1375 article-title: Erectile dysfunction after radical prostatectomy: hemodynamic profiles and their correlation with the recovery of erectile function publication-title: J Urol – volume: 13 start-page: 621 year: 1999 end-page: 625 article-title: Experimental study on heat production by a 23·5‐kHz ultrasonically activated device for endoscopic surgery publication-title: Surg Endosc – volume: 4 start-page: 92 year: 1994 end-page: 99 article-title: The experimental development of an ultrasonically activated scalpel for laparoscopic use publication-title: Surg Laparosc Endosc – volume: 65 start-page: 334 year: 1999 end-page: 337 article-title: Acute thermal injury to the canine jejunal free flap: electrocautery ultrasonic dissection publication-title: Am Surg – volume: 29 start-page: 301 year: 2003 end-page: 309 article-title: Determination of temperature elevation in tissue during the application of the harmonic scalpel publication-title: Ultrasound Med Biol – reference: 16106489 - Br J Surg. 2005 Sep;92(9):1180 |
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| Snippet | Background:
Iatrogenic nerve injury caused by heat from dissection instruments is a significant problem in many areas of surgery. The aim of the present study... Iatrogenic nerve injury caused by heat from dissection instruments is a significant problem in many areas of surgery. The aim of the present study was to... Background: Iatrogenic nerve injury caused by heat from dissection instruments is a significant problem in many areas of surgery. The aim of the present study... BACKGROUND: Iatrogenic nerve injury caused by heat from dissection instruments is a significant problem in many areas of surgery. The aim of the present study... |
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| SubjectTerms | adverse effects Animals Biological and medical sciences Dissection Dissection - adverse effects Electromyography Electrosurgery Electrosurgery - adverse effects etiology Evoked Potentials Evoked Potentials - physiology General aspects injuries instrumentation Medical and Health Sciences Medical sciences MEDICIN Medicin och hälsovetenskap MEDICINE Muscle Muscle, Skeletal - surgery Nervous System pathology physiology physiopathology Rats Rats, Sprague-Dawley Sciatic Nerve Sciatic Nerve - injuries Sciatic Nerve - pathology Sciatic Nerve - physiopathology Skeletal Sprague-Dawley surgery Surgical Instruments Trauma Trauma, Nervous System - etiology Trauma, Nervous System - pathology Trauma, Nervous System - physiopathology Ultrasonic Therapy Ultrasonic Therapy - adverse effects Ultrasonic Therapy - instrumentation |
| Title | Comparison of experimental nerve injury caused by ultrasonically activated scalpel and electrosurgery |
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