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Ultrasonic scalpel; fibrin glue; glove perforation and contamination; preoperative hemoglobin levels

AORN Journal, July, 2005 by George Allen

Ultrasonic scalpel use versus electrocoagutation in thyroidectomy

Surgery March 2005

The thyroid is a small, soft, butterfly-shaped gland located just below the larynx. The gland uses iodine to produce thyroid hormone, which has a key role in regulating metabolism and calcium levels. Thyroidectomy, one of the most frequently performed procedures in endocrine surgery, is the surgical removal of all or part of the thyroid gland. The procedure requires meticulous dissection and exhaustive hemostasis to prevent damage to adjacent structures.

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Suture ligatures and electrocoagulation are the two most common techniques for hemostasis. The use of electrocoagulation has the potential risk of injuring the surrounding structures from lateral dispersion of heat. In 1990, the ultrasonic scalpel was introduced. This instrument uses ultrasonic energy and mechanical vibrations at 55.5 kHz to cut and coagulate simultaneously and has the theoretical advantage of producing less thermal damage to surrounding tissue. The objective of this prospective, randomized, single-blinded study was to evaluate the potential advantages of using the ultrasonic scalpel versus electrocoagulation during thyroidectomies. (1)

Between July 2001 and July 2002, 60 patients undergoing thyroidectomy at a hospital in Mexico were randomly assigned to one of two groups. All patients received endotracheal general anesthesia, and a single surgeon performed all the procedures. In study group procedures (n = 30), dissection and vascular control of the gland, as well as division of superior, middle, and inferior vessels, were performed using the ultrasonic scalpel. In control group procedures (n = 30), electrocoagulation was used to transect small vessels, and knot tying was employed for the superior thyroid vessels, the thyroid vein, and some inferior arterial branches.

Outcome measures assessed included operative time; blood loss; postoperative drainage; number of ligatures and clips used; postoperative pain at the surgical site; and procedure complications, such as recurrent laryngeal nerve palsy and hypoparathyroidism. Pain was assessed using a numeric, visual pain rating scale where zero indicated no pain and 10 indicated the worst imaginable pain. Common statistical techniques were used to analyze differences between the two groups.

Findings. The mean operative time was significantly lower (P = .005) in ultrasonic scalpel procedures (96 [+ or -] 23 minutes versus 121 [+ or -] 34 minutes). The median number of ligatures used during the procedure was significantly lower (P < .001) for ultrasonic scalpel procedures than for electrocoagulation procedures (1, range 0 to 7 versus 17, range 6 to 28).

There was no significant difference in intraoperative bleeding, postoperative bleeding, and reports of postoperative pain between the groups. Three patients (ie, two in the ultrasonic scalpel group and one in the electrocoagulation group) had transient recurrent laryngeal nerve palsy that resolved spontaneously within 30 days. Nine patients in the electrocoagulation group and three patients in the ultrasonic scalpel group developed clinical hypocalcemia, manifested by numbness in the lips and hands. There were no mortalities.

Clinical implications. The results of this study revealed that the main advantage of using ultrasonic coagulation is the reduction in operative time; however, the authors note that controlled studies with larger numbers of patients may be needed to determine conclusively if using the ultrasonic scalpel is safer than using the standard technique. Perioperative managers should consider conducting studies on cost-effectiveness to evaluate whether the operative time savings can translate into surgical cost savings.

Using fibrin glue to attach conjunctival autografts

Ophthalmology April 2005

A pterygium is a pinkish, triangular-shaped growth of scar tissue and blood vessels on the sun-exposed surface of the eye that develops in response to ultraviolet damage from the environment. Although the growths are benign, they can cause decreased vision, pain, irritation, redness, and scarring. In addition, they are cosmetically unacceptable to many patients.

The main challenge of pterygium excision procedures is preventing recurrence. Conjunctival autografting after pterygium excision is associated with lower recurrence rates. The current method of attaching conjunctival autografts is by suturing; however, suturing requires a high degree of surgical skill and prolonged operating time. It also is associated with postoperative discomfort and the potential for suture-related complications, including buttonholes, suture abscess, granuloma formation, tissue necrosis, and giant papillary conjunctivitis. Tissue adhesives, including fibrin glue, are alternative means for attaching conjunctival grafts. The objective of this prospective, randomized study was to compare the safety and efficacy of fibrin glue to nylon sutures for attaching conjunctival autografts during pterygium excision procedures. (2)

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Ultrasonic scalpel; fibrin glue; glove perforation and contamination; preoperative hemoglobin levels

AORN Journal, July, 2005 by George Allen

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