Outcome of harmonic scalpel circumcision in children with hemophilia

Background: There are many techniques described to decrease the risk of bleeding after circumcision in patients with bleeding diathesis such as monopolar diathermy, bipolar scissors and fibrin glue. Up to our knowledge, no previous study described the use of the harmonic scalpel in patients with bleeding diathesis. Our aim was to evaluate postoperative outcome after harmonic scalpel circumcision in boys with hemophilia.Methods: This was a prospective observational study carried out in Sohag University Hospitals, Sohag, Egypt. The patients were recruited from Outpatient pediatric hematology clinic from January 2014 till January 2017. All procedures were done under general anesthesia. After strict sterilization, the dorsal aspect of the prepuce was incised using harmonic scalpel up to the coronal sulcus, then the whole prepuce was cut circumferentially using the harmonic scalpel. It is a sutureless technique.Results: 26 boys with hemophilia A and 5 with hemophilia B were included. Their median age was 5 and 8 years respectively. The most common indication for circumcision was religious (20/31), the intraoperative blood loss ranged between 0-5 ml, operative time ranged between 3-5 minutes, there was no intraoperative complication, one case of rebleeding managed conservatively by factor administration, two cases of wound infection responded to antibiotic therapy, hospital stay ranged between 1-3 days. It was a sutureless technique.Conclusions: Harmonic scalpel circumcision is a safe technique in children with hemophilia, it decreased the risk of rebleeding, decreased operative time and it is also a sutureless technique and may decrease the cost by reducing the amount of factor replacement.

Viability of Airborne Tumor Cells during Excision by Ultrasonic Device

Background. Laparoscopic surgery has become more widely used, but peritoneal dissemination and port-site metastasis have been reported to occur in these surgeries. One reason for these problems is the ultrasonically activated scalpel (UAS) used for laparoscopic surgery. This study aimed to investigate the viability of airborne cells released during cancer dissection using a UAS. Methods. Flank tumors measuring about 2 cm were induced in male NOD-Cg-Rag1tm1MomIL2rgtm1wjl/SzJ mice by subcutaneous injection of 1 × 106 HepG2 cells. Dissection was performed with UAS (in high or low power modes) and PowerStar bipolar scissors. The mist of released tissue was collected in cell culture medium. The viability of the cellular material was assessed with trypan blue exclusion cell counting, counting after immunofluorescence staining, and flow cytometric analysis. Results. Large quantities of cellular debris were trapped in the tissue dispersed by both devices. In all experiments, there were significantly more viable cells produced by the UAS in high power mode. By using suction at the excision site, the number of viable cancer cells was reduced. Conclusions. This study demonstrates that viable cancer cells can be released into the nearby environment during tumor ablation with a UAS.

Risk factors for secondary post-tonsillectomy haemorrhage following tonsillectomy with bipolar scissors: four-year retrospective cohort study

Objective:To analyse risk factors associated with secondary post-operative bleeding when only one technique, namely bipolar scissors, is used.Methods:The medical records of all consecutive patients aged six years or older who underwent tonsillectomy or adenotonsillectomy between 1 December 2010 and 30 November 2014 were retrospectively analysed.Results:A total of 1734 patients were included in the study. A secondary haemorrhage occurred in 208 patients (12 per cent). Patients aged 15 years or older were 4.5 times (95 per cent confidence interval = 2.6–7.9;p< 0.001) more likely to experience secondary haemorrhage. In cases of acute quinsy, patients aged 15 years or older had an 8.1-fold (95 per cent confidence interval = 1.1–59.6;p= 0.02) increased likelihood of experiencing secondary haemorrhage.Conclusion:Patients aged 15 years or older have a higher risk for bleeding regardless of the primary indication for the tonsillectomy. The risk for secondary haemorrhage does not seem to depend on the primary indication itself.

Interface Phenomena of Co-Sintered Steel-Zirconia Laminates

The composite formation of steel and ceramics is especially for medical applications of great interest. By use of the multicomponent tape casting metal-ceramic composite components like bipolar scissors and other surgical instruments can be produced. A coating technology that comes from the paper industry, allows to apply a very thin insulating layer of a few microns between the electrodes consisting of stainless steel. Until now bipolar surgical instruments are produced by mechanical joining of steel and ceramic parts or by spraying a ceramic layer on the steel instruments. This joining steps can lead to stresses in the sensitive ceramic material and leave fine interstices or pores that are not only avoidable with a force and / or tight fit. Both factors are reasons for premature failure of the instrument, even if the materials are not yet at the limits of their resistance. Through the joint shaping by the tape casting and subsequent co-sintering of both materials, a material bond is achieved in addition to the previously existing mechanisms of force and form fit. This optimizes the composite properties and increases the usage time of metal-ceramic layered composites. Special focus is given to the formation of the interface and the associated changes in properties of the individual components of the laminate. These investigantions illustrate the influence of co-manufacturing on the texture of the laminate materials and the formed interface between them. By x-ray diffraction (XRD), field emission scanning electron microscopy (FESEM), energy dispersive X-ray spectroscopy (EDX), x-ray fluorescence analysis (RFA) and thermodynamic calculations (FactSage) of the material bond at the metal-ceramic interface is investigated. In various application areas where steel and zirconia should occur as integral partners, this material combination may be established.

Intrapersonal Randomized Controlled Trial Comparing Bipolar Scissors and Conventional Cold Tonsillectomy

ABSTRACT Objective To evaluate bipolar scissors tonsillectomy by comparing it with traditional cold dissection tonsillectomy in the same patients, utilizing one technique on either side. Study design Randomized controlled trial. Settings The ENT day care unit of the Karolinska University Hospital at Danderyd Hospital, Stockholm. Patients A total of 50 patients of which 49 were eligible (M/F 20/29), mean age 14.3 (4-41) years and included in the study. Thirty-one patients were operated due to upper airway obstruction and 18 for chronic tonsillitis. Outcome measures: (1) Intraoperative bleeding, (2) operative time, (3) postoperative pain and (4) complication rates, including postoperative primary and secondary hemorrhage. Methods Modern cold technique; cold scissors, Henke tonsil elevator, bipolar diathermia. Hot technique; bipolar scissors (Ethicon, set on 20 W), bipolar diathermia if needed. Each side was completed separately. Blood loss and total operative time on each side were registered. Pain was evaluated daily on a visual analog scale, VAS (0-100 mm) in patients from 10 years of age. Results Mean operative time for the conventional cold technique was 11.6 SD ± 8.5 (range 1.0-55 mins) and for the hot technique 3.1 SD ± 3.1 min (range 0.5-8.5 mins) (Wilcoxon-test, p < 0.001). The corresponding median values were 3 and 1.9 mins, respectively. The mean blood loss was 43.2 SD ± 41.7 ml (range 7-225 ml) vs 3.0 SD ± 4.7 ml (range 0-25 ml) (Wilcoxon-test p < 0.001). The corresponding median values were 30 and 1 ml respectively. No primary or secondary postoperative hemorrhages requiring surgical intervention occurred. There was no difference in pain. Conclusion Tonsillectomy with bipolar scissors was almost four times faster and the blood loss significantly less than on the side operated with the conventional cold technique, whereas no difference in morbidity was found.