Comparison of the safety of electrotome, Harmonic scalpel, and LigaSure for management of thyroid surgery
Comparison of the safety of electrotome, Harmonic scalpel, and LigaSure for management of thyroid surgery
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电刀、谐波手术刀和 LigaSure 用于甲状腺手术管理的安全性比较
DOI：
10.1002/hed.24701
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发表时间：
2017-06-01
影响因子：
2.9
通讯作者：
Jiang, Kewei
中科院分区：
文献类型：
--
作者：
Yang, Xiaodong;Cao, Jian;Jiang, Kewei
基于能量的手术器械，包括电刀、谐波手术刀和LigaSure，已广泛应用于甲状腺手术，尽管其安全性和有效性的比较尚未报道。在这项研究中，我们研究了在犬模型甲状腺手术中使用止血能量手术装置的可行性。方法24只beagle犬随机分为电刀组（30kw）、电刀组（15kw）、谐波手术刀组（输出级3）、LigaSure手术刀组（中齿轮）。止血装置在甲状腺表面敷敷3秒，然后在喉返神经（RLN，距离5mm、3mm或1mm）附近敷敷3秒。术中神经监测（IONM）记录诱发肌电图（EMG）振幅。手术后立即通过光镜和电子显微镜评估甲状腺组织和RLN的急性显微结构形态学损伤。结果电刀在距离RLN 1mm的垂直距离处，与正常条件下相比，30 kW （1046 404.3 mu V vs 153 +/- 245.5 mu V, p < 0.001）和15 kW （1197 +/- 589.2 mu V vs 986.3 +/- 797.3 mu V, p = 0.037）电刀诱发的肌电图振幅显著降低。此外，光镜和电镜观察到RLNs明显的急性显微结构形态学改变。然而，电刀在距RLN垂直距离5 mm或3 mm处未引起明显的功能或组织学变化。当在垂直距离为5 mm、3 mm或1 mm时，谐波手术刀和LigaSure均未引起诱发肌电图振幅的显著变化（均p < 0.05），也未引起RLNs的微结构形态学变化。电刀（15 kW）对甲状腺组织的热损伤比谐波刀和LigaSure更严重（热损伤深度：0.951 +/- 0.061 vs 0.756 +/- 0.074, p < 0.001; 0.951 +/- 0.061 vs 0.724 +/- 0.116, p < 0.001）。然而，谐波手术刀组和LigaSure组之间没有差异（p = .435）。结论在甲状腺手术中使用LigaSure和Harmonic手术刀比电刀更安全。LigaSure产生的热量比Harmonic手术刀和电刀少。(c) 2017 Wiley期刊公司
Background Energy-based surgical devices, including electrotome, the Harmonic scalpel, and LigaSure, have been widely applied in thyroid surgery, although a comparison of their safety and efficacy has not been reported yet. In this study, we investigated the feasibility of using hemostatic energy-based surgical devices during thyroid surgery in a canine model.Methods Twenty-four beagle dogs were randomly divided into the following groups: electrotome (30 kW), electrotome (15 kW), the Harmonic scalpel (output level 3), and LigaSure (middle gear). The hemostatic devices were applied on the thyroid surface for 3 seconds and then near the recurrent laryngeal nerve (RLN; distance of 5 mm, 3 mm, or 1 mm) for 3 seconds. Evoked electromyography (EMG) amplitudes were recorded by intraoperative neuromonitoring (IONM). Acute microstructural morphological damage to thyroid tissues and the RLN were evaluated immediately after the procedure by light and electron microscopy.Results Electrotome caused a significant decrease in evoked EMG amplitudes when applied at a vertical distance of 1 mm from the RLN, both at 30 kW (1046 404.3 mu V vs 153 +/- 245.5 mu V; p < .001) and 15 kW (1197 +/- 589.2 mu V vs 986.3 +/- 797.3 mu V; p = .037), compared with those evoked under normal conditions. Furthermore, distinct acute microstructural morphological changes of the RLNs were observed by light and electron microscopy. However, no significant functional or histological changes were induced by the electrotome at a vertical distance of 5 mm or 3 mm from the RLN. The Harmonic scalpel and LigaSure induced neither marked changes in evoked EMG amplitudes when applied at vertical distances of 5 mm, 3 mm, or 1 mm (all p > .05) nor microstructural morphological changes in the RLNs. The electrotome (15 kW) caused more serious thermal damage to thyroid tissues than that caused by either the Harmonic scalpel or LigaSure (thermal damaged depth: 0.951 +/- 0.061 vs 0.756 +/- 0.074, p < .001; 0.951 +/- 0.061 vs 0.724 +/- 0.116, p < .001). Nevertheless, there were no differences between the Harmonic scalpel and LigaSure groups (p = .435).Conclusion LigaSure and the Harmonic scalpel might be safer than electrotome when used in thyroid operations. LigaSure generates less heat than the Harmonic scalpel and electrotome. (c) 2017 Wiley Periodicals, Inc.