Dissection of the Appendix with Ultrasound-Activated Scalpel: An Experimental Study in Pediatric Laparoscopic Appendectomy

Bartenstein, Andreas; Cholewa, Dietmar; Boillat, Colette; Zachariou, Zacharias (2009). Dissection of the Appendix with Ultrasound-Activated Scalpel: An Experimental Study in Pediatric Laparoscopic Appendectomy. Journal of laparoendoscopic & advanced surgical techniques, 20(2), pp. 199-204. New York, N.Y.: Mary Ann Liebert 10.1089/lap.2009.0028

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Abstract Background: The aim of this study was to examine mechanical, microbiologic, and morphologic changes of the appendicle rim to assess if it is appropriate to dissect the appendix with the ultrasound-activated scalpel (UAS) during laparoscopic appendectomy. Materials and Methods: After laparoscopic resection of the appendix, using conventional Roeder slings, we investigated 50 appendicle rims with an in vitro procedure. The overall time of dissection of the mesoappendix with UAS was noted. Following removal, the appendix was dissected in vitro with the UAS one cme from the resection rim. Seal-burst pressures were recorded. Bacterial cultures of the UAS-resected rim were compared with those of the scissors resected rim. Tissue changes were quantified histologically with hematoxylin and eosin (HE) stains. Results: The average time to dissect the mesoappendix was 228 seconds (25-900). Bacterial culture growths were less in the UAS-resected probes (7 versus 36 positive probes; (p > 0.01). HE-stained tissues revealed mean histologic changes in the lamina propria muscularis externa of 2 mm depth. The seal-burst pressure levels of the appendicle lumen had a mean of 420 mbar. Seal-burst pressures and depths of histologic changes were not dependent on the different stages of appendicitis investigated, gender, or age groups. Seal-burst pressure levels were not related to different depths of tissue changes (P = 0.64). Conclusions: The UAS is a rapid instrument for laparoscopic appendectomy and appears to be safe with respect to stability, sterility and tissue changes. It avoids complex time consuming instrument change manoeuvres and current transmission, which may induce intra- and postoperative complications. Our results suggest that keeping a safety margin of at least 5 mm from the bowel would be sufficient to avoid thermal damage.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Surgery
UniBE Contributor:	Bartenstein, Andreas, Cholewa, Dietmar, Boillat, Colette, Zachariou, Zacharias
ISSN:	1092-6429
ISBN:	19943784
Publisher:	Mary Ann Liebert
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 15:09
Last Modified:	05 Dec 2022 14:21
Publisher DOI:	10.1089/lap.2009.0028
PubMed ID:	19943784
Web of Science ID:	000275576700020
URI:	https://boris.unibe.ch/id/eprint/30286 (FactScience: 192344)