| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2001;72:2185
© 2001 The Society of Thoracic Surgeons
a Department of Cardiac Surgery, University Hospital Großhadern, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
e-mail: lamm{at}lrz.uni-muenchen.de
To the Editor
The harmonic scalpel (HS) differs from electrocautery in that there is only a minimal transfer of energy and no transfer of electrical energy to the tissues. It has been shown by histologic evaluation that little damage is done to the endothelium of mammary arteries when the HS is used in immediate proximity to the vessels, whereas considerable tissue damage is evident when electrocautery is used at a distance of less than 0.5 cm from the point of contact [1]. If the HS is applied for the dissection of the radial artery pedicle, there is a reduction in spasm of the artery [2]. The device is also useful for harvesting the mammary arteries in minimally invasive [3] as well as conventional revascularization operations. [4]. Furthermore, it has been shown that compared with electrocautery, the HS reduces muscle damage during endoscopic mobilization of the latissimus dorsi muscle [5].
In cardiac reoperations, dissection of adhesions is usually accomplished by a combination of sharp and blunt dissection with or without electrocautery. Electrocautery is normally used for the initial dissection of sternal adhesions, particularly after sternotomy. Because electrocautery works through conduction of electricity, if frequently causes interference with heart rhythm. If intractable, hemodynamic impairment that requires rapid onset of cardiopulmonary bypass can result. If this fails, the patient can die. On the basis of all the clinical reports about the HS, a significant decrease in intraoperative and possibly even postoperative heart rhythm disorders is to be expected, as there is no conduction of electricity.
In our institution, we have been using the HS to dissect adhesions since early 1998. In an initial study comparing the HS and electrocautery in terms of interference with heart rhythm, 20 patients who were to have a cardiac reoperation were randomly split into two groups. In group 1, only the HS was used. In group 2, electrocautery was combined with scissor dissection. Postoperatively, the electrocardiogram was monitored continuously while patients were in the intensive care unit, and heart rhythm disorders were recorded.
There were no intraoperative dysrhythmias in group 1. In group 2, however, multiple supraventricular and ventricular extrasystoles including two episodes of self-terminating ventricular tachyarrhythmias occurred during high-frequency electrocautery. There was one postoperative episode of ventricular tachyarrhythmia in each group. Two patients in group 1 had an implanted pacemaker (DDD mode). Although we did not program the pacemaker differently during the operation, there was no interference with the heart rhythm when the HS was used.
The HS proved feasible in cardiac reoperations. Intraoperatively, it does not interfere with the heart rhythm or an implanted pacemaker, and visualization is good, as there is no smoke when the device is used. Postoperatively, heart rhythm is stable. We believe the HS is the tool of choice for patients wearing a pacemaker.
References
This article has been cited by other articles:
|
|
 |
|
  N. Luciani, G. Nasso, M. Piscitelli, G. Possati, and A. Anselmi Computed Tomography Scan in Redo Valvular Surgery Ann. Thorac. Surg., December 1, 2005; 80(6): 2422 - 2423. [Full Text] [PDF]
|
|
|
|
|
|
N. Luciani, A. Anselmi, M. Gaudino, G. Nasso, F. Glieca, L. Martinelli, F. Santarelli, M. Perisano, and G. Possati Harmonic Scalpel Reduces Bleeding and Postoperative Complications in Redo Cardiac Surgery Ann. Thorac. Surg., September 1, 2005; 80(3): 934 - 938. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
