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Use of a Harmonic scalpel for laparoscopic adrenalectomy in two cats.

ABSTRACT:

Case series summary

Adrenal tumors are rare in cats and reports of laparoscopic adrenalectomy in cats are limited. This case series describes two cats that underwent laparoscopic adrenalectomy using a Harmonic scalpel for dissection and coagulation. Both surgeries were successful, with minimal hemorrhage, smoke production and lateral thermal damage. Vessels were appropriately sealed and surgical times were appropriate. Both cats recovered without complications postoperatively.

Relevance and novel information

To our knowledge, this is the first veterinary report to describe the use of the Harmonic scalpel for laparoscopic adrenalectomy as the sole device in cats. Owing to the absence of hemorrhage, there was no indication for irrigation, suction or hemostatics. The Harmonic scalpel is an ultrasonic vessel-sealing device with benefits over conventional electrosurgery, including less lateral thermal damage, less smoke production and improved safety due to the lack of an electrical current. This case report aims to highlight the usefulness of ultrasonic vessel-sealing devices for laparoscopic adrenalectomy in cats.

SUBMITTER: Zhang RM

PROVIDER: S-EPMC10034285 | biostudies-literature | 2023 Jan-Jun

REPOSITORIES: biostudies-literature

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Use of a Harmonic scalpel for laparoscopic adrenalectomy in two cats.

Zhang Rey M RM Case J Brad JB

JFMS open reports 20230101 1

<h4>Case series summary</h4>Adrenal tumors are rare in cats and reports of laparoscopic adrenalectomy in cats are limited. This case series describes two cats that underwent laparoscopic adrenalectomy using a Harmonic scalpel for dissection and coagulation. Both surgeries were successful, with minimal hemorrhage, smoke production and lateral thermal damage. Vessels were appropriately sealed and surgical times were appropriate. Both cats recovered without complications postoperatively.<h4>Relevan ...[more]

PMID: 36969148

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Project description:Background and objectiveIn spite of being one of the most common surgical procedures performed in adults, laparoscopic cholecystectomy (LC) is relatively uncommon in the pediatric age group. Most surgeons prefer to dissect the cystic duct using a monopolar electrosurgical hook and occlude it with simple metal clips. Although the safety of using the ultrasonically-activated shears, e.g., harmonic scalpel for dissection of the gallbladder is confirmed in many studies, its efficacy in the closure of the cystic artery and duct in adults is still debatable. Furthermore, very few reports studied its safety in children during LC. The aim of our work is to study the safety and efficacy of ultrasonic shears in controlling the cystic duct and artery during LC in children.Materials and methodsA prospective study was conducted from May 2017 to April 2020, where all children having symptomatic gallbladder stone disease were included in the study. HS was used as a sole instrument in gallbladder dissection as well as in controlling cystic duct and artery. No metal clips or sutures were used throughout the procedure.ResultsA total of forty-two children having symptomatic gallstone disease were included in the study. The main indication for LC was hemolytic anemia. Their age ranged from 3 to 13 years with a mean of 8.4 ± 3.25 years. All operations were completed laparoscopically, i.e., no conversion to open surgery was needed. The mean operative time was 40 ± 10.42 min. There were no intraoperative complications apart from gall bladder perforation in two cases during dissection from the liver bed while the postoperative recovery was smooth in all patients. Patients started oral feeding after 11.30 ± 3.01 h. The mean time for discharge was 25.47 ± 7.49 h, ranging from 14 to 48 h. Postoperative ultrasound for all cases showed no evidence of minor or major bile leaks or CBD injuries.ConclusionThis is the first report to evaluate the use of HS as a sole instrument during LC in the pediatric age group. HS is a safe and efficient instrument that can be used alone in gallbladder dissection as well as in controlling cystic duct and artery during LC in children.

Project description:ObjectiveTo explore the advantages and disadvantages of robot-assisted laparoscopic adrenalectomy compared with retroperitoneal laparoscopic adrenalectomy.MethodsA total of 101 patients with adrenal tumors who received retroperitoneal laparoscopic adrenalectomy (RLA) (n=75) or robot-assisted laparoscopic adrenalectomy (RARLA) (n=26) in our hospital from January 2021 to December 2021 were retrospectively collected. Patients' demographics, tumor characteristics, and perioperative indicators were compared. Statistical analysis was performed using t-test for continuous variables and Pearson chi-square test or Fisher's exact test for categorical variables.ResultsWe found that blood loss in the RARLA group was significantly less than that in the RLA group (66.9 ± 35.5 ml vs 91.5 ± 66.1 ml, p = 0.020). Gastrointestinal function recovery time in RARLA group was significantly less than that in RLA group (19.9 ± 6.9 hours vs 32.0 ± 9.0 hours, p < 0.001). However, the operation time, drainage tube placement time, post-operative hospital stay in the RARLA group were significantly longer compared with the RLA group (149.6 ± 53.4 mins vs 118.7 ± 41.2 mins, p = 0.003; 4.9 ± 2.0 days vs 3.6 ± 1.1 days, p = 0.004; 6.4 ± 1.8 days vs 4.6 ± 1.6 days, p < 0.001). The hospitalization expense in the RARLA group is significantly higher than that in the RLA group (59284 ± 8724 RMB¥ vs 39785 ± 10126 RMB¥, p < 0.001). We found that there was no significant difference in the incidence of postoperative complications between the two groups. However, the pathological types of the two groups were significantly different. Patients in the RLA group had a higher proportion of adrenocortical adenoma, while patients in the RARLA group had a higher proportion of pheochromocytoma.ConclusionCompared with traditional laparoscopic adrenalectomy, robot-assisted laparoscopic adrenalectomy can significantly reduce intraoperative blood loss and accelerate postoperative gastrointestinal recovery. It is committed to studying how to reduce the hospitalization time and hospitalization cost of RARLA, which can make RARLA more widely used.

Project description:BACKGROUND:laparoscopic adrenalectomy has become the standard treatment for adrenal lesions. The better clinical outcoms of laparoscopic technique are valid for treatment of small benign masses (<?5-6?cm), instead there are still open questions in literature regarding the correct management of larger lesions (>?6?cm) or in case of potentially malignant adrenal tumors. The aim of this study is to evaluate the outcomes of laparoscopic adrenalectomy in a referral surgical department for endocrine surgery. METHODS:at the University Hospital Policlinico "P. Giaccone" of Palermo between January 2010 and December 2017 we performed a total of 81 laparoscopic adrenalectomy. We created a retrospective database with analysis of patients data, morphologic and hormonal characteristics of adrenal lesions, surgical procedures and postoperative results with histological diagnosis and complications. RESULTS:Mean size of adrenal neoplasm was 7,5?cm (range 1.5 to 18?cm). The mean operative time was 145?min (range 75-240). In statistical analysis lenght of surgery was correlated to the lesion diameter (p?<?0.05) but not with pre-operative features or histological results. 5 intraoperative complications occurred. Among these patients 4 presented bleeding and 1 a diaphagmatic lesion. No conversion to open surgery was necessary and no intraoperative blood transfusion were required. Mean estimated blood loss was 95?ml (range 50-350). There was no capsular disruption during adrenal dissection. Mean length of hospital stay was 3.7?days (range 3-6?days). CONCLUSIONS:Laparoscopic adrenalectomy is a safe procedure with low rate of morbidity. An accurate preoperative radiological examination is fundamental to obtain a stringent patients selection. The lesion diameter is related to longer operative time and appeares as the main predictive parameter of intraoperative complications but these results are not statistically significant. On the other side secreting adrenal tumors require more attention in operative management without increased rate of postoperative complications.

Dataset Information

Use of a Harmonic scalpel for laparoscopic adrenalectomy in two cats.

Case series summary

Relevance and novel information

Publications

Use of a Harmonic scalpel for laparoscopic adrenalectomy in two cats.

Similar Datasets

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