Application of Ultracision Harmonic Scalpel in Laparoscopic Radical Gastrectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHENG Yongbin , TONG Shilun , TAN Haiyan , MA Shujin

Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, ChinaCorresponding Author: MA Shu-jin, E-mail: mashujinzyb@163.com;

Corresponding author：

Keywords：

Ultracision harmonic scalpel; Laparoscope; Gastric cancer; 　Lymphadenectomy; Radical resection

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Objective 　To study the application of ultracision harmonic scalpel in laparoscopic radical gastrectomy.
Methods 　Ten patients with gastric cancer were given laparoscopic-assisted radical gastrectomy by using ultracision harmonic scalpel.
Results 　All operations were successfully performed with ultracision harmonic scalpel, and none of which converted into open surgery. The operation time was 300-492 min, mean (385±64) min. The blood loss was 100-500 ml, mean (401±70) ml. The number of harvested lymph nodes was 21-43, mean 31±6. The time for gastrointestinal function recovery was 3-6 d, mean (4.2±1.0) d. The time of patients’ taking out-of-bed activity was 3-７ d, mean (4.5±1.3) d. The time of taking liquid food was 4-６ d, mean (5.0±0.9) d. No case had relapse or metastasis after 4-20 months (mean 12.6 months) of follow-up.
Conclusions 　Laparoscopic radical gastrectomy by using ultracision harmonic scalpel is safe and feasible. Ultracision harmonic scalpel has the advantage of minimal invasion, less bleeding and shorter operation time, which is a very important equipment and useful for laparoscopic gastrointestinal surgery.

Citation： ZHENG Yongbin,TONG Shilun,TAN Haiyan,MA Shujin. Application of Ultracision Harmonic Scalpel in Laparoscopic Radical Gastrectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(10): 781-784. doi: Copy

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2.	Lee WJ, Wang W, Chen TC, et al. Totally laparoscopic radical BⅡ gastrectomy for the treatment of gastric cancer: a comparison with open surgery [Ｊ]. Surg Laparosc Endosc Percutan Tech, 2008; 18(4): 369-374.
3.	Sarela AI. Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins [Ｊ]. Surg Endosc, 2009; 23(1): 153-160.
4.	Palmer MH, Hardin SR, Behrend C, et al. Urinary incontinence and overactive bladder in patients with heart failure [Ｊ]. J Urol, 2009; 182(1): 196-202.
5.	余佩武，王自强，钱锋, 等. 腹腔镜辅助胃癌根治术105例 [Ｊ]. 中华外科杂志， 2006; 44（10）： 1303-1306.
6.	陈峻青. 日本胃癌处理规约第13版重要修改内容简介 [Ｊ]. 中国实用外科杂志, 2000; 20(1): 60-62.
7.	Bresciani C, Perez RO, Jacob CE, et al. Endogastric surgery for gastric diseases-simplifying technical aspects [Ｊ]. Surg Laparosc Endosc Percutan Tech, 2007; 17(5): 407-412.
8.	胡建昆, 陈志新, 张波, 等. 胃癌根治术中No.8淋巴结清扫的意义和技巧 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(5): 560-563.
9.	Rino Y, Ashida A, Harada H, et al. Laparoscopy-assisted distal gastrectomy with 3-cm laparotomy, left hepatic lobe compression technique, and selection of automatic anastomosis device [Ｊ]. Hepatogastroenterology, 2007; 54(73): 4-9.
10.	胡建昆, 张波, 陈心足，等. 新型超声刀在胃癌根治术中的应用及技巧 [Ｊ]. 中国普外基础与临床杂志, 2008; 15(10): 718-721.
11.	余佩武, 唐波. 腹腔镜胃癌淋巴结清扫的策略 [Ｊ]. 外科理论与实践, 2007; 12(6): 522-524.
12.	李国新, 张策, 余江. 腹腔镜辅助远端胃癌D2根治术: 基于解剖的艺术 [Ｊ]. 外科理论与实践, 2007; 12(6): 533-538.
13.	Oz BS, Mataraci I, Iyem H, et al. Comparison of ultrasonically activated scalpel and traditional technique in radial artery harvesting: clinical research [Ｊ]. Thorac Cardiovasc Surg, 2007; 55(2): 104-107.
14.	Satoh S, Okabe H, Kondo K, et al. Video. A novel laparoscopic approach for safe and simplified suprapancreatic lymph node dissection of gastric cancer [Ｊ]. Surg Endosc, 2009; 23(2): 436-437.
15.	Ogura G, Nakamura R, Muragaki Y, et al. Development of an articulating ultrasonically activated device for laparoscopic surgery [Ｊ]. Surg Endosc, 2008; 31: [Epub ahead of print].
16.	余佩武. 腹腔镜胃癌根治术的原则与评价 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(1): 1-5.
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18.	Minutolo V, Gagliano G, Rinzivillo C, et al. Usefullness of the ultrasonically activated scalpel in laparoscopic cholecystectomy: our experience and review of literature [Ｊ]. G Chir, 2008; 29(5): 242-245.
19.	胡旭光, 郑成竹, 柯重伟, 等. 超声刀切割产生的烟雾中细胞及活性的研究 [Ｊ]. 中华实验外科杂志, 2004; 21(6): 690-691.
20.	Bessa SS, Al-Fayoumi TA, Katri KM, et al. Clipless laparoscopic cholecystectomy by ultrasonic dissection [Ｊ]. J Laparoendosc Adv Surg Tech A, 2008; 18(4): 593-598.
21.	Zhou BJ, Song WQ, Yan QH, et al. Ultrasonically activated scalpel versus monopolar electrocautery shovel in laparoscopic total mesorectal excision for rectal cancer [Ｊ]. World J Gastroenterol, 2008; 14(25): 4065-4069.
22.	Azagra JS, Goergen M, De Simone P, et al. Minimally invasive surgery for gastric cancer [Ｊ]. Surg Endosc, 1999; 13(4): 351-357.
23.	Ly QP, Sasson AR. Modern surgical considerations for gastric cancer [Ｊ]. J Natl Compr Canc Netw, 2008; 6(9): 885-894.
24.	Manouras A, Markogiannakis HE, Kekis PB, et al. Novel hemostatic devices in thyroid surgery: electrothermal bipolar vessel sealing system and harmonic scalpel [Ｊ]. Expert Rev Med Devices, 2008; 5(4): 447-466.
25.	Stoff A, Reichenberger MA, Richter DF. Comparing the ultrasonically activated scalpel (Harmonic) with high-frequency electrocautery for postoperative serous drainage in massive weight loss surgery [Ｊ]. Plast Reconstr Surg, 2007; 120(4): 1092-1093.
26.	Higami T, Maruo A, Yamashita T, et al. Histologic and physiology evaluation of skeletonized internal thoracic artery harvesting using an ultrasonic scalpel [Ｊ]. J Thorac Cardiovasc Surg, 2000; 120: 1142-1147.
27.	Bandi G, Wen CC, Wilkinson EA, et al. Comparison of bl-ade temperature dynamics after activation of Harmonic Ace scalpel and the Ultracision Harmonic Scalpel LCS-K5 [Ｊ]. J Endourol, 2008; 22(2): 333-336.

1. Hwang SI, Kim HO, Yoo CH, et al. Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer [Ｊ]. Surg Endosc, 2009; 23(6): 1252-1258.
2. Lee WJ, Wang W, Chen TC, et al. Totally laparoscopic radical BⅡ gastrectomy for the treatment of gastric cancer: a comparison with open surgery [Ｊ]. Surg Laparosc Endosc Percutan Tech, 2008; 18(4): 369-374.
3. Sarela AI. Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins [Ｊ]. Surg Endosc, 2009; 23(1): 153-160.
4. Palmer MH, Hardin SR, Behrend C, et al. Urinary incontinence and overactive bladder in patients with heart failure [Ｊ]. J Urol, 2009; 182(1): 196-202.
5. 余佩武，王自强，钱锋, 等. 腹腔镜辅助胃癌根治术105例 [Ｊ]. 中华外科杂志， 2006; 44（10）： 1303-1306.
6. 陈峻青. 日本胃癌处理规约第13版重要修改内容简介 [Ｊ]. 中国实用外科杂志, 2000; 20(1): 60-62.
7. Bresciani C, Perez RO, Jacob CE, et al. Endogastric surgery for gastric diseases-simplifying technical aspects [Ｊ]. Surg Laparosc Endosc Percutan Tech, 2007; 17(5): 407-412.
8. 胡建昆, 陈志新, 张波, 等. 胃癌根治术中No.8淋巴结清扫的意义和技巧 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(5): 560-563.
9. Rino Y, Ashida A, Harada H, et al. Laparoscopy-assisted distal gastrectomy with 3-cm laparotomy, left hepatic lobe compression technique, and selection of automatic anastomosis device [Ｊ]. Hepatogastroenterology, 2007; 54(73): 4-9.
10. 胡建昆, 张波, 陈心足，等. 新型超声刀在胃癌根治术中的应用及技巧 [Ｊ]. 中国普外基础与临床杂志, 2008; 15(10): 718-721.
11. 余佩武, 唐波. 腹腔镜胃癌淋巴结清扫的策略 [Ｊ]. 外科理论与实践, 2007; 12(6): 522-524.
12. 李国新, 张策, 余江. 腹腔镜辅助远端胃癌D2根治术: 基于解剖的艺术 [Ｊ]. 外科理论与实践, 2007; 12(6): 533-538.
13. Oz BS, Mataraci I, Iyem H, et al. Comparison of ultrasonically activated scalpel and traditional technique in radial artery harvesting: clinical research [Ｊ]. Thorac Cardiovasc Surg, 2007; 55(2): 104-107.
14. Satoh S, Okabe H, Kondo K, et al. Video. A novel laparoscopic approach for safe and simplified suprapancreatic lymph node dissection of gastric cancer [Ｊ]. Surg Endosc, 2009; 23(2): 436-437.
15. Ogura G, Nakamura R, Muragaki Y, et al. Development of an articulating ultrasonically activated device for laparoscopic surgery [Ｊ]. Surg Endosc, 2008; 31: [Epub ahead of print].
16. 余佩武. 腹腔镜胃癌根治术的原则与评价 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(1): 1-5.
17. 胃癌临床实践指南（中国版） [EB/OL]. 第1版. 2008. http://www.nccn-china.org/images/2008PDF/2008 Gastric Cancer guideline Chinese edition.pdf.
18. Minutolo V, Gagliano G, Rinzivillo C, et al. Usefullness of the ultrasonically activated scalpel in laparoscopic cholecystectomy: our experience and review of literature [Ｊ]. G Chir, 2008; 29(5): 242-245.
19. 胡旭光, 郑成竹, 柯重伟, 等. 超声刀切割产生的烟雾中细胞及活性的研究 [Ｊ]. 中华实验外科杂志, 2004; 21(6): 690-691.
20. Bessa SS, Al-Fayoumi TA, Katri KM, et al. Clipless laparoscopic cholecystectomy by ultrasonic dissection [Ｊ]. J Laparoendosc Adv Surg Tech A, 2008; 18(4): 593-598.
21. Zhou BJ, Song WQ, Yan QH, et al. Ultrasonically activated scalpel versus monopolar electrocautery shovel in laparoscopic total mesorectal excision for rectal cancer [Ｊ]. World J Gastroenterol, 2008; 14(25): 4065-4069.
22. Azagra JS, Goergen M, De Simone P, et al. Minimally invasive surgery for gastric cancer [Ｊ]. Surg Endosc, 1999; 13(4): 351-357.
23. Ly QP, Sasson AR. Modern surgical considerations for gastric cancer [Ｊ]. J Natl Compr Canc Netw, 2008; 6(9): 885-894.
24. Manouras A, Markogiannakis HE, Kekis PB, et al. Novel hemostatic devices in thyroid surgery: electrothermal bipolar vessel sealing system and harmonic scalpel [Ｊ]. Expert Rev Med Devices, 2008; 5(4): 447-466.
25. Stoff A, Reichenberger MA, Richter DF. Comparing the ultrasonically activated scalpel (Harmonic) with high-frequency electrocautery for postoperative serous drainage in massive weight loss surgery [Ｊ]. Plast Reconstr Surg, 2007; 120(4): 1092-1093.
26. Higami T, Maruo A, Yamashita T, et al. Histologic and physiology evaluation of skeletonized internal thoracic artery harvesting using an ultrasonic scalpel [Ｊ]. J Thorac Cardiovasc Surg, 2000; 120: 1142-1147.
27. Bandi G, Wen CC, Wilkinson EA, et al. Comparison of bl-ade temperature dynamics after activation of Harmonic Ace scalpel and the Ultracision Harmonic Scalpel LCS-K5 [Ｊ]. J Endourol, 2008; 22(2): 333-336.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of Ultracision Harmonic Scalpel in Laparoscopic Radical Gastrectomy

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