[The "Ultracision Harmonic Scalpel" ultrasound activated scalpel. Initial results in surgery of the tongue and soft palate].
The ultrasonically activated scalpel (UAS) performs tissue dissection and coagulation simultaneously by an ultra-high-frequency movement of the blade. In the present prospective study, results of UAS in the surgery of the tongue and the soft palate are analysed. 25 patients with carcinoma of the tongue and 11 patients with carcinoma of the soft palate were examined in regard to intra- and postoperative hemostasis, wound healing and postoperative pain. Also, the quality of the histo-pathological specimen obtained by UAS was evaluated. In 68% (17/25) of partial tongue resections, and in 82% (9/11) of soft palate resections efficient intraoperative hemostasis did not require electrocoagulation or suture ligature. In 32% (8/25) of tongue malignancies, all with extension to the tongue base, and in 18% (2/11) of soft palate resections additional ligation was required because of arterial bleeding from vessels exceeding 1.0 mm in diameter. Wound healing was uneventful in all cases. The histopathological evaluation, especially in the margin area, was not impaired. The UAS offers a tissue dissection with efficacious intra- and postoperative hemostasis. Arterial bleeding from vessels exceeding 1.0 mm in diameter should be sutured additionally. The combination of simultaneous tissue dissection and hemostasis enables a good overall view and control of the surgical situs. In addition, based on the mechanical function the UAS has only little thermical effect on neighbouring tissues and enables a controlled tumor resection without damaging vital structures.
Metternich
F U
FU
Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde des Universitätsklinikums Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg. metterni@uke.uni-hamburg.de
Wenzel
S
S
Sagowski
C
C
Jäkel
T
T
Koch
U
U
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005927:Glossectomy / Q000295:instrumentation; D006488:Hemostasis, Surgical / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D010157:Palatal Neoplasms / Q000473:pathology / Q000601:surgery*; D010160:Palate, Soft / Q000473:pathology / Q000601:surgery*; D013525:Surgical Instruments; D014062:Tongue Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000295:instrumentation*