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Il Giornale di Chirurgia

Usefullness of the ultrasonically activated scalpel in laparoscopic cholecystectomy: our experience and review of literature

Metodi, tecniche, farmaci, 242 - 245
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Abstract
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English version
Laparoscopic cholecystectomy (LC) actually represents the most used and proper treatment for gallbladder lithiasis, because its many and known advantages in comparison with ‘open’ abdominal surgery. But there are some problems during and after LC due to the use of the electric scalpel and these have brought to the search of an alternative system of dissection and coagulation.
The ultrasonically activated scalpel (Harmonic Scalpel, HS) allows to perform dissection and coagulation with a minimal thermal side effect for surrounding tissues, unlike the electrocoagulation. Furthermore, the use of the HS brings a series of advantages in comparison to the other electromagnetic forms of energy (electroscalpel, laser). HS cuts and coagulates with the same effectiveness of the electroscalpel but, unlike this, it doesn't introduce risks of wandering currents. Moreover, HS contributes to have a more clean and clear (smokes-free) field of operation and it reduces the operative time, the bleeding and the costs of the operation without an increase of the complications and of the percentages of ‘open’ conversion, and perhaps leads to a less negative influence on the postoperative systemic immune response.
The Authors report their experience that confirm these observations, according also with results reported in a brief review of the recent scientific literature, and support wider diffusion and technical development of this ultrasonically-operating surgical team.

Versione italiana
La colecistectomia laparoscopia (LC) attualmente costituisce il più usato e appropriato trattamento in caso di colelitiasiper i molti e noti vantaggi rispetto chirurgia “Open,,. Tuttavia alcuni problemi attribuibili all’impiego dell’elettrobisturi hanno spinto alla ricerca di sistemi alternativi di dissezione e coagulazione.
Il bisturi armonico (HS), ad ultrasuoni consente di ottenere dissezione e coagulazione con un minimo effetto termico sui tessuti viciniori, diversamente dalla elettrocoagulazione. Inoltre, l’uso dell’HS apporta una serie di vantaggi rispetto ad altre forme di energia elettromagnetica (elettrobisturi, laser). HS taglia e coagula con la stessa efficacia dell’elettrobisturi ma, diversamente da questo, non ha i rischi di correnti vaganti; inoltre, contribuisce ad avere un campo operatorio più pulito e visibile (privo di fumo), a ridurre la durata dell’intervento, il sanguinamento e i costi dell’intervento stesso, senza aumentarne complicanze e percentuali di conversione e potrebbe avere effetti negativi sul sistema immunitario del paziente.
Gli Autori riportano la loro esperienza che conferma live tali osservazioni, in accordo anche con quanto riportato in una breve rassegna della letteratura scientifica recente. Tutte queste considerazioni spingono ad una più vasta diffusione e a un perfezionamento tecnico di tale strumentazione chirurgica operante ad ultrasuoni.

Vol XL (No. 4) 2019 July-August

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