HARMONIC ULTRACISION DEVICE IN SPINE SURGERY

HARMONIC ULTRACISION DEVICE IN SPINE SURGERY

HARMONIC ULTRACISION
DEVICE IN SPINE SURGERY
Pr. Christian Mazel
Dr. Laurent Balabaud
IMM
Paris France
Disclosure:
Authors did not received any funds for this
work and presentation
PRINCIPLES OF ULTRASONIC ENERGY
FOR CUTING AND COAGULATING
Description of the system
Description of the 4 Qualities
of action
DESCRIPTION OF THE SYSTEM
Generator
Ultrasonic
transducer (hand
piece)
ULTRASONIC PRINCIPLE
Longitudinal blade oscillation of
55 500 cycles per second
(55.5 kHz)
ULTRASONIC PRINCIPLE
Ultrasonic waves are produced by applying
electromagnetic energy to a piezoelectric
ceramic transducer
Céramique piézoélectrique
Support
Onde mécanique
Vibration is transferred to a cutting blade Hook
DESCRIPTION OF THE 4
QUALITIES OF ACTION
HarmonicTM
Hook Blade (Level 5)
Cutting
Cavitation
Coaptation
Coagulation
Monopolar Pencil
50 watts Blend
CAVITATION
Production of vapor bubbles and tissue
vaporization by intracellular and extra cellular
water vaporization creates a desiccation of
the tissues
COAPTATION - COAGULATION
Fragmentation of protein compounds causes
collagen molecule to collapse and lead to
tissue adherence and welding of the vascular
walls
ELECTRO CAUTERY VERSUS
ULTRACISION
No electric current is
passed through the
patient
Ultracision effects on
tissues are achieved
at temperature under
150°C
Electric current passes
trough the patient with
possible injuries
Carbonization occurs
at temperatures over
400°C
EFFECTIVENESS OF ULTRACISION
IN DECREASING BLEEDING
Prospective non randomized series
Posterior spine surgery
Harmonic scalpel dissection versus
conventional dissection
HARMONIC VERSUS ELECTRO
CAUTERY
Patients: 36
Gender (males/females): 10 / 26
Body weight : 70 kg +/- 14
Body Mass index : 26 +/- 4.5
Type of procedure
–
–
–
Laminectomy 15
Laminectomy and Fusion 9
Fusion alone 12
COMPARATIVE STUDY
Harmonic
Electro
-cautery
Univariate P
Value
N° patient
17
19
Gender M/F
3/14
7/12
0.27
Height
163 +/- 7
165 +/- 11
0.35
Body weight
69 +/- 15
71 +/- 17
0.79
Body mass
index
26.1 +/-4.7
25.8 +/- 5.2
0.83
TYPE OF PROCEDURE
9
8
7
6
5
4
3
2
1
0
Harmonic 6.1 +/- 4.1
Electrocautery 3.7 +/- 2.6
laminectomy
Lam+fusion
Fusion
ultracision
Electro
cautery
Mean number of treated
vertebra
Univariate P value 0.0047
NUMBER OF VERTEBRA
TREATED
9
Treated pathology is
not correctly matched in
the two groups
Univariate P value
0.042
8
7
6
2 vert;
3 vert.
4 vert.
5 to 9 vert.
10 or more
5
4
3
2
1
0
Ultracisioin
Electrocautery
BLOOD LOSS ACCORDING TO THE
PROCEDURE
Blood loss according to procedure (in ml)
Laminectomy
Laminectomy + Arthrodesis
Arthrodesis
668
390
408
490
520
163
Total Intraoprative blood loss
Total drainage volume
MEAN INTRAOPERATIVE BLEEDING
during surgical approach in ml.
300
250
200
2 Vertebrae
3 to 5 vert.
6 or more
150
100
50
0
Harmonic
Electrocautery
MEAN DRAINAGE VOLUME in
post op in ml.
700
600
500
400
2 Vertebrae
3 to 5
6 or more
300
200
100
0
Ultracision
Electro cautery
RED CELL BLOOD TRANSFUSION
RCB Transfusion according to procedure
0
5
Laminectomy
Laminectomy +
Arthrodesis
7
Arthrodesis
POST OP PAIN
Statistically significant decrease of pain on day 2 in
the Ultracision group.
Multivariate P value 0.042
Results on pain
4
3,5
Pain intensity (0-10)
3
Group A: Harmonic
Scalpel
*
2,5
2
Group B:
Blade / electrocautery
1,5
1
*: p = 0.042 (m ultivariate;
with ajus tm ent of num ber of
vertebra)
0,5
0
0
1
2
3
Day
4
5
Results on pain
4
Pain intensity (0-10)
3,5
3
Group A: Harmonic
Scalpel
*
2,5
2
Group B:
Blade / electrocautery
1,5
1
*: p = 0.042 (m ultivariate;
with ajus tm ent of num ber of
vertebra)
0,5
0
0
1
2
3
Day
4
5
TIME OF SURGICAL APPROACH
Time for surgical access according to number of
vertebra treated (in min)
Group A: Harmonic
Group B: Electrocautery
76
57
41
2
47
37
36
3 to 5
6 or more
TOTAL DURATION OF SURGERY
ACCORDING To Number of vertebrae
Total duration of surgery according to number of
vertebra treated (in min)
Group A: Harmonic
Group B: Electrocautery
180
110
89
2
88
180
87
3 to 5
6 or more
OTHER COMPLICATIONS
No dural tear or post op leak
No Infection
No neurological complications
No difference in length of hospital stay
CONCLUSIONS
Ultracision does not decrease dramatically
bleeding during surgery
Post op bleeding tends to be less but not in a
statistically significant way
Post op pain is undoubtfully statistically
decreased on day 2 with Ultracision
Approach takes longer but Total operative
time is not increased by Ultracision