A novel diathermy knife with suction function capable of keeping clear visibility while controlling bleeding.
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ABSTRACT:
SUBMITTER: Furuhashi H
PROVIDER: S-EPMC6494991 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PURPOSE:The purpose of this study was to develop intra-ocular diathermy forceps and test them on perfused porcine cadaver eyes. METHODS:We designed two types of 23-gauge intra-ocular bipolar diathermy forceps by modifying commercially available membrane peeling forceps. In the first type, the emitting electrode is connected to one-half of the core and the return electrode to the other half, with one jaw of the forceps attached to each half. In the second type, the emitting electrode is attached to the core and both jaws of the forceps, and the return electrode to the surrounding tube. We compared the new diathermy forceps to conventional intra-ocular diathermy, on perfused porcine cadaver eyes. First-order retinal artery and vein closure was confirmed both by a perfusion study and by histology of the treated vessels. RESULTS:Type 1 diathermy forceps closed retinal arteries and veins more successfully (five of five and five of five successful treatments, respectively) than Type 2 diathermy forceps (five of five and four of five, respectively) and conventional diathermy (three of five and four of five, respectively). Less energy was used with Type 1 compared to Type 2 and conventional for artery closure (1.5 ± 0.0 versus 4.6 ± 3.3 versus 2.1 ± 0.8 joules, respectively) and vein closure (1.5 ± 0.0 versus 5.4 ± 4.6 versus 2.4 ± 0.8 joules, respectively). Histology of the treated vessels confirmed the perfusion study results. CONCLUSION:We designed two types of a new multifunctional intra-ocular instrument with the ability to peel membranes and to grasp, compress and coagulate retinal blood vessels. Both types pose operational advantages compared to current conventional intra-ocular diathermy.
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Project description:Abstract Background Inadequate visualization during upper gastrointestinal bleeding (UGIB) is a common problem. The BioVac direct suction device is designed to enhance endoscopic suction to improve visualization. We initiated a randomized clinical trial to determine the efficacy of this device (NCT02150941). Aims In this report, we present the results of a feasibility analysis. Methods Between July 2014 and June 2016, patients admitted to two academic hospitals undergoing endoscopy for UGIB with suspicion of active bleeding (ie. fresh blood hematemesis, hemodynamic instability, acute drop in hemoglobin) were invited to participate. EGD was performed and patients where the source of bleeding was not found due to poor visualization after 5 minutes were randomized to BioVac or standard endoscopy suction. Due to the difference in suctioning power, a placebo was not possible. Instead, the procedure was recorded and assessed by a blinded outcome assessor. The procedure was otherwise performed at the discretion of the endoscopist without input from the study staff. The primary outcome was whether the bleeding source was found. Secondary outcomes included the mucosa visualization score, endoscopic therapy, need for repeat endoscopy within 7 days, rebleeding, and 30-day mortality. Results Over 24 months, a total of 70 subjects were recruited. 60 subjects were excluded due to the source of bleeding being found within the first 5 minutes or there being no blood in the upper GI tract. Of the 10 subjects randomized, 7 were assigned to standard endoscopy suction and 3 to BioVac. The mean (SD) age was 68.3 (13.4) and 30% were females. 60% presented with fresh blood hematemesis, 30% had a history of cirrhosis, 50% bled as an inpatient, and 60% had an ASA score of ≥4. The source of bleeding was found in 66% in the BioVac group and 71% among the controls. The mean (SD) mucosal visualization score was 15.3 (2.6) for BioVac and 7.7 (3.3) for controls although there was no difference in the application of endoscopy therapy (33% in both groups). 33% in the BioVac group and 83% in the control group required a repeat endoscopy within 7 days. No patients rebleed or died in the BioVac group compared to 3 who rebleed and 4 who died in the control. Conclusions Study feasibility is hampered by low recruitment and high exclusion rates. A multi-centre approach to increase recruitment and the development of a better clinical prediction tool for active bleeding are required. Funding Agencies Vantage Endoscopy
| S-EPMC6507613 | biostudies-literature
Project description:BackgroundSuction drainage is commonly applied after total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) to reduce hematoma, swelling and to favor surgical wound healing. However, its efficacy remains controversial; thus, the purpose of this study is to evaluate drainage efficiency in the management of postoperative bleeding in TKA and UKA.MethodsThe cohort comprised 134 clinical records of patients affected by knee osteoarthritis (OA) who underwent either TKA or UKA. All the patients were subdivided into 2 groups: the first one with drainage and the second one without drainage (respectively 61 and 73 patients). For each group, hemoglobin levels in the preoperative, first, second and third postoperative day were collected. Postoperative complications such as swelling, bleeding from the surgical wound or the need for blood transfusion, were also recorded.ResultsOur results did not show any significant difference of hemoglobin levels in the first (p = 0.715), second (p = 0.203) and third post-operative day (p = 0.467) between the two groups. Moreover, no significant correlation between knee swelling or transfusion rate and the drainage was observed (p = 0.703 and p = 0.662 respectively). Besides, a significant correlation was found between bleeding from the surgical wound and the absence of drainage (p = 0.006).ConclusionsThe study demonstrates how the routine use of suction drainage does not provide substantial benefits in the postoperative blood loss management after TKA or UKA.Trial registrationClinicalTrials.gov NCT04508101 , 09/08/2020, Retrospectively registered LEVEL OF EVIDENCE: III.
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Project description:ObjectivesThis study aimed to objectively evaluate the water-jet-functioned electrosurgical knife injection performances in a desktop experiment.MethodsFive types of water-jet-functioned electrosurgical knives, including two injection styles of sheath-type (A: DualKnife J, KD-655L; B: FlushKnife, DK2620-J-B20S; C: Splash M-Knife, DN-D2718B; D: ISSEN, SN1650-20) and tip-type (E: ORISE ProKnife, M00519361) were evaluated. These knives were compared with an injection needle (Control: SuperGrip 25G) as a control. The injection speed under constant pressure and the injection efficiency for each knife against prepared porcine stomach mucosa were evaluated. The additional clear gel injections using an injection needle were observed using an indigo blue-colored gel to evaluate the difference between the locations of water-jet holes.ResultsFour types of knives, except for A, showed significantly higher water-jet speeds (A: 0.79 ± 0.03 g/20 s, B: 2.56 ± 0.05 g/20 s, C: 3.09 ± 0.06 g/20 s, D: 2.86 ± 0.05 g/20 s, and E: 1.79 ± 0.03 g/20 s) compared to that of the control (1.21 ± 0.03 g/20 s). Meanwhile, significantly higher efficacy of injection was found in the tip-type water-jet function knife, second to the injection needle (Control: 37.2% ± 35.5%, A: 20.9% ± 20.2%, B: 1.1% ± 2.2%, C: 6.2% ± 12.6%, D: 12.5% ± 15.6%, and E: 33.3% ± 32.2%). An additional injection experiment revealed that the injection with a piercing tip into the gel could achieve sufficient additional injection inside the stacked clear gel.ConclusionsThe tip-type water-jet function electrosurgical knife is preferable for effective submucosal injection during endoscopic treatments.
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Project description:Video 1Triangle-tip jet knife with hood attachment: a novel modification over existing endoscopic knife.
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