The Hit and Away technique

optimal usage of the ultrasonic scalpel in laparoscopic gastrectomy

Tomoyuki Irino, Naoki Hiki, Manabu Ohashi, Souya Nunobe, Takeshi Sano, Toshiharu Yamaguchi

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Thermal injury and unexpected bleeding caused by ultrasonic scalpels can lead to fatal complications in laparoscopic gastrectomy (LG), such as postoperative pancreatic fistulas (POPF). In this study, we developed the “Hit and Away” protocol for optimal usage of the ultrasonic scalpel, which in essence involves dividing tissues and vessels in batches using the tip of the scalpel to control tissue temperature. Methods: To assess the effectiveness of the technique, the surface temperature of the mesocolon of female swine after ultrasonic scalpel activations was measured, and tissue samples were collected to evaluate microscopic thermal injury to the pancreas. In parallel, we retrospectively surveyed 216 patients who had undergone LG before or after the introduction of this technique and assessed the ability of this technique to reduce POPF. Results: The tissue temperature of the swine mesocolon reached 43 °C, a temperature at which adipose tissue melted but fibrous tissue, including vessels, remained intact. The temperature returned to baseline within 3 s of turning off the ultrasonic scalpel, demonstrating the advantage of using ultrasonic scalpel in a pulsatile manner. Tissue samples from the pancreas demonstrated that the extent of thermal injury post-procedure was limited to the capsule of the pancreas. Moreover, with respect to the clinical outcomes before and after the introduction of this technique, POPF incidence decreased significantly from 7.8 to 1.0 % (p = 0.021). Conclusion: The “Hit and Away” technique can reduce blood loss and thermal injury to the pancreas and help to ensure the safety of lymph node dissection in LG.

Original languageEnglish
Pages (from-to)245-250
Number of pages6
JournalSurgical Endoscopy
Volume30
Issue number1
DOIs
Publication statusPublished - 2016 Jan 1
Externally publishedYes

Fingerprint

Gastrectomy
Ultrasonics
Pancreatic Fistula
Pancreas
Hot Temperature
Temperature
Mesocolon
Wounds and Injuries
Swine
Lymph Node Excision
Capsules
Adipose Tissue
Hemorrhage
Safety
Incidence

Keywords

  • Laparoscopic gastrectomy
  • Pancreatic fistula
  • Thermal injury
  • Ultrasonic scalpel

ASJC Scopus subject areas

  • Surgery

Cite this

The Hit and Away technique : optimal usage of the ultrasonic scalpel in laparoscopic gastrectomy. / Irino, Tomoyuki; Hiki, Naoki; Ohashi, Manabu; Nunobe, Souya; Sano, Takeshi; Yamaguchi, Toshiharu.

In: Surgical Endoscopy, Vol. 30, No. 1, 01.01.2016, p. 245-250.

Research output: Contribution to journalArticle

Irino, T, Hiki, N, Ohashi, M, Nunobe, S, Sano, T & Yamaguchi, T 2016, 'The Hit and Away technique: optimal usage of the ultrasonic scalpel in laparoscopic gastrectomy', Surgical Endoscopy, vol. 30, no. 1, pp. 245-250. https://doi.org/10.1007/s00464-015-4195-9
Irino, Tomoyuki ; Hiki, Naoki ; Ohashi, Manabu ; Nunobe, Souya ; Sano, Takeshi ; Yamaguchi, Toshiharu. / The Hit and Away technique : optimal usage of the ultrasonic scalpel in laparoscopic gastrectomy. In: Surgical Endoscopy. 2016 ; Vol. 30, No. 1. pp. 245-250.
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