Harmonic Scalpel Hemorrhoidectomy
The HARMONIC SCALPEL
uses ultrasonic technology, the unique energy form that allows both cutting
and coagulation of hemorrhoidal tissue at the precise point of application,
resulting in minimal lateral thermal tissue damage. Because the HARMONIC
SCALPEL uses ultrasound, there is less smoke than is generated
by both lasers and electrosurgical instruments. The HARMONIC
SCALPEL cuts and coagulates by using lower temperatures than
those used by electrosurgery or lasers. HARMONIC
SCALPEL technology controls bleeding by coaptive coagulation
at low temperatures ranging from 50ēC to 100ēC: vessels are coapted (tamponaded)
and sealed by a protein coagulum. Coagulation occurs by means of protein
denaturation when the blade, vibrating at 55,500 Hz, couples with protein,
denaturing it to form a coagulum that seals small coapted vessels. When
the effect is prolonged, secondary heat is produced that seals larger
vessels. Because ultrasound is the basis for
HARMONIC SCALPEL technology, no electrical energy is conducted
to the patient.
By contrast, electrosurgery coagulates by
burning (obliterative coagulation) at temperatures higher than 150ēC.
Blood and tissue are desiccated and oxidized (charred), forming eschar
that covers and seals the bleeding area. The reduced postoperative pain
after Harmonic Scalpel hemorrhoidectomy compared with electrocautery controls,
likely results from the avoidance of lateral thermal injury.
 
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Harmonic Scalpel Applied to
Tissue
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Harmonic Scalpel Hemorrhoidectomy
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The protein coagulum caused by the application
of the HARMONIC SCALPEL is superior
at sealing off large bleeding vessels during surgery. It has been my experience
that this method is useful on large hemorrhoids that may bleed during
surgery, thus minimizing blood loss and reducing the time needed for surgery.
Video References
1. Video: View
Actual Hemorrhoid Surgery using the Harmonic Scalpel (8 minutes),
Ethicon Endo-Surgery Inc. 2001,
http://www.jnjgateway.com/home.jhtml?loc=USENG&page=viewContent&
contentId=fc0de00100000325&parentId
2. Video: Harmonic
Scalpel & Laser Hemorrhoidectomy (5 minutes), Rick Shacket, DO.
2002, get > Real
Player
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