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Ultrasonic instruments associated with improved outcomes
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CHICAGO—Using ultrasonic surgical instruments is associated with more favorable outcomes when compared with conventional instruments for some procedures, according to a meta-analysis of 51 previously published studies in the June issue of Archives of Surgery, one of the JAMA/Archives journals.

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Ultrasonic surgical equipment uses vibrations at a frequency of 55,500 hertz to help make incisions into skin and other tissues and seal blood vessels, according to background information in the article. Ultrasonic instruments were introduced into the clinical practice of surgery approximately a decade ago to minimize the risks associated with conventional surgical technologies.

Brent Matthews, M.D., of the Washington University School of Medicine, St. Louis, and colleagues analyzed studies published between 1990 and 2005 comparing ultrasonic to conventional surgical instruments. Their analysis included 51 studies—24 randomized controlled trials and 27 non-randomized studies— involving 4,902 patients who underwent a variety of procedures, including colorectal, gynecological, solid organ and head and neck surgery.

Overall, ultrasonic equipment appeared at least as effective and safe as conventional equipment. Average blood loss was less for ultrasonic procedures, with the exception of colorectal procedures and Nissen fundoplication, a stomach procedure used to treat acid reflux. Average surgery time was shorter when ultrasonic instruments were used, except in the case of mastectomy. No significant difference was observed in length of hospital stay.

Other complications that occurred less frequently in patients undergoing surgery with ultrasonic instruments included blood clots, bowel leaks, fistulas (unintentional connections between adjacent tissues or structures), blocked blood vessels and injuries to nerves, organs and tissues. “Overall, ultrasonic surgical instrumentation use seems to be associated with fewer complications across all studies that report these outcomes; however, data are sparse,” the authors write.

“The expanded use of ultrasonic instrumentation in general or minimally invasive surgery, colorectal surgery, gynecologic surgery, plastic and reconstructive surgery and otolaryngology is supported by the outcomes from this systematic review,” they conclude. “A decrease in operative blood loss combined with less local thermal damage than traditional electrosurgical instrumentation may prove to be of particular benefit in selected surgical procedures.”
(Arch Surg. 2008;143[6]:592-600.

Editor's Note: This study was supported by Ethicon Endo-Surgery. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org .

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