Ann Surg Treat Res.  2018 Jun;94(6):285-290. 10.4174/astr.2018.94.6.285.

Comparing the safety of harmonic ACE and ACE+ around the recurrent laryngeal nerve in swine models

• Kim HK
• Chai YJ
• Lee HY
• Kim HY
• Dionigi G

• KMID: 2412397
• DOI: http://doi.org/10.4174/astr.2018.94.6.285

Abstract

PURPOSE
Among the various energy-based devices, ultrasonic shears are popular in thyroid surgeries. In this study, we tested the safety of Harmonic ACE and Harmonic ACE+ around the recurrent laryngeal nerve (RLN) in experimental swine models.
METHODS
Harmonic ACE and Harmonic ACE+ were each tested in 4 piglets. Harmonic ACE and Harmonic ACE+ were activated at a 0- to 5-mm distance from the RLN. The function of the RLN was assessed using continuous electrophysiological monitoring.
RESULTS
For Harmonic ACE, there was no adverse EMG event found when activated at 4- and 5-mm distances from the RLN. At a 2- to 3-mm distance, there were 4 adverse EMG events observed. In these 4 cases, adjacent tissue shrinkage occurred after 6 to 15 seconds of activation, and the RLN touched the Harmonic ACE. At a 1-mm distance, there were 2 adverse EMG events found after 25 seconds of activation. For Harmonic ACE+, there was no adverse EMG event observed when activated at 1- and 3-mm distances from the RLN. At a 0-mm distance, 2 adverse EMG events occurred after 6 to 10 seconds of activation.
CONCLUSION
The safe distance of Harmonic ACE and ACE+ was 4 and 1 mm, respectively, in the swine models. Harmonic ACE+ is safer than Harmonic ACE because it did not cause any tissue shrinkage. Surgeons need to understand the characteristics of devices for safe operation.

Keyword

Thyroid; Recurrent laryngeal nerve; Neuromonitoring

MeSH Terms

Recurrent Laryngeal Nerve*
Surgeons
Swine*
Thyroid Gland
Ultrasonics

Figure

• 

  Fig. 1 Experiments of thermal injury of recurrent laryngeal nerve (RLN) induced by Harmonic ACE (Ethicon, a subsidiary Johnson and Johnson, Cincinnati, OH, USA) and Harmonic ACE+ (Ethicon, a subsidiary Johnson and Johnson) in swine model. (A) Harmonic ACE is activated at 2 mm from RLN. (B) Harmonic ACE+ is activated with direct contact to RLN.

• 

  Fig. 2 Electromyography (EMG) signal changes in recurrent laryngeal nerve (RLN) during thermal injury in swine model. (A) The EMG signal remains stable during the Harmonic ACE (Ethicon, a subsidiary Johnson and Johnson, Cincinnati, OH, USA) activation (black arrow) at 3 mm from the RLN for 10 seconds. (B) EMG shows abrupt amplitude and latency decrease when Harmonic ACE is activated (black arrow) at 1 mm from RLN for 25 seconds. Amplitude and latency did not recover for 20 minutes.

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