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Eur J Cardiothorac Surg 2008;34:223. doi:10.1016/j.ejcts.2008.03.037
Copyright © 2008, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Letters to the Editor

Does the electric scalpel facilitate bronchial tissue damage?

Mitsuhiro Kamiyoshihara*, Takashi Ibe

Department of General Thoracic Surgery, Maebashi Red Cross Hospital, 3-21-36 Asahi-Cho, Maebashi, Gunma 371-0014, Japan

Received 13 March 2008; accepted 26 March 2008.

* Corresponding author. Tel.: +81 27 224 4585; fax: +81 27 243 3380. (Email: micha2005jp{at}yahoo.co.jp).

Key Words: Electric scalpel • Tissue damage • Bronchial perforation

We have read with great interest the description of postoperative perforation of the bronchus intermedius membrane after primary lung cancer resection by Hirami et al. [1] and we would like to add to the discussion.

The authors said that 15 patients (1.65%) developed bronchopleural fistulas and four of them (0.44%) involved perforation of the bronchus intermedius membrane. In addition, the authors postulated that risk factors included subcarinal lymph node dissection, bronchial artery dissection, and burning with an electric scalpel. They are absolutely right on this point. However, we have two questions regarding the authors’ surgical technique.

First, what does ‘sharp dissection using an electric scalpel’ mean? An electric scalpel cuts organs and tissues while cauterizing the bleeding vessels with an electric current. ‘Sharp dissection’ is possible only using scissors. Second, what does ‘protective handling of the bronchial membrane’ mean? That is a very general term. It is natural to handle tissues protectively; all surgeons do it routinely.

We perform sharp dissection for lymph nodes and use scissors and vascular clips whenever possible, not an electric scalpel. Experience tells us that using an electric scalpel will lead to bronchial fistulas and perforation. Just subcarinal lymph node dissection causes ischemic change in bronchial stumps [2]. In addition, the electric scalpel causes greater tissue damage in animal experiments [3]. We think that using an electric scalpel causes bronchial fistulas and perforation.

Whenever an electric scalpel is used, tissue damage cannot be avoided, even if the electric output is turned down. Therefore, we recommend the use of scissors and clips for lymph node dissection whenever possible, or ultrasonic devices.

References

  1. Hirami Y, Toyooka S, Sano Y, Date H. Postoperative perforation in the bronchus intermedius membrane after a primary lung cancer resection. Eur J Cardiothorac Surg 2008;33:130-132.[Abstract/Free Full Text]
  2. Satoh Y, Okumura S, Nakagawa K, Horiike A, Ohyanagi F, Nishio M, Horai T, Ishikawa Y. Postoperative ischemic change in bronchial stumps after primary lung cancer resection. Eur J Cardiothorac Surg 2006;30:172-176.[Abstract/Free Full Text]
  3. Meyer F, Ioshii SO, Chin EW, Esser DM, Marcondes RT, Patriani AH, Pimpão B de F. Laparoscopic partial nephrectomy in rats. Acta Cir Bras 2007;22:152-156.[Medline]



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Y. Hirami, S. Toyooka, Y. Sano, and H. Date
Reply to kamiyoshihara and ibe.
Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 223 - 224.
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