Published in:
01-08-2012 | Case Report
The use of harmonic scalpel in spinal surgery with contraindication to the use of monopolar electrocautery: a case report in a 14-year-old girl with a primary generalized dystonia and a 100° thoracic scoliosis
Authors:
Benjamin Bouyer, Manon Bachy, Anne-Isabelle Vermesch, Diane Doummar, Philippe Coubes, Raphaël Vialle
Published in:
Child's Nervous System
|
Issue 8/2012
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Excerpt
Many techniques are reported to decrease blood loss in children and adolescents undergoing extensive spinal surgeries. The reduction of blood loss and subsequent reduction of allogenic blood transfusion is a desired outcome in such surgical programs. In patients with severe neuromuscular scoliosis, this becomes a greater concern due to a variety of factors such as the need for extensive surgical exposure and the longer intraoperative time [
18]. A lot of pharmacological, anesthetic, and surgical techniques including preoperative autologous blood donation [
1], human recombinant erythropoietin [
17,
27], intraoperative blood salvage techniques, and topical and systemic hemostatic agents [
8,
20] are employed to reduce intraoperative and postoperative bleeding. The extensive use of monopolar electrocautery has been proposed as a safe and rapid technique to perform posterior exposure of the spine [
18]. No significant differences with operative times, intraoperative blood loss, and postoperative hemoglobin levels have been demonstrated in orthopedic patients using bipolar sealer devices for intraoperative haemostasis [
3,
11,
13]. In some patients with implanted pacemaker of brain stimulator, electrocautery has a potential risk of serious implanted hardware dysfunction [
2,
6,
19,
24,
25]. In these patients, the use of harmonic scalpel, using high-frequency mechanical vibrations to cut and coagulate at the same time, could be an alternative technique to the use of monopolar electrocautery [
14,
16]. We report the case of a 14-year-old girl previously treated for a severe acquired dystonia by pallidal bilateral stimulation. The presence of brain stimulators contraindicated the use of monopolar electrocautery for a requested extensive scoliosis surgery. In this case, the successful use of harmonic scalpel is reported and discussed. …
