Gli abstracts più recenti sulla tecnologia PIEZOSURGERY®
Piezosurgery in pediatric neurosurgery.
Massimi L, Rapisarda A, Bianchi F, Frassanito P, Tamburrini G, Pelo S, Caldarelli M.
World Neurosurg. 2019 Mar 1. pii: S1878-8750(19)30514-5. doi: 10.1016/j.wneu.2019.02.103. [Epub ahead of print]
BACKGROUND: Piezosurgery (PS) gained an increasing diffusion in neurosurgery. In pediatric neurosurgery, the experience is limited to craniosynostosis surgery. The present study assesses PS in the pediatric population considering outcome and complications also in cranial and spinal procedures.
METHODS: All consecutive craniotomies and laminotomies, performed with PS (group A) or conventional osteotomes (group B) in the 2014-2017 period, have been reviewed. The following variables were analyzed: dural tears, estimated blood loss (EBS) and need of transfusion, cosmetic outcome (Sloan's score), operative times. A review of the pertinent literature has been included.
RESULTS:172 children were enrolled, 90 belonging to group A and 82 to group B. The mean follow-up was 2.1 years. A statistically significant difference in favor of group A was found about EBS (105 vs 113 ml) and late outcome (Sloan's class A 98.5% vs 91.5%). PS also reduced the risk of dural tears (1 vs 7 cases in group A and B, respectively) and blood transfusion (52% vs 55.5%) but without statistical significance. The operative times were significantly shorter in group B (13 vs 23 minutes), though the newer PS plus (PSP) was demonstrated to significantly shorten these times compared with the traditional PS (3.5 vs 6.5 minutes for orbitotomy, 7.5 vs 9.5 minutes for hemi-craniotomy).
CONCLUSIONS: PS is a safe and effective tool that can be specifically recommended for bone splitting and graft, laminotomy and craniotomy in cosmetically eloquent areas. The limit of operation times can be overcome by a learning curve in neurosurgery and PSP.
Copyright © 2019. Published by Elsevier Inc.
KEYWORDS: Piezosurgery; bone graft; bone harvesting; craniofacial surgery; craniotomy; osteointegration
A comparative analysis of piezosurgery and oscillating saw for balanced orbital decompression.
Stähr K, Eckstein A, Holtmann L, Schlüter A, Dendy M, Lang S, Mattheis S.
Orbit. 2018 Dec 4:1-7. doi: 10.1080/01676830.2018.1552709. [Epub ahead of print]
INTRODUCTION: Different minimally invasive surgical approaches to the orbit allow individualized bone resection to reduce proptosis and decompress the optic nerve in patients with Graves' orbitopathy (GO). This study aims to compare piezosurgery to an oscillating saw used to resect bone from the lateral orbital wall.
METHODS: In a retrospective study, we analyzed balanced orbital decompressions performed on 174 patients (318 cases) with GO. An oscillating saw was used in 165 cases (saw group) and piezosurgery in 153 cases (piezo group). Peri- and postoperative complications, reduction of proptosis, new onset of diplopia and improvement of visual acuity in cases of pre-operative optic nerve compression were analyzed.
RESULTS: We observed no significant differences in the surgical outcome between the two groups. Proptosis reduction was 4.6 mm in the saw group (p < 0.01) and 5.3 mm in the piezo group (p < 0.01). Intraoperative handling of the piezosurgery device was judged superior to the oscillating saw, due to soft tissue conservation and favourable cutting properties. Duration of the surgery did not differ between the groups. No serious adverse events were recorded in both groups.
CONCLUSION: The application of piezosurgery in orbital decompression is more suitable than an oscillation saw due to superior cutting properties such as less damage to surrounding soft tissue or a thinner cutting grove.
KEYWORDS: Graves’ orbitopathy; Orbital decompression; diplopia; piezosurgery; proptosis reduction
Piezosurgery for infra- and supratentorial craniotomies in brain tumors surgery.
Vetrano IG, Prada F, Perin A, Casali C, DiMeco F, Saini M.
World Neurosurg. 2018 Nov 17. pii: S1878-8750(18)32611-1. doi: 10.1016/j.wneu.2018.11.064. [Epub ahead of print]
OBJECTIVE: Piezoelectric surgery represents an innovative technique to perform safe and effective osteotomies, alternative to traditional bony tissue management using rotating or perforating instruments. We evaluated safety and feasibility of craniotomies using an ultrasonic device that allows the selective cut of mineralized structures, avoiding damages to the vascular, dural and parenchymal structures.
METHODS: We analyzed a series of 300 patients (range 1-81 years, SD±15.2) that underwent elective cranial surgery for brain tumors, in which the craniotomy was performed using a piezoelectric device. Preoperative and postoperative imaging, clinical notes and intraoperative details were collected.
RESULTS: 197 patients (66%) underwent surgery for supratentorial tumors, the remaining 103 (34%) for infratentorial ones. Tumors involved the skull base in 125 cases. Meningiomas, gliomas and schwannomas represented the most common histotypes. Duraplasty for dural damages was not necessary in all cases; no venous sinuses or parenchymal injuries were reported during bone work. We noted in 13 cases (4,3%) a minor dural tear, requiring only direct sutures. Bone flaps were always intact after craniotomy. No subgaleal cerebrospinal fluid (CSF) collection or CSF leak were recorded. Due to the minimal bone gap, we always achieved correct bone flaps ossification. No reabsorption or mobilization of bone flap was noted.
CONCLUSION: We illustrate the feasibility and safety of a piezosurgical cutter to perform craniotomies. This alternative technique appears to be safe, with excellent cosmetic effects. Adding another tool to the neurosurgical armamentarium.
Copyright © 2018 Elsevier Inc. All rights reserved.
KEYWORDS: Brain tumors; Craniotomy; Dural sinuses; Piezosurgery; Ultrasonic surgery.
Piezoelectric Surgery for Dorsal Spine.
Franzini, Legnani, Beretta, Prada, DiMeco, Visintini, Franzini.
World Neurosurg. 2018 Jun;114:58-62. doi: 10.1016/j.wneu.2018.03.026. Epub 2018 Mar 10.
BACKGROUND: Laminoplasty and laminectomy are two common surgical procedures utilized in approaching degenerative and neoplastic disease of the spinal canal. Routinely adopted instruments, such as Kerrison rongeur or high-speed drill (HSD), entail some potentially serious complications such as dura injuring and thermal and mechanical damage to neurovascular structures. We have adopted piezoelectric bone surgery, which permits a selective cut of mineralized tissues, to perform posterior procedures on the thoracic spine, where the relationship between bone and the spinal cord are critical.
OBJECTIVE: To evaluate the use of piezoelectric surgery for performing dorsal spine laminectomy and laminoplasty.
METHODS: Mectron piezosurgery device is an instrument developed for cutting bone with microvibrations that are created by the piezoelectric effect. This instrument allows a safe and precise bone cut, and it is characterized by no heat generation, thus avoiding thermal injury to bone and soft tissues. We have adopted this device to perform eight laminoplasty for tumors of the dorsal spine and two laminectomies for thoracic spinal stenosis, for a total of ten patients.
RESULTS: Across all surgeries there were no procedure-related intraoperative complications, such as dura injuring or damage to neural structures.
CONCLUSION:The piezoelectric device showed excellent results in terms of safety and precise bone cutting properties when performing posterior surgical procedures in the dorsal spine, where thermal injury produced by the conventionally used drill may damage the spinal cord, closer to bony elements.
KEYWORDS: Dorsal spine; Laminectomy; Laminoplasty; Mectron; Piezoelectric surgery; Thoracic spinal stenosis
Copyright © 2018 Elsevier Inc. All rights reserved.
Structural and ultrastructural analyses of bone regeneration in rabbit cranial osteotomy: Piezosurgery versus traditional osteotomes.
Anesi A, Ferretti M, Cavani F, Salvatori R, Bianchi M, Russo A, Chiarini L, Palumbo C.
J Craniomaxillofac Surg. 2017 Oct 12. pii: S1010-5182(17)30343-8. doi: 10.1016/j.jcms.2017.10.004. [Epub ahead of print]
Clinical advantages of piezosurgery have been already proved. However, few investigations have focused on the dynamics of bone healing. The aim of this study was to evaluate, in adult rabbits, bone regeneration after cranial linear osteotomies with two piezoelectrical devices (Piezosurgery® Medical - PM and Piezosurgery® Plus - PP), comparing them with conventional rotary osteotomes (RO). PP was characterized by an output power three times higher than PM. Fifteen days after surgery, histomorphometric analyses showed that the osteotomy gap produced with PM and PP was about half the size of that produced by RO, and in a more advanced stage of recovery. Values of regenerated bone area with respect to the total osteotomy area were about double in PM and PP samples compared with RO ones, while the number of TRAP-positive (tartrate-resistant acid phosphatase positive) osteoclasts per linear surface showed a significant increase, suggesting greater bone remodelling. Under scanning electron microscopy, regenerated bone displayed higher cell density and less mineralized matrix compared with pre-existent bone for all devices used. Nanoindentation tests showed no changes in elastic modulus. In conclusion, PM/PP osteotomies can be considered equivalent to each other, and result in more rapid healing compared with those using RO.
KEYWORDS: Bone regeneration; Cranial osteotomy; Elastic modulus; Nanoindentation; Piezosurgery