UNASSIGNED: Hemostasis is an important step in all surgical procedures. Mechanical methods of hemostasis have been gradually abandoned in favor of electrosurgery. The aim of this systematic review was to evaluate the effectiveness of electrosurgical instruments utilized in minimally invasive gynecological procedures.
UNASSIGNED: We performed a systematic review, including randomized controlled trials, prospective and retrospective studies, comparing the outcomes of different energy devices (EDs) used in laparoscopic gynecologic surgeries. We extracted data about blood loss (BL), mean operative time, post-operative pain, hospital stay and complications associated with each electrosurgical device.
UNASSIGNED: We included 30 studies reporting comparative outcomes concerning conventional (bipolar and monopolar) and innovative EDs (Harmonic scalpel, LigaSure, Plasma kinetic gyrus, Thunderbeat, EnSeal, Marseal, Caiman and ALAN). New EDs were found to be more efficient in complex surgeries due to less intraoperative BL and shorter operative time. No significant decrease in hospital stay, post-operative pain or complications was found with the use of new energy instruments.
UNASSIGNED: Although new electrosurgical devices seem an appealing and safer option, there is still insufficient evidence for one vessel-sealing technology to be considered superior to another. Therefore, monopolar and conventional bipolar (CB) are still widely used in laparoscopic gynecology.

BACKGROUND: Seroma formation after axillary lymph node dissection (ALND) remains a troublesome complication with significant morbidity. Numerous studies have tried to identify techniques to prevent seroma formation. The aim of this systematic review and network meta-analysis is to use available literature to identify the best intervention for prevention of seroma after standalone ALND.
METHODS: A literature search was performed for all comparative articles regarding seroma formation in patients undergoing a standalone ALND or ALND with breast-conserving surgery in the last 25 years. Data regarding seroma formation, clinically significant seroma (CSS), surgical site infections (SSI), and hematomas were collected. The network meta-analysis was performed using a random effects model and the level of inconsistency was evaluated using the Bucher method.
RESULTS: A total of 19 articles with 1962 patients were included. Ten different techniques to prevent seroma formation were described. When combining direct and indirect comparisons, axillary drainage until output is less than 50 ml per 24 h for two consecutive days results in significantly less CSS. The use of energy sealing devices, padding, tissue glue, or patches did not significantly reduce the incidence of CSS. When comparing the different techniques with regard to SSIs, no statistically significant differences were seen.
CONCLUSIONS: To prevent CSS after ALND, axillary drainage is the most valuable and scientifically proven measure. On the basis of the results of this systematic review with network meta-analysis, removing the drain when output is < 50 ml per 24 h for two consecutive days irrespective of duration seems best. Since drainage policies vary widely, an evidence-based guideline is needed.

Recent developments in wearable and implanted devices have resulted in numerous, unprecedented capabilities that generate increasingly detailed information about a user\'s health or provide targeted therapy. However, options for powering such systems remain limited to conventional batteries which are large and have toxic components and as such are not suitable for close integration with the human body. This work provides an in-depth overview of biofluid-activated electrochemical energy devices, an emerging class of energy sources judiciously designed for biomedical applications. These unconventional energy devices are composed of biocompatible materials that harness the inherent chemistries of various biofluids to produce useable electrical energy. This work covers examples of such biofluid-activated energy devices in the form of biofuel cells, batteries, and supercapacitors. Advances in materials, design engineering, and biotechnology that form the basis for high-performance, biofluid-activated energy devices are discussed. Innovations in hybrid manufacturing and heterogeneous integration of device components to maximize power output are also included. Finally, key challenges and future scopes of this nascent field are provided.

The aim of this study was to compare energy devices used for intraoperative hemostasis during colorectal surgery.
A systematic literature review and Bayesian network meta-analysis performed. MEDLINE, EMBASE, Science Citation Index Expanded, and Cochrane were searched from inception to August 11th 2021. Intraoperative outcomes were operative blood loss, operative time, conversion to open, conversion to another energy source. Postoperative outcomes were mortality, overall complications, minor complications and major complications, wound complications, postoperative ileus, anastomotic leak, time to first defecation, day 1 and 3 drainage volume, duration of hospital stay.
Seven randomized controlled trials (RCTs) were included, reporting on 680 participants, comparing conventional hemostasis, LigaSure™, Thunderbeat® and Harmonic®. Harmonic® had fewer overall complications compared to conventional hemostasis. Operative blood loss was less with LigaSure™ (mean difference [MD] = 24.1 ml; 95% confidence interval [CI] - 46.54 to - 1.58 ml) or Harmonic® (MD = 24.6 ml; 95% CI - 42.4 to - 6.7 ml) compared to conventional techniques. Conventional hemostasis ranked worst for operative blood loss with high probability (p = 0.98). LigaSure™, Harmonic® or Thunderbeat® resulted in a significantly shorter mean operative time by 42.8 min (95% CI - 53.9 to - 31.5 min), 28.3 min (95% CI - 33.6 to - 22.6 min) and 26.1 min (95% CI - 46 to - 6 min), respectively compared to conventional electrosurgery. LigaSure™ resulted in a significantly shorter mean operative time than Harmonic® by 14.5 min (95% CI 1.9-27 min) and ranked first for operative time with high probability (p = 0.97). LigaSure™ and Harmonic® resulted in a significantly shorter mean duration of hospital stay compared to conventional electrosurgery of 1.3 days (95% CI - 2.2 to - 0.4) and 0.5 days (95% CI - 1 to - 0.1), respectively. LigaSure™ ranked as best for hospital stay with high probability (p = 0.97). Conventional hemostasis was associated with more wound complications than Harmonic® (odds ratio [OR] = 0.27; CI 0.08-0.92). Harmonic® ranked best with highest probability (p = 0.99) for wound complications. No significant differences between energy devices were identified for the remaining outcomes.
LigaSure™, Thunderbeat® and Harmonic® may be advantageous for reducing operative blood loss, operative time, overall complications, wound complications, and duration of hospital stay compared to conventional techniques. The energy devices result in comparable perioperative outcomes and no device is superior overall. However, included RCTs were limited in number and size, and data were not available to compare all energy devices for all outcomes of interest.

Electrospun nanofibers have been exploited in multidisciplinary fields with numerous applications for decades. Owing to their interconnected ultrafine fibrous structure, high surface-to-volume ratio, tortuosity, permeability, and miniaturization ability along with the benefits of their lightweight, porous nanofibrous structure, they have been extensively utilized in various research fields for decades. Electrospun nanofiber technologies have paved unprecedented advancements with new innovations and discoveries in several fields of application including energy devices and biomedical and environmental appliances. This review article focused on providing a comprehensive overview related to the recent advancements in health care and energy devices while emphasizing on the importance and uniqueness of utilizing nanofibers. A brief description regarding the effect of electrospinning techniques, setup modifications, and parameters optimization on the nanofiber morphology was also provided. The article is concluded with a short discussion on current research challenges and future perspectives.

The evolution of minimally invasive surgery has brought forward the appearance of new advances in the course of the most recent couple of years and has introduced energy-based devices. The newest among them today are the ultrasonically activated devices, which are utilized with a great deal of components in-play, including ergonomics and financial aspects amid surgery. The methodology embraced was finding significant investigations through studies from PubMed, Medline and Google Scholar on current ultrasonic dissectors, which are Ethicon\'s Harmonic Scalpel (ACE®), Covidien\'s Sonicision™ (SNC), Conmed\'s SonoSurg® (SS) and Olympus\'s Thunderbeat®, to describe their efficacy in terms of vessel sealing speed, vessel burst pressure, visibility, operation time and thermal speed. We found postmarketing evidence to determine which device exhibits the better performance. Animal studies showed that emissivity values and maximum temperatures for coagulation are similar among devices but maximum cutting temperatures are significantly different: ACE = 191.1°C, SNC = 227.1°C, SS = 184.8°C (p < 0.001). Cooling times are significantly different among devices: 35.7 s for ACE, 38.7 s for SNC and 27.4 s for SS (p < 0.001). Cooling times of passive jaws to reach 60°C after activation were also significantly different: 25.4 s for ACE, 5.7 s for SNC, and 15.4 s for SS (p < 0.001). The perfect device would unify brilliant hemostatic outcomes with visual sharpness while permitting none or insignificant thermal damage at the place of use.

BACKGROUND: Acne scarring is a very common problem, which can be extensive, and may lead to significant psychosocial morbidity. Multiple types of treatments are used to ameliorate atrophic scars with varying degrees of success. This paper provides an overview of the various energy-based modalities that are commonly employed against acne scarring.
OBJECTIVE: A comprehensive literature search of papers published since 2008 was performed in order to determine the efficacy and adverse reactions of commonly used energy-based treatments against post-acne scarring.
RESULTS: A total of 59 relevant articles were identified covering a multitude of different devices.
CONCLUSIONS: Ablative lasers seem to achieve the highest degree of efficacy, albeit this is associated with significant pain and downtime, and the risk for long-term pigmentary changes. Non-ablative fractional photothermolysis (FP) has a much safer profile but cannot achieve as good cosmetic results. The efficacies of fractional radiofrequency microneedling and radiofrequency are slightly inferior to that of FP but offer an even safer adverse profile. Little evidence is available on the remaining devices, with larger studies required in order to reach more solid conclusions.
CONCLUSIONS: Multiple devices have been used with varying levels of efficacy and very different safety profiles. There is an overall lack of high-quality evidence about the effects of different interventions. Furthermore, no standardised scale is available for acne scarring, leading to variability in evaluation and interpretation of data in different studies.

The specialty of laparoscopy has evolved with the advent of new technologies over the last few years. Energy-based devices and Ultrasonic dissectors are used with a lot of factors in play-including ergonomics and economics during surgery. Here an attempt is based to review the surgical efficacy and safety of these dissectors with importance to plume production and lateral thermal damage. The factors contributing to adversities to the dissectors are also to be noted. The strategy adopted was aimed at finding relevant studies from PubMed from 1995 to 2014. The basic principle of plume production and thermal damage are studied in this review. Factors contributing to the same that can lead to adversities during laparoscopic surgeries are identified. Summarizing key points that increase lateral thermal damage and plume production amongst different ultrasonic shears and suggesting a technique to identify the right balance between the existing dissectors was possible. The RF Device and USS are both useful and widely used and are more safer than monopolar devices. RF Device is considerably slower than USS, as it cannot achieve coagulation and cutting at the same time. Although USS definitely improvises dissection and has less thermal injury than RF Device, the clinical implications in balancing dissection efficacy with hemostasis need to be investigated further. The ideal haemostatic energy-based shear device would be one with excellent hemostatic results and visual acuity while allowing none or minimal thermal energy escape at the point of application. In our current setting, a combined use of both RF and USS device usage as applied in the particular situations has potential.