Thunderbeat

Manufactured by Olympus

Sourced in Japan, United States

The Thunderbeat is a surgical instrument designed for tissue dissection and vessel sealing. It utilizes both ultrasonic and advanced bipolar energy to achieve precise and efficient tissue cutting and coagulation.

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Lab products found in correlation

Ligasure, by Medtronic (7 mentions) Harmonic scalpel, by Johnson & Johnson (4 mentions) Enseal, by Johnson & Johnson (4 mentions) Harmonic ace, by Johnson & Johnson (3 mentions) Laparoscopic cusa, by Integra LifeSciences (2 mentions) Echelon vascular staplers, by Johnson & Johnson (2 mentions) Da vinci si, by Intuitive Surgical (2 mentions) Ultracision, by Johnson & Johnson (1 mentions) Endopath, by Johnson & Johnson (1 mentions) Endo gia, by Medtronic (1 mentions) Sils port, by Medtronic (1 mentions) Roticulator, by Medtronic (1 mentions) Sonop 5000, by Hitachi (1 mentions) Cavitron ultrasonic surgical aspirator, by Integra LifeSciences (1 mentions) Da vinci si system, by Intuitive Surgical (1 mentions) Biclamp, by Erbe (1 mentions)

19 protocols using thunderbeat

Surgical Resection Protocol for Liver Tumors

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Surgical resections were performed in a single tertiary referral center using a mixture of laparoscopic and open surgical procedures. Intraoperative ultrasound was routinely performed to allow localization of the tumor, provide an accurate vascular map of feeding vessels, and establish general liver anatomy.
Resection of the liver parenchyma was done using a Cavitron ultrasonic surgical aspirator, often in combination with a Thunderbeat (Olympus Medical Systems) or Ultracision (Ethicon Endosurgery) device. Hemostasis was achieved using a combination of bipolar coagulation, titanium vascular clips, tying or suturing, and an argon beam coagulator. Postoperatively, patients were managed in a high-dependency unit before being transferred to a general surgical ward. Patients undergoing surgical resection followed local protocol, with follow-up imaging in the form of MRI every 4 months during the first year and every 6 months during the second year, followed by ultrasound imaging thereafter.

Ward E.M., Sherif A.E., O’Neill S., Hughes M., Ireland H., Wigmore S.J, & Adair A. (2021). Clinical Outcomes of Ablation Compared with Resection for Single Hepatocellular Carcinoma Lesions, as a Primary Treatment or Bridging to Liver Transplantation: A Retrospective Comparative Study. Annals of Transplantation, 26, e931980-1-e931980-12.

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Surgical Techniques for Liver Resection

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Surgical technique will be at the discretion of the operating surgeon. For open surgery, an L-shaped, subcostal or midline incision will be used according to tumor size and location. For laparoscopy, three ports are used initially, with addition of extra ports or, in selected cases, hand ports as necessary.
For both open and laparoscopic surgery, parenchyma will be divided with electrosurgical instruments, mainly LigaSure® (Covidien, Mansfield, MA, USA), Thunderbeat® (Olympus, Tokyo, Japan) or Cayman® (B.Braun, Melsungen, Germany), sometimes assisted by ultrasonic aspirators, mainly SonoSurg aspirator® (Olympus, Tokyo, Japan) and Söring aspirator® (Söring, Quickborn, Germany). Endoscopic staplers, Endo-GIA® (Covidien) and Endopath® (Ethicon, Bridgewater, NJ, USA), will be used for dividing large vessels and sometimes also for parenchyma division. When the LigaSure® is not used for this purpose, the liver capsula will be divided with ultrasonic scissors, such as Sonicision® (Covidien), SonoSurg scissors® (Olympus) or Harmonic scalpel® (Ethicon).

Fretland Å.A., Kazaryan A.M., Bjørnbeth B.A., Flatmark K., Andersen M.H., Tønnessen T.I., Bjørnelv G.M., Fagerland M.W., Kristiansen R., Øyri K, & Edwin B. (2015). Open versus laparoscopic liver resection for colorectal liver metastases (the Oslo-CoMet study): study protocol for a randomized controlled trial. Trials, 16, 73.

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Single-Port Laparoscopic Surgery Techniques

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The SPA laparoscopic surgeries were performed in the same surgical procedures and steps by the two surgeons. After incising the skin at about 2.0–2.5 cm, subcutaneous tissue and anterior abdominal fascia were opened by Bovie electrocauterization in 40-W, monopolar coagulation mode (Bovie Medical Corporation, Inc., Melville, NY, USA) using the open Hasson technique. Entering the peritoneum, a single-port access was created by inserting a polyurethane multi-channel single-port system. The previously described platform which consisted of a wound retractor and a surgical glove was used during the earlier period of the study^{13 (link),14 (link)}, then it was replaced by a number of commercial platforms including The One Port (LapaKorea, Inc., Seoul, South Korea), OCTO Port (DalimSurgNet, Inc., Seoul, South Korea), SILS Port (Covidien, Inc., Norwalk, CT, USA) and LabSingle (Sejong Medical, Inc., Paju, South Korea). The carbon dioxide pneumoperitoneum was kept at 13 mmHg throughout the operations. The instruments used during the operations included monopolar scissors, laparoscopic energy devices such as ENSEAL (Ethicon, Inc., Somerville, NJ, USA), THUNDERBEAT (Olympus, Inc., Tokyo, Japan), or LigaSure (Medtronic, Inc., Minneapolis, MN, USA), myoma screws, laparoscopic needle holders and articulating graspers (Roticulator, Covidien, Inc., Norwalk, CT, USA).

Noh J.J., Kim T.H., Kim C.J, & Kim T.J. (2020). Incisional hernia after 2498 single-port access (SPA) gynecologic surgery over a 10-year period. Scientific Reports, 10, 17388.

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Laparoscopic and Open Hepatic Resection Techniques

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The laparoscopic and open surgical techniques routinely used in our department have been described previously [5 (link)–8 (link)]. Parenchymal transection was performed using a surgical tissue management system (Thunderbeat, Olympus Inc., Tokyo, Japan) and a Sonop 5000 ultrasonic dissector (Hitachi Aloka Medical, Ltd., Tokyo, Japan). Small vessels were ligated or coagulated using a soft-coagulation system. Intraparenchymal control of major vessels was achieved with nonabsorbable sutures, while biliary and vascular radicle division was accomplished with stapling devices or nonabsorbable sutures. The hepatic pedicle was always isolated to enable the Pringle maneuver by inhibiting the blood flow with a vascular occlusion tube (Vessel-Clude; Argon Medical Devices Inc., Frisco, TX, USA), if possible.

Inoue Y., Suzuki Y., Yokohama K., Ohama H., Tsuchimoto Y., Asai A., Fukunishi S., Kimura F., Higuchi K, & Uchiyama K. (2021). Diabetes mellitus does not influence results of hepatectomy in hepatocellular carcinoma: case control study. Contemporary Oncology, 24(4), 211-215.

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Laparoscopic Liver Surgery with ERAS

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Operations were performed using high-flow laparoscopic insufflators (Air-Seal ® , Conmed, Utica, NY, USA), energy devices (Thunderbeat ® , Olympus, Shinjuku, Tokyo, Japan), laparoscopic CUSA ® (Integra ® Excel, Plainsboro, NJ, USA) and laparoscopic bipolar forceps (Storz, Tuttlingen, Germany,and Sutter, Freiburg, Germany). Each operation was conducted by two surgeons, experienced in both hepatic and advanced laparoscopic surgery. Since 2018, all patients were enrolled in an ERAS (Enhanced Recovery After Surgery) protocol for liver surgery in Winterthur, not in Lugano.

Heid F., Toti J., C Balzarotti Canger R., Cristaudi A., Breitenstein S., Majno-Hurst P, & Schadde E. (2021). Is laparoscopic major hepatectomy feasible and safe in Swiss cantonal hospitals?. Swiss medical weekly, 151.

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Liver Resection Techniques and Safety Measures

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Operative technique followed common clinical standards [4 ]. Intraoperative ultrasonography confirmed preoperative imaging findings and excluded new manifestations. In open surgery, the Cavitron Ultrasonic Surgical Aspirator (CUSA®, Integra LifeSciences, Plainsboro NJ, USA) was used for parenchymal transection, with clipping or ligation of vascular and biliary structures. In laparoscopic cases, either the THUNDERBEAT (Olympus K.K., Tokyo, Japan), HARMONIC ACE® (Ethicon Inc. Somerville, NJ, USA) or laparoscopic CUSA® (Integra LifeSciences, Plainsboro NJ, USA) devices were employed, combined with ECHELON™ vascular staplers (Ethicon, Somerville, New Jersey, USA) or Weck® Hem-o-lok® polymer clips (Teleflex Inc., Pennsylvania, USA). Pringle maneuvers were applied as needed. Anatomical or parenchyma-sparing resections were chosen according to general patient condition, preoperative liver function tests, and limiting factors, such as macrovascular invasion. Resection margins were controlled intraoperatively with frozen section examination.

Amygdalos I., Hitpass L., Schmidt F., Josephs G., Bednarsch J., Berres M.L., Lüdde T., Olde Damink S.W., Ulmer T.F., Neumann U.P., Bruners P, & Lang S.A. (2023). Survival after combined resection and ablation is not inferior to that after resection alone, in patients with four or more colorectal liver metastases. Langenbeck's Archives of Surgery, 408(1), 343.

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Standardized Liver Resection Technique

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Operative technique adhered to common clinical standards for liver resection^{9 (link)}. Intraoperative sonography confirmed preoperative imaging findings and ruled out new or undetected lesions. The Cavitron Ultrasonic Surgical Aspirator (CUSA^®, Integra LifeSciences, Plainsboro NJ, USA) was used for parenchymal transection in open surgery, with clipping or ligation of vascular and biliary structures. In laparoscopic cases, either the THUNDERBEAT (Olympus K.K., Tokyo, Japan), HARMONIC ACE^® (Ethicon Inc. Somerville, NJ, USA) or laparoscopic CUSA^® (Integra LifeSciences, Plainsboro NJ, USA) devices were combined with ECHELON™ vascular staplers (Ethicon, Somerville, New Jersey, USA) or Weck^® Hem-o-lok^® polymer clips (Teleflex Inc., Pennsylvania, USA). Intermittent Pringle maneuvers were carried out as needed. Anatomical or parenchyma-sparing resections were carried out according to general patient condition, preoperative liver function tests, and limiting factors, such as macrovascular invasion. Radicality of tumor resection was controlled through frozen section. Anesthesiologic management aimed for a low central venous pressure (CVP) during the resection phase.

Elmaagacli S., Thiele C., Meister F., Menne P., Truhn D., Olde Damink S.W., Bickenbach J., Neumann U., Lang S.A., Vondran F, & Amygdalos I. (2024). Preoperative three-dimensional lung volumetry predicts respiratory complications in patients undergoing major liver resection for colorectal metastases. Scientific Reports, 14, 10594.

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Liver Resection Surgical Protocol

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Low central venous pressure anaesthesia was used routinely during parenchymal division. The Pringle manoeuvre was performed at the discretion of the operating surgeon. Energy devices (Cavitron Ultrasonic Surgical Apirator, CUSA; Integra, Ireland; Lotus Ultrasonic energy device; BOWA-electronic GmbH, Gomaringen, Germany; Thunderbeat; Olympus, Hamburg, Germany) were used according to the operative surgeon’s preference. It was the departmental policy for patients who had a prior chemotherapy to wait for at least six weeks between the completion of chemotherapy and liver resection surgery. Enhanced recovery pathway was followed in the later cohort.

Nutu A., Wilson M., Ross E., Joshi K., Sutcliffe R., Roberts K., Marudanayagam R., Muiesan P., Chatzizacharias N., Mirza D., Isaac J, & Dasari B.V. (2022). Influence of middle hepatic vein resection during right or left hepatectomy on post hepatectomy outcomes. Annals of Hepato-Biliary-Pancreatic Surgery, 26(3), 257-262.

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Laparoscopic Liver Resection Technique

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The Pringle maneuver was used during parenchymal transection, when necessary. The livers were transected using an alternating combination of a laparoscopic ultrasonic aspirator (Cavitron Ultrasonic Surgical Aspirator [CUSA] Excel, Integra LifeSciences) and THUNDERBEAT (Olympus). The hepatic parenchyma was divided along the right side of the falciform ligament; the pedicles to segment IV were also divided. Small branches of the hepatic vein were controlled using endoclips. After the initial parenchymal dissection on the lateral side of the liver, the right anterior Glissonian pedicle was transected using an endoscopic linear stapler (Endo GIA Curved Tip Reload with Tri-Staple with iDrive Ultra Powered Stapling System, Medtronic). The specimen was wrapped in an endo bag and extracted through a separate Pfannenstiel incision in the pelvic region. After careful hemostasis, fibrin glue and hemostatic materials were applied to the liver cut surface. A drain was inserted, and the wound was closed layer by layer.

Na Y.H., Kim W.B., Kang J.S., Choi S.B, & Kim W.J. (2024). Early outcomes of single-port robotic left lateral sectionectomy in patients with hepatic tumor. Annals of Surgical Treatment and Research, 106(2), 78-84.

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Operative Techniques in Laparoscopic Pancreatectomy

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Various operative techniques were adopted depending on the individual surgeon preference. Our operative technique for laparoscopic or robotic pancreatectomies has been described previously.[11 13 14 (link)] In general, the patient was placed in the reverse Trendelenburg position with the left shoulder elevated with or without the legs apart. Various laparoscopic energy devices were utilised such as the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH, USA), ENSEAL (Ethicon Endo-Surgery, Cincinnati, OH, USA), LigaSure (Covidien, Boulder, CO, USA) or Thunderbeat (Olympus, Tokyo, Japan). Dissection of the pancreas proceeded from the medial to lateral position in most cases except for distal lesions in the pancreatic tail. Endoscopic staplers were used to transect the pancreas and were reinforced with sutures in selected cases.

Goh B.K., Lee S.Y., Kam J.H., Soh H.L., Cheow P.C., Chow P.K., Ooi L.L., Chung A.Y, & Chan C.Y. (2018). Evolution of minimally invasive distal pancreatectomies at a single institution. Journal of Minimal Access Surgery, 14(2), 140-145.

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