Blood-saving dissection with monopolar tungsten needle electrodes and Teflon-coated spatula electrodes in tumor orthopedics

Abstract

Introduction: Resection of musculoskeletal tumors and reconstruction with tumor endoprostheses often results in blood loss requiring transfusion of blood products. We assessed the blood-saving potential of using monopolar tungsten needle electrodes and polytetrafluoroethylene (PTFE)-coated spatula electrodes (intervention) compared with conventional dissection with sharp instruments and coagulation with uncoated steel electrodes (control).

Methods: We retrospectively analyzed data of 132 patients (79 interventions, 53 controls) undergoing surgery by one single experienced surgeon in our tertiary referral center between 2012 and 2021.

Results: Intraoperative blood loss in the intervention group was reduced by 29% [median (IQR): 700 (400-1200) vs 500 (200-700) ml; p = 0.0043]. Postoperative wound drainage decreased by 41% [median (IQR): 1230 (668-2041) vs 730 (450-1354) ml; p = 0.0080]. Additionally, patients in need of PRBCs during surgery declined from 43% to 15% (23/53 vs 12/79; p = 0.0005), while the transfusion rate after surgery did not change notably. The number of patients in need of revision surgery due to wound healing disorders was low in both groups (control group: 4/53 vs intervention group: 4/79). Only one patient in the control group and two patients in the intervention group underwent revision surgery due to hemorrhage. Baseline characteristics were similar between groups (sex, Charlson Comorbidity score, tumor entity).

Conclusion: Dissection with tungsten needle electrodes and PTFE-coated spatula electrodes appears an effective surgical blood-saving measure without increased risk of wound healing disorders.

Level of evidence: III, retrospective comparative study.

Clinical trial registration: The study was registered at ClinicalTrials.gov. Identifier: NCT05164809.

Keywords: Blood loss; Electrosurgery; Patient blood management; Tumor endoprosthesis; Tumor orthopedics.

Fig. 1

Intraoperative photographs of tumor dissection performed exclusively with monopolar electrodes; a Monopolar tungsten needle electrode (1), Teflon-coated spatula electrode (2) (both: Erbe Elektromedizin GmbH, Tuebingen, Germany). b Skin incision and superficial dissection of the biopsy channel (*), that is inevitably contaminated with tumor cells after incisional biopsy and thus must be completely removed together with the tumor. This step is performed with the high-precision tungsten needle electrode (1). c Deep dissection to achieve wide tumor resetion is then performed with the teflon-coated spatula electrode (2). Visibility of the surgical site is excellent due to minimal bleeding

Fig. 2

Flow of participants included in the analysis

Fig. 3

Comparison of main outcomes between the intervention group and the control group. a Intraoperative blood loss in ml. b Postoperative wound drainage in ml. c Intraoperative transfusions of packed red blood cells (PRBCs) in units. Bars indicate median, error bars indicate interquartile range, ** p-value <0.01, *** p-value <0.001

Fig. 4

Comparison of the number of patients in need of transfusions with packed red blood cells (PRBCs) during surgery between the intervention group and the control group. ** p-value <0.01