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At least 199 records · Page 11Linked to original sources
PubMed1993

Exposure, dissection, and laser versus electrosurgery in laparoscopic cholecystectomy.

The technical complications of laparoscopic cholecystectomy occur while creating the pneumoperitoneum, placing trocars, obtaining exposure, and performing the initial dissection of the cystic duct and artery. The errors most feared are intestinal injury, vascular injury, and common bile duct injury. Bile duct injury usually results from the misinterpretation of the extrahepatic biliary anatomy. Confusion is most likely if the gallbladder infundibulum is pushed superiorly and medially, pulling the common bile duct out from behind the duodenum and into line with the cystic duct and gallbladder. Other dissection errors resulting in bile duct injury include the failure to begin dissection on the gallbladder, routine dissection of the cystic duct all the way to the common bile duct, failure to identify anomalies of the cystic and hepatic ducts, failure to open all folds of the gallbladder infundibulum, and entrapment of a narrow common bile duct by a cystic duct clip "slid" too far proximally. Proper dissection strategy includes posterolateral traction on the gallbladder infundibulum and initiation of dissection at the most medial point where the gallbladder is clearly seen. Pedunculation of the gallbladder will reveal most ductal anomalies but should be supplemented with routine digital fluoroscopic cholangiography. The controversy over optimal sources for thermal dissection of the gallbladder has largely been resolved. Electrosurgical dissection is a more rapid, hemostatic, and economical dissection.

Cholecystectomy, Laparoscopic↗
PubMed1985

A comparison between laser surgery and electrosurgery for bilateral hydrosalpinx: a 2-year follow-up.

The overall pregnancy rate after salpingostomy in women with complete bilateral terminal tubal occlusions was 26.9%. No difference was found in the intrauterine pregnancy rate and the surgery-conception interval between salpingostomy with the CO2 laser or the microdiathermy needle at a 2-year follow-up. The advantage of the CO2 laser in other reproductive surgery remains to be seen.

Adult↗
PubMed1987

Experimental comparison of endoscopic yttrium-aluminum-garnet laser, electrosurgery, and heater probe for canine gut arterial coagulation. Importance of compression and avoidance of erosion.

We compared five endoscopic thermal devices that have been used clinically for control of arterial bleeding in the gastrointestinal tract: neodymium:yttrium-aluminum-garnet (YAG) laser, electrofulguration, monopolar and bipolar electrocoagulation, and heater probe. In canine models we determined the ability to coagulate arteries of varying size and depth. The most effective method for coagulation of medium size arteries was first to occlude the vessel by compression, then to apply heat to seal it (coaptive coagulation). For the contact probes (monopolar, bipolar, and heater probes), the depth of tissue coagulation was controlled by varying probe appositional force and energy, and coagulation of deep arteries was possible. Undesirable erosion of tissue and vessels was noted with electrical sparking from the monopolar electrode and with YAG laser at high power density. In contrast, heater probe and bipolar electrocoagulation did not produce tissue erosion at any instrument setting. In this comparative study of arterial coagulation, overall ranking was as follows: heater probe = bipolar electrocoagulation greater than monopolar electrocoagulation greater than neodymium:YAG laser greater than electrofulguration greater than control. In our opinion these data should assist the clinician or investigator who plans to coagulate arterial bleeding lesions such as peptic ulcers, although further clinical research will be needed to verify these experimental results.

Animals↗
PubMed2005

Post-sphincterotomy bleeding after the introduction of microprocessor-controlled electrosurgery: does the new technology make the difference?

BACKGROUND: Bleeding as a complication of endoscopic sphincterotomy is influenced by several factors. The objective of this study was to compare rates of bleeding after sphincterotomy performed with two different electrosurgical current generators (Valleylab SSE2L and ERBE ICC200). METHODS: A total of 6179 consecutive reports of ERCP were analyzed to compare the frequency of endoscopically and clinically evident bleeding after sphincterotomy when using the Valleylab SSE2L generator (from February 1994 to November 1997) and the ERBE ICC200 generator (from December 1997 to September 2000). Relevant risk factors were assessed by univariate analysis and significant predictors were included in a multiple logistic regression model. RESULTS: A total of 2711 sphincterotomies were performed in 2309 patients (1749 biliary, 962 pancreatic). Endoscopically observed bleeding occurred in 68 patients (5.5%) in the ValleyLab group and 13 (1.2%) in the ERBE group. The ValleyLab generator was independently associated with an increase in endoscopically observed bleeding (OR 4.02: 95% CI[2.13, 7.61], p <0.001). There was no significant difference in clinically evident bleeding between the two groups. CONCLUSIONS: Use of the microprocessor-controlled ERBE electrosurgical generator for endoscopic sphincterotomy was associated with a significantly lower frequency of endoscopically observed bleeding but not clinically evident bleeding.

Adult↗