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PubMed1992

The ultrasonic dissector facilitates laparoscopic cholecystectomy.

The ultrasonic dissector disrupts tissues in proportion to their fluid content by ultrasonically induced cavitational forces. Since sturdy tissues are spared, the instrument tends to follow tissue planes and to dissect fat and other soft tissues selectively. We performed a prospective, randomized, controlled trial in 73 patients comparing the safety and efficacy of a prototype ultrasonic dissector with that of electrosurgery and laser during laparoscopic cholecystectomy. Randomization was as follows: ultrasonic dissector, 37 patients; electrosurgery, 21 patients; and laser, 15 patients. The results were not different with respect to patient characteristics, amount of blood loss, technical difficulties, length of hospital stay, or return to work. Subjectively, the ultrasonic dissector was thought to be of special value in isolating the hilar structures, particularly when they were edematous or embedded in fat. The ultrasonic dissector disintegrated the fat, which was rapidly cleared up the suction channel, allowing the cystic duct and artery to be bared with less risk of injury. We concluded that the ultrasonic dissector has unique attributes that contribute to the ease and safety of laparoscopic cholecystectomy.

Adolescent↗

PubMed2002

Radiofrequency treatment of tonsillar hypertrophy.

OBJECTIVE: To describe radiofrequency electrosurgery and the devices and techniques available for using this technology to treat tonsillar hypertrophy. STUDY DESIGN: Review. METHODS: Electrosurgical devices, which include the Bovie, Elmed, somnoplasty, and coblation systems and argon plasma coagulators, use energy transfer by means of electromagnetic radiation to generate heat within tissue for cutting and coagulation. With these devices, tonsillar tissue can be removed completely, partly ablated, or decreased in volume. RESULTS: Tissue ablation with radiofrequency that preserves the outer portion of the tonsillar capsule may reduce postoperative pain and allow earlier return to normal diet and activity. Removal of the entire tonsil using the coblation method may produce less damage in adjacent tissue than standard electrosurgery, thereby decreasing postoperative pain and healing time. Tissue reduction procedures may have a reduced risk of bleeding and produce less patient discomfort than other methods and can be performed in the office setting in some patients. CONCLUSION: Use of radiofrequency technology may decrease the morbidity associated with treatment of tonsillar hypertrophy. Preliminary trials of radiofrequency procedures have yielded promising results, but larger studies evaluating costs and benefits are needed.

Catheter Ablation↗

PubMed1995

Laparoscopic surgery of chronic hyperandrogenic anovulation.

The review describes briefly the clinical and endocrinological characteristics of chronic hyperandrogenic anovulation (CHA), as well as ovulation induction by hormone therapy (therapy of first choice) and by classical wedge resection. The main purpose of this study, however, is to compare different laparoscopic treatments of CHA, with emphasis on laser treatments by argon, CO2, Nd:YAG, and frequency-doubled Nd:YAG laser. The overall results of laparoscopic treatments in hormone-therapy-resistant patients with CHA are encouraging and the results are comparable. In the studies considered in this review, ovulation was induced for longer or shorter periods in 21 out of 31 patients (68%) after ovarian biopsy, in 57 out of 73 patients (78%) after electrosurgery, and in 82 out of 118 patients (70%) after laser treatment. Subsequent conception occurred in 44%, 40%, and in 41% of the patients, respectively. Of interest is the fact that some hormone-therapy-resistant patients become sensitive to Clomiphene after laparoscopic treatment, giving an overall percentage of ovulation and an overall pregnancy rate of 89% and 54%, respectively, for electrosurgery, and of 88% and 50%, respectively, for laser treatment. Unfortunately, adhesion formation, a serious complication of surgical treatment of the ovaries, is still a drawback using laparoscopic surgical techniques.

Anovulation↗

PubMed2005

[Transurethral resection for benign prostatic hyperplasia. current developments].

Transurethral resection of the prostate still represents the "gold standard" in surgical treatment of symptomatic benign prostatic enlargement (BPE). New demands were made on transurethral electrosurgery with the appearance of alternative, minimal invasive procedures. Bleeding complications had to be reduced. Different attempts were made to improve the conventional TURP. Band loops and roller bars were developed in order to gain a more effective coagulation during the cutting process by a larger tissue contact. Major advances could be achieved by modifications of the high-frequency generator. Improved procedures like the "Coagulating-Intermittent-Cutting" (CIC), the "Instant-Response-", as well as the "Dry-Cut-Technology" combine cutting and coagulating effects to realize lowered bleeding and an efficient resection process. The introduction of bipolar currency flow opens the possibility of conventional TUR-P with saline solutions and thus to the theoretical avoidance of the TUR-syndrome. By the neoadjuvant use of 5alpha-reductase-inhibitors before planned TUR-P, bleeding- and irrigation fluid absorption should be reduced by lowering perfusion and the size of the prostate. Regarding these innovative approaches which improve the surgical standard and minimize the risk of perioperative complications, transurethral electrosurgery remains the method of choice in instrumental therapy of symptomatic BPE. In the future efficacy and costs will be comparable to those of the transurethral laser-resection or laser-vaporisation.

Electrosurgery↗

PubMed1991

Laser or electrocautery for laparoscopic cholecystectomy?

There are few concerns related to laparoscopic cholecystectomy that evoke as much emotion as the question of which is the superior energy source, laser or electrocautery. Monopolar radio frequency electricity (electrosurgery) and collimated coherent light (laser) injure tissue by the generation of heat, and in this regard are remarkably similar. The greatest differences between these sources of heat are related to predictability of injury, selective absorption of free beam laser energy, ability to coagulate, and cost. Although there are no prospective data yet available to answer the question of superiority, it appears that electrosurgical dissection may be faster and is generally less costly. Laser dissection may be more precise. In difficult cases, hemostasis appears to be superior with electrosurgery.

Cholecystectomy↗

PubMed1979

Tissue damage from electrosurgical power output variations in hamster tongues.

An investigation was designed to determine the differences in the amount of tissue damage produced by variations in the amount of cutting power delivered to the hamster tongue with electrosurgery. By dividing the power of an electrosurgical instrument into 5 W intervals, from the lowest setting which would produce a cut up to the 50 W setting, histometric comparisons were made in the hamster tongue. Histologic analysis showed the following: 1. The 30 W power interval produced less tissue damage than any other power interval. 2. The 25 and 35 W intervals produced significantly greater damage than the intervals from 40 thorugh 50 W. 3. Histologically the experimental defect showed an area of coagulation necrosis approximately 50 mu wide along the margin of the incision. Tissue damage decreased laterally and inferiorly from the surface of the defect except at the 30 W setting, where the damage in the epithelium and the damage in the connective tissue were essentially equal. 4. There is some validity to the sparking-dragging test for setting the power interval of an electrosurgical instrument. 5. Higher power values which produce excessive sparking should be avoided by the clinician during electrosurgery due to the imprecise nature of the clinical incision.

Animals↗

PubMed1983

Epithelial and connective tissue healing following electrosurgical incisions in human gingiva.

Electrosurgery is used for intraoral incisions by many clinicians. Much controversy surrounds the effect of lateral heat produced during the electrosurgical incision upon the healing of adjacent connective tissue. Ten electrosurgical incisions were made in the gingiva in each of five adult male volunteers. The duration of incision and actual energy production for each incision were calculated. Excisional biopsies of the incisions were obtained at 0-504 hours. At the light microscopic level, epithelium, totally degenerated immediately following the electrosurgery incision, showed extensive activity at 24-48 hours and had covered all wounds by 72 hours. Early hour specimens showed a homogenous connective tissue region, adjacent to the wound site, devoid of cells and fibers. This zone of denatured connective tissue gradually diminished until it was no longer present at 396 hours.

Adult↗

PubMed1995

Laparoscopic electrosurgical complications and their prevention.

Insulation failures, direct coupling, and capacitive coupling around active electrodes may cause serious burns and tissue damage to patients undergoing laparoscopic procedures. A coordinated team effort between perioperative nurses and surgeons can prevent life-threatening complications from laparoscopic electrosurgical procedures. Knowledge of the biophysics of electrosurgery, the mechanisms of electrosurgery complications, and prevention of patient injuries will empower surgical team members to provide quality outcomes for patients undergoing laparoscopic procedures.

Adult↗

PubMed1998

Applications of electrical energy to the prostate: an evolutionary perspective.

PURPOSE: We review modern electrosurgical treatments for removing benign prostatic tissue based on an historical perspective of medical applications of electrical energy. MATERIALS AND METHODS: We reviewed historical reports and landmark observations concerning the evolution of medical applications of electrical energy in the literature, with a special focus on the development of principles pertinent to the transurethral electrosurgical removal of prostate tissue. RESULTS: Modern transurethral electrosurgery of the prostate in a fluid medium has been well founded on key electrosurgical principles. Traditionally, the best clinical results and the least complications have been obtained through an understanding of the important precepts of this form of energy. These precepts have included distinctions between the reliability of effect and safety with direct and alternating current, and how different tissue effects can be achieved, either with selective current modes (cutting and coagulating waveforms) or by varying the size and configuration of the active electrode and its application time. CONCLUSIONS: This review chronicles the prominent role of electrosurgery in our efforts to debulk an enlarged prostate in patients with symptomatic voiding dysfunction. History reminds us that many of today's "new ideas" are merely updated variations on a theme, have often been tried before in a fashion by our predecessors and have for one reason or another fallen by the wayside. The conundrum of the perfect combination of electrosurgical variables that can fulfill our goal of making this an efficient and complication-free treatment continues to stimulate and challenge us as we move towards the next millennium.

Electrosurgery↗

PubMed1993

Histology of laser- and high-frequency-electrosurgical incisions in the palate of pigs.

The histological effects of CO2-laser-, Nd-YAG-laser- and electrosurgical incisions were investigated in the oral mucosa of pigs. Laser- as well as electrosurgery caused necrosis by thermal effects. Undermining vacuolisation in the stratum basale and denaturation of collagenous fibers in the lamina propria were typical findings. The CO2-laser incisions were trough-like with a sharply bordered coagulation. The Nd-YAG-laser produced exclusively coagulation but no incision. Electrosurgery yielded radiating coagulation and the best ratio of depth of incision to width of coagulation.

Aluminum Silicates↗

PubMed1997

Evaluation of electrosurgical interference to low-power spread-spectrum local area net transceivers.

OBJECTIVE: To study whether an electrosurgery device interferes with the operation of a low-power spread-spectrum wireless network adapter. METHODS: Nonrandomized, unblinded trials with controls, conducted in the corridor of our institution's operating suite using two portable computers equipped with RoamAbout omnidirectional 250 mW spread-spectrum 928 MHz wireless network adapters. To simulate high power electrosurgery interference, a 100-watt continuous electrocoagulation arc was maintained five feet from the receiving adapter, while device reported signal to noise values were measured at 150 feet and 400 feet distance between the wireless-networked computers. At 150 feet range, and with continuous 100-watt electrocoagulation arc five feet from one computer, error-corrected local area net throughput was measured by sending and receiving a large file multiple times. RESULTS: The reported signal to noise (N = 50) decreased with electrocoagulation from 36.42+/-3.47 (control) to 31.85+/-3.64 (electrocoagulation) (p < 0.001) at 400 feet inter-adapter distance, and from 64.53+/-1.43 (control) to 60.12+/-3.77 (electrocoagulation) (p < 0.001) at 150 feet inter-adapter distance. There was no statistically significant change in network throughput (average 93 kbyte/second) at 150 feet inter-adapter distance, either transmitting or receiving during continuous 100 Watt electrocoagulation arc. CONCLUSIONS: The manufacturer indicates "acceptable" performance will be obtained with signal to noise values as low as 20. In view of this, while electrocoagulation affects this spread spectrum network adapter, the effects are small even at 400 feet. At a distance of 150 feet, no discernible effect on network communications was found, suggesting that if other obstructions are minimal, within a wide range on one floor of an operating suite, network communications may be maintained using the technology of this wireless spread spectrum network adapter. The impact of such adapters on cardiac pacemakers should be studied. Wireless spread spectrum network adapters are an attractive technology for mobile computer communications in the operating room.

Electricity↗

PubMed2006

Evaluation of stray radiofrequency radiation emitted by electrosurgical devices.

Electrosurgery refers to the passage of a high-frequency, high-voltage electrical current through the body to achieve the desired surgical effects. At the same time, these procedures are accompanied by a general increase of the electromagnetic field in an operating room that may expose both patients and personnel to relatively high levels of radiofrequency radiation. In the first part of this study, we have taken into account the radiation emitted by different monopolar electrosurgical devices, evaluating the electromagnetic field strength delivered by an electrosurgical handle and straying from units and other electrosurgical accessories. As a summary, in the worst case a surgeon's hands are exposed to a continuous and pulsed RF wave whose magnetic field strength is 0.75 A m(-1) (E-field 400 V m(-1)). Occasionally stray radiation may exceed ICNIRP's occupational exposure guidelines, especially close to the patient return plate. In the second part of this paper, we have analysed areas of particular concern to prevent electromagnetic interference with some life-support devices (ventilators and electrocardiographic devices), which have failed to operate correctly. Most clinically relevant interference occurred when an electrosurgery device was used within 0.3 m of medical equipment. In the appendix, we suggest some practical recommendations intended to minimize the potential for electromagnetic hazards due to therapeutic application of RF energy.

Electrocardiography↗

PubMed2003

A third-degree burn caused by a neurogenic motor-evoked potential monitoring electrode during spinal surgery: a case report.

STUDY DESIGN: A case report is presented. OBJECTIVE: To report a previously undescribed complication related to use of a neurogenic motor-evoked potential monitoring electrode and electrosurgery during spinal surgery. SUMMARY OF BACKGROUND DATA: Although electrosurgery is one of the most commonly used technologies in the operating room, its electrophysical properties, including the potential for complications, are poorly understood by many surgeons. Complications related to the use of electrosurgical instruments, monitoring electrodes, and radiofrequency current are underreported in the literature. METHODS: Clinical case analysis and investigation report were used. RESULTS: A case of third-degree skin burn at the site of a neurogenic motor-evoked potential monitoring electrode during posterior spinal fusion surgery is described. CONCLUSIONS: A burn resulting from a neurogenic motor-evoked potential monitoring electrode is rare. However, surgeons and electrophysiologists should be familiar with this potential complication in order to prevent it.

Adolescent↗

PubMed1995

Comparative study of wound healing in porcine skin with CO2 laser and other surgical modalities: preliminary findings.

BACKGROUND: The CO2 laser is a common surgical modality in dermatology. To clarify conflicting reports on the histological healing properties of CO2 laser on incisional or ablative wounds, we have applied it in a miniature hairless porcine skin model at power settings similar to those used in clinical practice. METHODS: Histological parameters of wound healing in skin incisions using the CO2 laser were compared with those using scalpel, hot scalpel, and electrosection, and in dermal ablation using CO2 laser, fraize, wire brush, and electrofulguration alone or with curettage. RESULTS: In incisional wounds, tissue damage was most extensive in CO2 laser wounds, with delayed dermal healing and reepithelialization. In ablative wounds, CO2 laser caused a similar degree of tissue damage as did the electrosurgical modalities, and more damage than did fraize or wire brush. Reepithelialization was complete in CO2 laser, fraize, and wire brush wounds before electrosurgical wounds. Final histology of both incisional and ablative wounds at 6 weeks was similar with all surgical modalities. CONCLUSION: The CO2 laser and electrosurgery both produce greater focal tissue damage in incisional and ablative applications than the other modalities. Delayed epithelialization of the wound occurs with both modalities in incisional wounds but only with electrosurgery in ablative wounds. At 6 weeks, the appearance of the scar in all incisional and ablative modalities is similar grossly and histologically. Confirmation of these findings requires standardization of power density of the CO2 laser in incision and ablation.

Animals↗

PubMed1998

Laparoscopic intra-abdominal ligation and removal of cryptorchid testes in horses.

Laparoscopic intra-abdominal ligation and removal of cryptorchid testes in horses was evaluated retrospectively in 50 horses that underwent the procedure between 1991 and 1996. Sixty-one cryptorchid testes were removed by one of the following methods; the use of 1) an endoscoping stapling and transection device, 2) an endoscopic clipping device, 3) an endoscopic ligating loop. Monopolar electrosurgery was combined with these methods to facilitate coagulation and cutting of tissue. In 8 horses, 9 testes were retained between the internal and external inguinal rings. The inguinal testes were removed by cutting the internal inguinal ring and bringing the testis back into the abdomen for removal. No attempt was made to close the internal inguinal ring. The most frequently employed and most cost effective method for laparoscopic intra-abdominal removal of cryptorchid testes in this study was the combined use of an endoscopic ligating loop and monopolar electrosurgery. One intra-operative complication (perforation of the small intestine) occurred and was dealt with successfully. One horse developed a fever attributed to upper respiratory tract infection post operatively and was treated successfully with antibiotic. Intra-abdominal ligation and transection of cryptorchid testes is an effective method for cryptorchid castration. This technique minimises the loss of insufflation, allows inspection of the cut tissue for haemorrhage and offers secure closure of the abdominal wall preventing inguinal herniation and excellent visualisation of the cryptorchid testis.

Animals↗

PubMed1999

Mortality following laparoscopic surgery.

The rapid advance in laparoscopic surgery in different surgical specialities has raised concerns about its safety, especially when the procedures are now being performed by less-experienced surgeons. The use of electrosurgery further increases the possibility of unrecognized organ injury and requires a good understanding of the basic principles. Despite the fact that the use of electrosurgery is frequently emphasized and discussed in most of laparoscopic surgery conferences, this is seldom taught in in-house residence programs. We describe a case of death as a result of unrecognized thermal damage and would like to stress the importance of awareness of this potential lethal complication.

Electrosurgery↗

PubMed1975

Histological evaluation of effects produced in alveolar bone following gingival incision with an electrosurgical scalpel.

Gingival incisions were performed distal to each of the two lower incisors on 25 adult male guinea pigs. For every animal, electrosection with an electrosurgical scalpel was used on one side, and a conventional scalpel was used on the other. The surgical instruments in all cases were brought into direct contact with periosteum. Five animals were sacrificed at each postoperative period (12, 24, 48, 72, and 96 hours), and sections of the areas of surgery were prepared by standard laboratory procedures. At 12 hours postoperatively there were far more soft tissue necrosis, a more extensive inflammatory reaction, and greater destruction of periosteum after electrosurgery. No significant changes in osteocyte viability were seen after either technique. However, by 24 hours, many empty lacunae were observed in the bone associated with electrosurgery, such necrosis being even more extensive by 48 hours. In contrast, only very minor, localised areas devoid of some osteocytes were seen after use of the conventional scalpel. By 96 hours the electrosurgical connective tissue wounds were still lined by coagulum, but repair of the scalpel wounds had begun. The periosteum and bone had the same features that were seen at 48 hours. Throughout the study, no increase in osteoclasts was seen in any section, nor were significant changes in adjacent bone marrow observed.

Alveolar Process↗

PubMed2005

Human papillomavirus: burden of illness and treatment cost considerations.

The monetary and personal costs to society of human papillomavirus (HPV) infection are enormous. In order to make a comparison of different treatment methods we reviewed the entire literature on HPV treatment from January 1966 to December 2003 using MEDLINE, with particular reference to published meta-analyses, randomized controlled and comparative studies. Patient-applied therapies offer patients the possibility of convenient and, on the whole, pain-free treatment. Podofilox (podophyllotoxin) and salicylic acid for genital and extragenital warts, respectively, have the additional advantage of being the most cost-effective treatments and, on this basis, they are to be commended as appropriate first-line agents. The second-line treatment of choice for common warts is cryotherapy. For recalcitrant common warts possible options include inosine pranobex with cryotherapy or electrosurgery, imiquimod with paring and occlusion, intralesional bleomycin, or diphencyprone. Alternative first-line and second-line treatments for genital warts would be either some form of surgical removal or imiquimod. The first option may be the cheapest but this has to be balanced against a degree of post-operative morbidity. Limited data from comparative studies do not show any clear difference in efficacy between cryotherapy, trichloroacetic acid, scissor excision, electrosurgery, and laser surgery in the treatment of genital warts, and the cost effectiveness of these therapies is probably similar to that of imiquimod. Cryotherapy and trichloroacetic acid are relatively expensive and inconvenient for patients and should be reserved as third-line treatments with certain exceptions, such as cryotherapy for meatal warts. The duration of treatment is significantly related to the number of warts present, the area covered by the warts, and the length of time the warts have been present. For recalcitrant anogenital warts third-line treatment options that show promise include surgery in combination with imiquimod or cidofovir cream. For squamous intraepithelial lesions that cannot easily be excised or physically ablated current treatment options include imiquimod and fluorouracil cream. The latter is an inexpensive option but causes the greatest morbidity. It is hoped that cidofovir may be added to this list if it becomes commercially available, and that protective and therapeutic HPV vaccines will transform the management of HPV in the future.

AIDS-Related Opportunistic Infections↗