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At least 595 records · Page 33Linked to original sources

PubMed2005

Late complications of operative hysteroscopy: predicting patients at risk of uterine rupture during subsequent pregnancy.

The main purpose of this study was to identify predictors of uterine rupture following operative hysteroscopy. We also attempted to assess possible clinical or imaging methods in order to detect and avoid impending ruptures. A MEDLINE and EMBASE search of the English, German and French literatures was performed to retrieve case reports of uterine rupture following operative hysteroscopy. A total of 14 cases were retrieved. Twelve patients had a history of hysteroscopic metroplasty. Uterine perforation complicated operative hysteroscopy in eight cases and electrosurgery was used in nine cases. The interval between hysteroscopy and subsequent pregnancies varied from 1 month to 5 years with an average range of 16 months. Hysterosalpingogram follow-up was carried out in six cases and was considered normal in five cases. During pregnancy, serial ultrasound scans were performed in two cases to detect impeding rupture without success. Hysteroscopic metroplasty subjected patients to high risks of uterine rupture during subsequent pregnancies. Uterine perforation and/or the use of electrosurgery increase this risk but are not considered an independent risk factor. Uncomplicated hysteroscopic resection of submucous myomas and endometrial polyps did not alter obstetrical outcome. Apart from favourable use of scissors for hysteroscopic metroplasty, no accurate methods to prevent or detect impending ruptures in subsequent pregnancies were found. Physicians providing care for patients with previous hysteroscopic metroplasty or complicated operative hysteroscopy, should be aware of the potential risks for uterine rupture during pregnancy.

Female↗

PubMed1995

Safety and training.

Provided progress is made systematically, the surgeon never attempts to perform operations that are too difficult, and all the safety protocols are adhered to, hysteroscopic surgery should be within the capabilities of most gynaecologists. Failure to appreciate the risks and failure to undergo continuous training in the learning period will inevitably lead to complications which should otherwise be avoidable. Hysteroscopic surgery offers many advantages over conventional surgery and, like many other types of minimal access surgery, appears to be the surgery of the future. Endoscopic surgery will not supplant open surgery but will become another essential part of our practice which the patient will expect and, indeed, demand. There will be problems. Training programmes must be established to try to prevent complications which will be encountered if inadequately trained surgeons perform these new forms of surgery. There must be continuous education in existing methods and research into value and results of new techniques and instruments both for laser and electrosurgery. It is possible that in the future new biophysical or pharmacological approaches may render laser and electrosurgery obsolete. Safer forms of physical energy, photosynthesis and new forms of hormone therapy are all undergoing trials with preliminary results which are encouraging. Whichever techniques eventually prove to be the most effective and safe, we must learn to use them because we owe to our patients the opportunity to benefit from them.

Education↗

PubMed1994

Endometrial ablation using SideFire laser fiber.

The first successful use of the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser to control hypermenorrhea was reported in 1981. Variations on the technique were attempted to improve the amenorrhea rate. Using the Nd:YAG laser with the blanching or nontouch technique seems to result in a better outcome and higher rate of total amenorrhea than using the dragging technique. Unipolar coagulation attached to a rollerball or rollerbar was also introduced to improve treatment of the sidewalls of the uterus. The unpredictable nature of electrosurgery resulted in varying rates of amenorrhea from as low as 6% and in a subset of patients under 35 years old, to the 70% range in a nonage-adjusted patient population. Due to the report of improved rates of amenorrhea when using the blanching technique and the Nd:YAG laser, a fiber was developed to direct the laser energy at right angles to the axis of the fiber, therefore allowing a total treatment of the entire uterus in a perpendicular fashion. The theoretic benefit of this would be more complete and predictable destruction of the endometrial lining, avoiding fluid overload by coagulating and sealing the vessels and lymphatics. Results in 27 patients in this study seem to support that theory, since 23 patients (86%) experienced total amenorrhea. Mild spotting, requiring no more than a minipad for 3 days, occurred in the other four women. Fluid loss averaged 150 ml with a maximum of 500 ml; six patients had no measurable fluid loss. The age of the patient was not associated with any difference in the final result. The average time of the procedure was 46 minutes, with an average energy use of 89,670 joules. This seems to be a reasonable alternative that offers improved results compared with methods using electrosurgery or the Nd:YAG laser without the SideFire device.

Adult↗

PubMed2003

Ultracision in gynaecological laparoscopic surgery.

The Ultracision harmonic scalpel and laparosonic coagulating shears use high-frequency ultrasound energy and can be used as a substitute for electrosurgery, lasers and steel scalpels in both laparoscopic and conventional gynaecological surgery. Its unique mechanism of action allows cutting and coagulation without causing a significant rise in temperature at the tissue level. Its safety has been tested extensively in animal experiments and there is now ample evidence to suggest that it produces less thermal damage in vitro compared to electrosurgery and lasers. Although these results have been extrapolated to human beings, there are no in vivo studies in humans to corroborate the above observations. This review highlights the mechanism of action, tissue effects, safety aspects, applications, versatility and limitations of this novel technique. The many advantages demonstrated by this instrument over other energy sources used in laparoscopic surgery should make it more popular in forthcoming years.

Female↗

PubMed1999

Histologic and physiologic effects of electrocautery, CO2 laser, and radiofrequency injury in the porcine soft palate.

OBJECTIVES: This study was undertaken to compare the effects of electrosurgery, CO2 laser, and radiofrequency on the histological structure and physiological properties of the soft palate. These surgical techniques are used for stiffening and reducing the soft palate in the treatment of snoring and mild sleep apnea. STUDY DESIGN: Fifteen pigs were divided into five groups. METHODS: group 1 underwent electrosurgery incision of the lateral soft palate and excision of the uvula. Group 2 underwent the same procedure with the CO2 laser. Group 3 underwent CO2 laser ablation of the midline soft palate mucosa. Group 4 underwent radiofrequency volumetric reduction. Group 5 served as control. After 5 weeks the animals were sacrificed. Soft palate mucosa and muscle were subjected to tensiometric and histological analysis. Statistical analysis of tensiometric measurements was done with an ANOVA using a Bonferroni-Dunn correction. RESULTS: Tensiometric measurements of the mucosa were increased over normal controls when the surgical technique resulted in mucosal disruption. When the surgical technique resulted in primarily muscle disruption (radiofrequency) tensiometric measurements of the muscle were increased over controls. Histological analysis demonstrated normal remucosalization in all specimens, with fibrosis increased at the site of the primary injury. CONCLUSIONS: The type of injury produced resulted in identifiable patterns of physiological and histological change. Understanding of the effects of available surgical techniques is important in guiding our choice of surgical approach and allows us to better counsel our patients on their surgical options.

Animals↗

PubMed2001

Tonsillectomy with argon plasma coagulation (APC): evaluation of pain and hemorrhage.

OBJECTIVE: Argon plasma coagulation (APC) offers a new possibility for tonsillectomy (TE) because of its effective hemostasis and limited penetration depth of the coagulation zone. The APC dissector allows dissection and hemostasis in a one-step procedure. The aim of this prospective, randomized, single-blinded study was the evaluation of pain and hemorrhage of the "hot" argon-plasma-coagulation tonsillectomy (TE(APC)) compared with a conventional "cold" non-electrosurgery tonsillectomy (TE(Conv)). METHODS: Two hundred one consecutive patients undergoing tonsillectomy were included in a single-blinded, randomized, prospective study with stratification in two age groups. RESULTS: There was no statistical significant difference between TE(APC) and TE(Conv) in the intensity of postoperative pain and primary or secondary hemorrhage in both age groups. In the TE(APC) group, the mean duration of tonsillectomy was significantly reduced by more than 50% in both age groups (P <.01). The blood loss was 90% decreased in the TE(APC) compared with the TE(Conv) in both age groups (P <.01). CONCLUSIONS: The APC technique does not face the general problem of electrosurgery or thermal coagulation techniques in which the postoperative pain is often increased compared with conventional cold techniques. It offers an innovative new tonsillectomy method with significant reduced blood loss and surgical time.

Child↗

PubMed2006

Periorbital syringoma: a pilot study of the efficacy of low-voltage electrocoagulation.

BACKGROUND: Management of periorbital syringomas is problematic and avoided by many inexperienced physicians. The medical literature presently prefers CO(2) laser resurfacing to many other modalities, but the subject of electrosurgery has not been well explored. OBJECTIVES: To evaluate the clinical efficacy of electrocoagulation at low voltages in treating periorbital syringomas. MATERIALS AND METHODS: Twenty cases were collected during the period of 2002 through 2005. All cases were photographed before treatment with a dual-frequency 4-MHz radiofrequency device (Surgitron, Ellman International, Inc., Hewlett, NY) at a power of 1 to 2 in electrocoagulation mode. Six-week follow-up visits were scheduled to discuss occurrences and expectations, observe treatment effects, and apply further electrosurgery if needed. RESULTS: Clinical improvement increased with each subsequent treatment session. All patients scored either moderate or marked clinical improvement by their final visits, with 60% (11/18) revealing a marked clinical improvement (i.e., >70% clearance). The most common encountered adverse effects consisted of periorbital burning, swelling, redness, and pigmentary changes. CONCLUSION: Low-voltage electrocoagulation is an effective therapy for periorbital syringoma and should be considered when treating this difficult condition. To our knowledge, this is the first study utilizing electrocoagulation for removal of syringomas.

Adolescent↗

PubMedDate not supplied

Neodymium:yttrium aluminum garnet surgical laser versus bipolar electrocoagulation for laparoscopic ovariectomy in dogs.

OBJECTIVE: To compare use of neodymium:yttrium aluminum garnet (Nd:YAG) surgical laser and bipolar electrocoagulation (BEC) for laparoscopic ovariectomy (OVE) in dogs. STUDY DESIGN: Prospective clinical trial. ANIMALS: Female dogs (n=72). METHODS: Laparoscopic OVE by Nd:YAG laser (600 microm optical fiber, contact mode) in 36 dogs was compared with laparoscopic OVE by bipolar electro-coagulating grasping forceps. Dogs were paired (laser, electrocoagulation) matched for breed, age, body weight, obesity, and number of heat cycles. Duration of predetermined surgery times and total surgical time were compared between groups. Occurrence of intra- and postoperative complications and their effect on surgical duration were evaluated. RESULTS: Laser surgery resulted in a higher incidence of intraoperative mesovarial bleeding (12 times; 9 dogs) compared with electrosurgery (4 times; 3 dogs). Use of laser caused a 2 minute delay for transection of the left ovary compared with electrosurgery. Postoperative complication rates and convalescence were similar for both groups. CONCLUSIONS: BEC reduced surgical time and intraoperative mesovarial bleeding compared with laser resection. CLINICAL RELEVANCE: Although the laser was effective for laparoscopic OVE, bipolar electrosurgical laparoscopic OVE remained the method of choice.

Animals↗

PubMed1995

Guidance section: ensuring monopolar electrosurgical safety during laparoscopy.

In this study, we have discussed how direct leakage currents flowing through defects in active electrode insulation or capacitive leakage currents originating from the shaft of the active electrode can cause serious patient injuries during laparoscopic monopolar electrosurgical procedures. We have also discussed a number of other surgical scenarios, varying in likelihood, severity, and cause, in which electrosurgical injuries can occur during laparoscopy. This section provides a discussion of protective measures that hospitals can take to reduce the unique risks of serious patient injuries posed by monopolar electrosurgery used laparoscopically. In the Protective Measures for Laparoscopic Monopolar Electrosurgery table, we list our recommendations for reducing the risk of electrosurgical injuries in four common scenarios, as described in the Clinical and Technical Overview.

Electric Injuries↗

PubMed1996

[The ultrasound scalpel in laparoscopic surgery].

The ultrasonically activated scalpel works by means of the longitudinally vibrating sharp blade. The most important advantages- compared with electrosurgery-are the lack of current flow through the patient and limited local heat generation. It can be used as an instrument for coagulation, dissection and preparation. There is no generation of smoke. It is easy to use. Disadvantages are the slow speed of cutting and the high costs. In the future it could be an alternative to preparation on with dissector, scissors, and electrosurgery.

Dermatologic Surgical Procedures↗

PubMed1997

[Prevention and therapy of complications in laparoscopic appendectomy].

It has been verified that laparoscopic appendectomy increases safety. The indications for laparoscopic appendectomy depend on the surgeon's confidence in diagnosis, his skills and the stage of appendicitis. The complications could be prevented by placement of open trocars and (dividing the mesoappendix and appendix with sutures, clips or staples. Electrosurgery should never be used. Bipolar electrosurgery should be limited to 20 Watt power for 5 s. The appendix is removed either though a trocar or in a specimen bag.

Abdominal Abscess↗

PubMed2004

Randomized, controlled, multisite study of intracapsular tonsillectomy using low-temperature plasma excision.

OBJECTIVE: To determine the efficacy of intracapsular tonsillectomy using low-temperature plasma excision for improving the quality of the postoperative experience and for treating obstructive symptoms through 12 months postoperatively. DESIGN: Prospective, randomized, controlled, single-blind study. SETTING: Multiple private or institutional otolaryngology clinics. PATIENTS: Fifty-five children (aged 3-12 years) with obstructive tonsillar hypertrophy. INTERVENTION: Patients were randomly assigned and blinded to undergo either intracapsular tonsillectomy using low-temperature plasma excision (n = 27) or total tonsillectomy using conventional electrosurgery (n = 28). MAIN OUTCOME MEASURES: Operative data, 14-day recovery variables, and obstructive symptoms were prospectively collected through 12 months. RESULTS: During the first 14 days, significantly fewer children in the intracapsular group reported nausea (P = .01) or lost weight (P = .003). The intracapsular group had a significantly faster resolution of pain (P = .01), had an earlier return to a normal diet (P = .004), ceased taking pain medication sooner (P = .002), and returned to normal activity sooner (P = .04). Postoperatively, the intracapsular group had more residual tonsil tissue than the total tonsillectomy group (P = .002 for the 3- and 12-month visits). However, the incidence of recurring obstructive symptoms, pharyngitis, and antibiotic use was similar in both treatment groups during the 12 months. CONCLUSIONS: Postoperative morbidity normally associated with traditional (total) tonsillectomy was significantly reduced after intracapsular tonsillectomy using low-temperature plasma excision. The residual tonsillar tissue associated with this technique was of no clinical consequence.

Child↗

PubMed1990

Granuloma faciale. Comparison of different treatment modalities.

Granuloma faciale is an uncommon cutaneous condition characterized by brownish-red macules, papules, nodules, and plaques. Separate areas of granuloma faciale involving the nasal skin of a 32-year-old man were treated using electrosurgery, carbon dioxide laser, and dermabrasion. All modalities provided good cosmetic and functional outcomes. The relative advantages and disadvantages of each technique are presented.

Adult↗

PubMed1975

Electrosurgical excision of full-thickness burns.

Massive intraoperative blood loss and poor graft take have been the major problems associated with early excision and immediate grafting of full-thickness burns. By employing electrosurgery, excessive blood loss was virtually eliminated in a series of major burn excisions. Immediate graft take was excellent on electrosurgical wounds after primary burn excisions and in late reconstructive procedures. Simplicity, improved hemostasia, good graft take, and the absence of special anesthetic requirements make this method particularly applicable to the management of patients with burn injury.

Abdomen↗

PubMedDate not supplied

Endoscopic treatment of adenomas.

The endoscopic removal of colon polyps can be safely and efficiently accomplished when established principles of colonoscopy and electrosurgery are followed. This technique requires the proper equipment, a skilled endoscopy assistant, and a well-trained, experienced endoscopist. Complete mastery of basic colonoscopy is essential along with an understanding of the concepts of electrocautery and knowledge concerning the structural configurations of polyps.

Colonic Polyps↗

PubMed2003

[The harmonic scalpel in conventional thyroid surgery. Possibilities and advantages].

INTRODUCTION: Use of the harmonic scalpel is well established in surgery. The simple use and ability to save blood and time make this equipment usable in thyroid surgery, too. METHODS: In a prospective, nonrandomized study including 32 patients, operating time, weight of resected thyroid tissue, and complications were analysed. A classic surgery group (ligature and HF electrosurgery) was compared with an ultracision group. RESULTS: Mean+/-SD operative time was shorter in the harmonic scalpel group than in the conventional technique group (143.12+/-25.24 min vs 64.68+/-23.83 min, P<0.01). There was no difference between the two techniques regarding complications and patient characteristics. CONCLUSIONS: Use of the harmonic scalpel in thyroid surgery is a safe procedure. The possibility it presents of saving operative time without increasing complications has now been published in several studies.

Adult↗

PubMed2003

[Basic principles of radiosurgical systems and their applications in arthroscopy].

Electrosurgical devices are being used in each medical subdiscipline,and, only recently, they have found widespread distribution in the field of arthroscopic surgery, as well. This development is mainly due to the construction of small and relatively cheap devices that work in a bipolar mode at high frequency. A local plasma field is being built up between the electrodes at the tip of the probe which has enough energy to allow the disintegration of molecules within the treated tissue. The local current flow helps to minimize the numerous disadvantages of monopolar or Laser-based systems. Nevertheless, there is considerable discrepancy between the wide spectrum of clinical use on the one hand and the knowledge of mid- or even long-term biological effects on the treated tissue on the other. So far, clinical and experimental studies exist for the frequent indications of chondroplasty and capsular or ligamental shrinkage. But, still, there is no agreement upon these indications. Studies have shown a considerable number of dead chondrocytes or fibroblasts within a depth of several millimeters within the tissue of the joint capsule or the articular cartilage after electrosurgical treatment. But especially these cells are thought to be essential for the maintenance of the tissue. While the results of other studies seem to be less critical, some authors propose not to use electrosurgery in arthroscopy at all, until further studies prove the safety of these devises. Unfortunately, there is no reliable feedback system for the temperature increase within the treated tissue or other important parameters. The use of these instruments affords a high degree of experience from a skilled arthroscopic surgeon.

Animals↗

PubMed2001

Ultrasonically activated shears in extended lymphadenectomy for gastric cancer.

Gastrectomy, followed by extended lymphadenectomy, is the treatment of choice in some stages of advanced gastric cancer. Lymphorrhea, as a result of the many divided lymphatic vessels, increases the morbidity. Ultrasonically activated coagulated shears (UACS) may divide all small vessels followed by immediate sealing of the coapted vessel walls. We designed a prospective randomized study to determine the effectiveness of the UACS versus monopolar electrosurgery in D2 dissection. Forty patients with gastric cancer stage II or stage IIIA were enrolled and randomized into 2 groups of 20 patients each. Group A underwent lymphatic dissection with monopolar cautery. Group B underwent lymphatic dissection with UACS. Subhepatic and left sudiaphragmatic closed drains were left until lymphorrhea and/or oozing stopped. Total gastrectomy was performed in 16 patients of group A and 14 of group B; subtotal gastrectomy was performed in 4 patients in group A and 6 patients in group B. The drains were removed after 6-17 days (mean 9.7 +/- 2.9) in group Aand after 4-8 days (mean 5.6 +/- 1.2) in group B(p < 0.001). The total amount of drained fluid was 300-2050 ml (mean 985 +/- 602) in group A and 230-1080 ml (mean 480 +/- 242) in group B (p < 0.002). Eight patients in group A and 5 in group B had postoperative fever, while 3 and 1 patients, respectively, had wound infections. In conclusion the use of UACS is a safe method of lymphatic dissection which reduces operative blood loss, postoperative lymphorrhea, blood transfusions,and hospital stay.

Aged↗