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The authors describe the function of harmonic scalpel (HC) and it's use in laparoscopy. They present the main benefits of HC in comparison with monopolar electrosurgery in laparoscopic cholecystectomy. The only disadvantage of HC is high purchase cost.
We describe a completely innovative approach to vaginal hysterectomy where the surgeon and anesthetist work in tandem to ensure that the patient receives optimal pain management: combined use of general and long-acting local-regional anesthesia and use of the "bi-clamp" procedure for bipolar electrosurgery which has proved to be a significant technical improvement. In this way, pain, until now the major drawback of this procedure, is really decreased allowing a better acceptance of the procedure and a greatly improved quality of life.
Capacitively coupled currents may not be appreciated during laparoscopic and endoscopic radiofrequency electrosurgery. Two specific problems are documented and quantified: coupling of current into metal trocar cannulas during laparoscopic surgery and coupling of current into a guide wire during endoscopic surgery. The examples can yield power levels in excess of 25 watts (laparoscopic) and 15 watts (endoscopic) on nearby metal conductors, which can in turn be dissipated into patient organs such as the bowel or the common bile duct. This capacitive coupling can be, in part, responsible for serious patient complications. Methods to minimize capacitive coupling, e.g., active electrode shielding, dispersive metal cannulas, sheathed guide wires, and bipolar active electrodes, are discussed for each example.
OBJECTIVE: To assess the efficacy of hysteroscopic endometrial ablation with the rollerball resectoscope. METHODS: From April 1989 to March 1991, 64 women underwent hysteroscopic endometrial ablation using electrosurgery. Telephone follow-up was obtained for 61 patients at least 6 months after the procedure. The majority of patients requested endometrial ablation because of irregular heavy menses, and two patients presented with postmenopausal bleeding. All patients had preoperative endometrial sampling that demonstrated benign endometrial histology. Five women had previous endometrial ablation with the Nd:YAG laser, with persistent bleeding. Eight patients had endometrial polyps and six had submucous fibroids that were resected at the time of hysteroscopic ablation. RESULTS: The average operative time was 31.6 minutes, and an average of 304 mL of distending medium was absorbed during the procedure. Complications included one uterine perforation in a patient who had a previous Nd:YAG ablation, and one epidural anesthetic complication. At follow-up, 18 women (29.5%) reported amenorrhea, 16 (26.2%) reported spotting, 21 (34.4%) reported decreased menstrual flow, four (6.6%) had no change, and two (3.3%) noted increased flow. Subjectively, 49 patients (80.3%) reported a satisfactory outcome. Of the 12 who were not satisfied, seven underwent a repeat ablation with satisfactory results, four chose hysterectomy, and one elected not to have further therapy. CONCLUSION: Endometrial ablation with the rollerball electrode is a safe, excellent method of management in women with excessive menstrual flow and provides a cost-effective, minimally invasive alternative to hysterectomy.
A procedure of argon-plasma coagulation is suggested to be used alone or in conjunction with chemical necrolysis and high-frequency electrosurgery for endoscopic palliation of dysphagia. Its outstanding impact on tumor-induced dysphagia, involving no life-threatening complications, was demonstrated in a group of 97 patients. A number of basic factors immediately influencing the results of therapy are outlined and relevant recommendations on clinical use are provided.
OBJECTIVE: Bipolar electrosurgery is an excellent method for obtaining hemostasis at laparoscopy. The present study describes and evaluates a bipolar device that can be more versatile and cost effective in advanced operative procedures than the traditional instrumentation. METHODS: This was a retrospective, case-controlled analysis of bipolar instrumentation with a design classification of II-2. A single surgeon in a private practice setting performed all procedures. Sixteen patients, matched for age and pathology were evaluated by videotape review to determine the comparative efficiency of the BiCOAG bipolar dissector/grasper versus traditional Kleppinger bipolar forceps. Efficiency here is defined as comparative operating times in each group. RESULTS: The number of instrument changes per case was counted because this appeared to be the only variable other than time that differentiated the 2 groups. The BiCOAG bipolar dissector/grasper device group had 4 times fewer instrument changes and significantly decreased operating room times when compared with that of the Kleppinger forceps group. Because cost per unit of operating room time was a constant figure, the decrease in cost that resulted due to the decrease in operating time is considered a cost-effective measure. CONCLUSIONS: The BiCOAG bipolar dissector/grasper is a cost-effective, efficient instrument for use in operative laparoscopic procedures.
Long-term results of conservative treatment of 153 patients with invasive cancer of the urinary bladder were studied retrospectively. The patients had stage T2 (n=121, 79.1%), T3 (n=26, 17%), T4 (n=6, 3.9%). All the patients had transitional cell cancer. GI, G2 and G3 tumors were registered in 104 (68%), 35 (24%) and 12 (8%) cases, respectively. 88 (57.5%) patients received combined treatment, 65 (42.5%) patients--only surgery. In the patients with a small invasive tumor of the urinary bladder subjected to surgery alone (TUR-vaporization), overall 5-year survival was 70.4%. In patients with advanced cancer of the urinary bladder who had received curative radiotherapy in case of superficial residual tumor had TUR-vaporization of the urinary bladder overall 5-year survival was 76.5%. In patients exposed to large-fraction (TFD 20-25 Gy) preoperative radiotherapy followed by TUR-vaporization, survival at this moment was 84.6%. Three-year overall and recurrence-free survival at stage T2 was 97.5 and 47.4%, respectively; at stage T3 and T4 overall 3-year survival was 57.1 and 26.6%, respectively. Thus, the conclusion is that transurethral electrosurgery in conservative therapy of patients with invasive cancer of the urinary bladder is a promising approach.
ECRI detailed some of the lesser-known risks of electrosurgery in a collection of articles published in the August 2005 Health Devices. However, it's also important to recognize that even hazards that are well understood by clinical personnel can lead to injury if appropriate safety measures aren't applied consistently. In this follow-up to our August 2005 articles, we offer guidance to help healthcare facilities conduct a safety audit that examines critical aspects of the facility's use of electrosurgical technology. ECRI recommends that healthcare facilities periodically conduct such an audit to ensure that the appropriate equipment and procedures are in place to protect patients and staff from injury. This article reviews some of the key questions to ask during a safety audit, and it includes detailed guidance for developing an electrosurgical safety checklist.
A mathematical model of electrosurgical polypectomy was suggested. The problem of emitted heat distribution in biological tissues exposed to endosurgical loop electrode was solved. Analysis of the obtained solution made it possible to determine the dependence of the results of electrosurgery on the parameters of the loop electrode and the loop size. Optimization of load performance allowed the efficiency of electrosurgical polypectomy to be increased.
Retraction of gingival margin means a very important step to take a precise impression. Most used methods are electrosurgery and retraction's fibres. This study compares both techniques analysing the reaction of gingival tissues by anatomical-histological observation.
Lasers, electrosurgery, and conventional pelviscopic techniques all provide the accomplished endoscopic surgeon with a sophisticated approach to advanced operative laparoscopy. The different lasers, as well as other energy delivery systems and conventional techniques, offer a wide choice of pathways through which a desired end result may be achieved. The sophisticated laparoscopic surgeon is able to choose the best instrument and technique to fit the purpose of the operation and skills of the surgeon. As in conventional surgery, different surgeons prefer different instruments and use different techniques. These various instruments and operative techniques should be considered synergistic rather than competitive, because they have greatly increased the scope and safety of laparoscopic surgery.
The advantage of electrosurgery in minor dental surgery is demonstrated with regard to contraindications and especial precautions. In reports of case some indications are presented in combination with the treatment procedure.
Of all arthroscopic procedures, lateral retinacular release carries the greatest potential for morbidity. Complication rates of up to 7.2% have been reported, secondary to intraoperative and postoperative hematoma formation. A prospective double-blind study was conducted in which patients were randomly assigned to one of two groups treated with or without cold therapy for 24 hours postoperatively, subsequent to arthroscopic lateral retinacular release utilizing electrosurgery. Seventy-four percent of the patients treated with cold therapy had good to excellent results postoperatively, and none had significant complications. Thirty-two percent of the patients treated without cold therapy had good to excellent results postoperatively, and two patients experienced significant complications in this group.
Fifteen pair of commercially available gloves were tested under conditions that occur during radio frequency electrosurgery to determine their potential to cause burns or shocks. Two pair of gloves showed a hydration effect that produced sufficiently low direct current resistance, 1500 and 5000 ohms, to be a potential shock or burn hazard. All intact gloves passed in excess of 0.75 A of radio frequency current by capacitive coupling. Eleven pair of gloves displayed dielectric breakdown of the latex or neoprene at voltages between 2200 and 2600 volts; the remaining gloves ranged from 5800 to 7000 volts. Under specific conditions all gloves tested have the potential to cause burns or shocks to the surgeon during electrosurgical procedures. To avoid burns, shocks, or glove perforation, surgeons should be aware of situations that put them at high risk.
11 electrosurgical units of several manufactures were analysed by physical measurements. Conventional units and those with constant output voltage demonstrate nearly identical behavior in their voltage- and power-characteristics at load-impedance occurring during dental electrosurgery. So far there are no advantages of simple voltage control. We did not find technical deficiencies concerning security in the modern units examined.
Electrodesiccation and electrocoagulation are commonly used to control bleeding and destroy tissue. In certain outpatient settings, the clinician routinely uses one of these electrosurgical modalities on successive patients without sterilization or antisepsis of the treatment electrode tip. In controlled laboratory experiments using electrodesiccation and electrocoagulation, we investigated bacterial transference of Staphylococcus aureus from inoculated tissue to sterile electrode tips and from inoculated electrode tips to sterile tissue. With use on inoculated tissue, sterile electrode tips remained sterile after electrocoagulation but not after electrodesiccation. Bacterial transference from inoculated electrode tips to sterile tissue occurred with electrodesiccation but not with electrocoagulation. These results are consistent with bacterial destruction by electric current and suggest that bacterial transference via the treatment electrosurgery electrode from one patient to another is possible but much more probable during electrodesiccation than during electrocoagulation.
In hydrocolloid impressions, the visibility of the margins of cavity preparation is most important. Purely mechanical management of the gingival tissue by cotton threads does not always give satisfactory results, particularly in multiple preparations. Electrosurgery, subtly used, avoids blood and seepage from the sulcus and seems to better control the accessibility of the margins to the hydrocolloid material.
A 1976 report of the use of radiofrequency current to devitalize carcinomas in man stimulated this review of the historical background, the presently used techniques, and the problems associated with electrosurgery. Difficulties in electrosurgical techniques requiring further research are identified--i.e., the high heating and variable performance of dry dispersive electrodes, the hazards of tissue stimulation, high-frequency interference, and the potential impact of government regulation.