Bovie: the man and the machine.
The origins of electrosurgery are presented and recognition given to one of its forgotten pioneers, William T. Bovie. Though not a physician, Bovie contributed greatly to patient care.
Electrocoagulation↗
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Results for “ELECTROSURGERY”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Treatment of colonic polyps--practical considerations.
The adenomatous colonic polyp, a neoplastic lesion, is the precursor of most if not all carcinomas of the colon and rectum. Confirmatory evidence is derived from epidemiological, histological and clinical data demonstrating a close parallelism between adenomas and cancer of the colon. Based on current knowledge, all colonic polyps should be removed to prevent the development of colonic cancer. However, since the risk of malignancy within an adenoma is related to its size, histology and the degree of dysplasia, practical considerations dictate that all polyps 1 cm in diameter or larger should be removed upon their detection by barium enema or colonoscopy since such adenomas are the ones most likely to contain malignancy. The endoscopic removal of colon polyps can be efficiently and safely accomplished when established principles of colonoscopy and electrosurgery are followed. This technique requires the proper equipment, a skilled endoscopy assistant, and an experienced endoscopist with the ability to adeptly perform colonoscopy, an understanding of the basic concepts of electrocautery and knowledge of the various structural configurations of colonic polyps. Colonoscopic polypectomy will avoid the need for surgical resection in most instances. Management of the malignant colonic polyp remains controversial. The patient with a sessile or pseudo-pedunculated polyp containing invasive cancer should undergo colonic resection. Surgery is not necessary for the majority of patients whose pedunculated adenomas contain invasive cancer, unless the malignancy is poorly differentiated, the cancer invades lymphatics or vascular channels, or tumour is seen at or near the resection margin. Surveillance colonoscopy after endoscopic polypectomy should be performed in most instances within one year to look for recurrent tumour, missed polyps or a metachronous adenoma. Subsequently, colonoscopy should be performed every two years in patients with multiple index polyps, and every three years after removal of a single index adenoma.
Adenoma↗
Lysis of postoperative pelvic adhesions in infertility.
Ovum pickup, sperm transport, and zygote transfer depend on unrestricted contractile, ciliary, and peristaltic mechanisms in the uterine tube and ovary. When adhesions hobble these mechanisms, infertility results. Traditional surgical correction may invite new adhesions thru trauma, disruption of blood supply, and inflammatory reactions from foreign materials. Microsurgery with electrosurgery reduced such surgical sequelae and doubled the term pregnancy rate.
Electrosurgery↗
Therapeutic modalities and procedures. Part III: Kinetic procedures, surgical considerations, direct and alternating currents.
Among the topics discussed in this article are kinetic procedures such as massage, manipulation, vibration, traction, and exercise; electrosurgery with high-frequency currents; and electrical stimulation.
Electric Stimulation Therapy↗
[Characteristic features of the diagnosis and clinical course of malignant rectal melanoma].
The paper discusses the results of an analysis of clinical data on 47 in patients with rectal malignant melanoma. Unsatisfactory results of treatment were largely due to erroneous interpretation of morphological features of pigmented lesions in the rectum, preclinical misdiagnosis and inadequate treatment. Long-term results of the treatment will remain unsatisfactory unless early diagnosis and timely surgical intervention involving abdomino-perineal extirpation (electrosurgery are provided).
Adult↗
Electrosurgical management of soft tissues and restorative dentistry.
Proper use of oral electrosurgery permits rapid, full management of soft-tissue problems related to mouth preparation for fixed and removable prosthodontics. The ability to control precisely the zone of coagulation enables the dentist to carve, sculpture, or modify the soft-tissue contours with or without hemorrhage. Restorative dentists possess a high degree of artistic sculpturing skills that can be effectively utilized to harmonize restorative and soft-tissue contours. The life expectancy and function of all fixed and removable restorations depend upon optimal health of the supporting tissues for biomechanical compatibility. Modern electrosurgical techniques and equipment make it possible for the general practitioner, as well as the specialist, to deliver more timely and more comfortable improved fixed and removable appliance therapy to their patients.
Dental Restoration, Permanent↗
Preclinical exercises in electrosurgical technique.
This article describes a basic laboratory exercise in the teaching of dental electrosurgery for certain restorative dental procedures. This step is a pedagogic approach for orientation to this modality prior to laboratory tissue specimen exercises and, finally, clinical application. It is hoped that through the use of this basic exercise students will become more familiar with electrosurgical instrumentation and that repeated exercises will stimulate clinical use with less apprehension. The advantages of using this exercise include the following (1) the instruments, methods, and materials for the exercise are economical, easily procured, and comprehensive; (2) the laboratory time involved is minimal; (3) the exercise can be taught in conjunction with restorative dentistry; and (4) this approach can stimulate student interest in tissue management and restorative dentistry.
Clinical Competence↗
Electrosurgical quality assurance: the view from the OR table.
Because of the potential hazards involved in electrosurgery, a number of tasks must be performed by the clinical staff when an electrosurgical unit is used. The tasks can be broken down into three groups--those that must be carried out before commencing with the electrosurgical procedure, those that must be checked during the course of the procedure, and those that must be attended to at the end of the procedure. The author recommends preparing a checklist to ensure proper completion of these tasks, to enhance the safety and efficacy of the ESU.
Burns, Electric↗
Investigation and management of cervical intraepithelial neoplasia in Canadian Inuit: enhancing access to care.
Cervical intraepithelial neoplasia (CIN) is a major cause of morbidity among Circumpolar women. Cervical cancer comprised 15% of all cancers in Canadian Inuit women from 1969-1988. The age standardized incidence for invasive cervical cancer in Canadian Inuit women is 3.1 times the rate in the general Canadian population. Management of CIN in women of remote Arctic regions has traditionally required multiple visits to specialized medical centres for diagnosis, therapy and follow-up. Such centralized care requires separation of women from their families, resulting in significant medical, emotional and economic costs for the patient, her family and community. In the Canadian Central Arctic, a program for the diagnosis and therapy of CIN has been established using colposcopy with loop electrosurgery, performed by a trained local family practitioner and visiting gynecologist. Early program evaluation has indicated reduction in medical expenditures due to travel costs, minimal procedure-related morbidity and discomfort, and improved patient satisfaction associated with reduced separation from family and community. It is hoped that the program design, which harnesses technology in order to provide improved care closer to home, will be applicable to other Circumpolar regions.
Arctic Regions↗
Dissection techniques in laparoscopic surgery: a review.
Efficient and safe dissection in laparoscopic surgery consists of the elements of exposure, tissue stabilization and tissue division. Exposure includes bulk exposure of organs and fine exposure of tissues during dissection. In endoscopic surgery this necessarily requires meticulous haemostasis. Tissue stabilization by atraumatic means displays the tissues with appropriate lines of tension to facilitate tissue division. This can be accomplished by a variety of energy types. Besides conventional dissection techniques, technologically advanced dissection systems employing different energy types have been incorporated in laparoscopic surgery. Mechanical energy sources such as ultrasound waves and the kinetic energy of a pressurized water-jet achieve precise dissection without haemostasis. However, thermal energy sources such as high-frequency electrosurgery and lasers achieve haemostatic dissection. Thermal methods generate destructive heat in the body which leads to coagulation or separation of tissues. Surgeons have to be aware of the principles of these dissection techniques, their tissue interactions, their advantages and limitations.
Dissection↗
[Electro- versus laser surgery for conservative laparoscopic revision of tubal pregnancies].
The objective of this study was to determine possible benefits of carbon dioxide laser over electrosurgical usage in conservative laparoscopic treatment of ectopic pregnancies (EP). 41 ectopic pregnancies managed by laparoscopic surgery were analysed retrospectively in regard to operation time, intraoperative blood loss and postoperative complications. No significant differences between both groups were observed. According to our data no advantage of the CO2 laser over electrosurgery in the conservative laparoscopic management of EP's could be demonstrated.
Adolescent↗
Evaluation of Electroscope Electroshield System.
Hospitals have used a number of approaches to managing the risks of serious complications during laparoscopic monopolar electrosurgery: implementing clinician credentialing policies, considering the interaction of the primary equipment selected for laparoscopy, and introducing an accessory safety device--the Electroscope Electroshield System, which we evaluate here--to reduce the effects of high leakage currents originating on the shaft of the active electrode. We evaluated only the monopolar electrode shielding feature of the device.
Electric Injuries↗
[Use of the Ellmann Surgitron in eyelid and plastic surgery].
BACKGROUND: The Ellman Surgitron is a new electrosurgical device with high frequencies (4 MHz) for special use in oculoplastic surgery. Four different operational functions are available: (1) cutting with minimal coagulation, (2) combined cutting and coagulation, (3) coagulation and (4) fulguration. METHODS: The Ellman Surgitron was used in plastic eyelid surgery (blepharoplasty of the upper lid) and in resection of tumors of the upper and lower lid. Histological sections of the excised tumours and skin were performed with special respect to the cut tissues. RESULTS: Blepharoplasty in the cutting mode was performed in nearly complete haemostasis. Histological sections of the excised skin documented better perpendicularity of the cut tissues after electrosurgery than after conventional surgery. Superficial or complete resection of small and larger tumours was performed in haemostasis of deep and superficial vessels. Perfect evaluation of histological sections of the cut tissue was possible after dissection in the cutting mode or the combined cutting and coagulation mode. Per primam postoperative wound healing was observed in all subjects. CONCLUSION: Use of the Ellman Surgitron decreases operating time and permits efficient tissue dissection, excellent haemostasis and perfect wound healing in oculoplastic surgery.
Basal Cell Carcinoma↗
[Surgical laparoscopy--our experience].
Fifty-two of 304 infertile women were surgically treated by the time of diagnostic laparoscopy. Table 1 represents surgical treatment via laparoscopy. Forty-one (78.84%) patients had electrosurgery or laser surgery of endometriosis. Salpingo-ovariolysis was performed in 6 patients (11.53%). Salpingostomy was performed in 2 patients. Fimbrioplasty was performed by incising the peritoneal band surrounding the terminal end of the fallopian tube in 2 patients. Bleeding of vascular adhesions was followed by electrocautery. No patient required laparotomy for control of bleeding. In two patients (3.84%) with ectopic pregnancy had light arterial bleeding along the salpingostomy incision and was controlled by bipolar cautery. In three patients (5.76%) cysts up to 7 cm in diameter were treated. The capsule were dissected and removed how possible. Any residual capsule was vaporized.
Adnexal Diseases↗
Electrosurgical injuries during laparoscopy: prevention and management.
Despite the fact that electrophysics and its application to surgery, in particular endoscopic surgery, is a discreet science, there is little attention paid to the applied principles of the physics involved when surgeons receive their formal training in the technical aspects of surgery. Most training programs consider the discipline of electrosurgery as a skill that is left to the 'hands on' exposure of the student, and that the skills and knowledge of the average professor have been awarded through a 'grandfather' process of credentials. As a result, many myths have been perpetuated over the past decades since William Bovie introduced the first electrosurgical diathermy machine using high frequency radio waves instead of heated instruments (cautery) to destroy human tissue. Electrogenerators, today, have become finely tuned instruments that offer many versatile variables for the contemporary surgeon to harness and deliver, in either a discreet or broad manner, to tissue to obtain a desired effect and outcome.
Electric Injuries↗
Neurogenic tumors of the small intestine. Review of the literature and report of a case with endoscopic removal.
Epigastric pain and melena prompted the study of a woman with cutaneous neurofibromatosis (von Recklinghausen's disease). Roentgenographic and endoscopic examination demonstrated an ulcerated polypoid neurilemoma of the duodenum. It was removed by endoscopic electrosurgery. Neurogenic tumors of the intestine are rare, but should be considered in the differential diagnosis when patients with multiple café au lait spots or cutaneous neurofibromatosis manifest epigastric pain, gastrointestinal bleeding, or intestinal obstruction. Endoscopic polypectomy may offer a low risk method of treatment for sutably located bleeding neurogenic tumors of the stomach or duodenum.
Diagnosis, Differential↗
Cause and prevention of electrosurgical injuries in laparoscopy.
BACKGROUND: Electrosurgical injuries occur during laparoscopic operations and are potentially serious. The overall incidence of recognized injuries is between one and two patients per 1,000 operations. The majority go unrecognized at the time of the electrical insult and commonly present three to seven days afterward with fever and pain in the abdomen. Since these injuries appear late the pathophysiology remains speculative. STUDY DESIGN: This article reviewed the physics of electrosurgery and provides the surgeon with an insight to the mechanisms responsible in each type of injury. In addition, a comprehensive search of the world literature has reviewed all articles on the topic. RESULTS: The main causes of electrosurgical injuries are: inadvertent touching or grasping of tissue during current application, direct coupling between a portion of intestine and a metal probe that is touching the activated probe, insulation breaks in the electrodes, direct sparking to the intestine from the diathermy probe, and current passage to the intestine from recently coagulated, electrically isolated tissue. The majority of injuries, not surprisingly, are caused by monopolar diathermy. Bipolar diathermy is safer and should be used in preference to monopolar diathermy, especially in anatomically crowded areas. CONCLUSIONS: An awareness of the hazards of diathermy together with an understanding of the mechanisms of injury should enable the surgeon to dissect tissue and to achieve hemostasis, while at the same time decreasing the risk of serious complications to the patient.
Burns, Electric↗
The advantages of laparoscopic assisted bipolar high-frequency surgery.
Monopolar and bipolar application techniques of high-frequency surgery are compared concerning safety regulations, functional and energetic aspects and aspects of application. The availability of newly developed bipolar and multipolar surgical instruments for cutting and coagulating without instrument change and at low high-frequency power opens up a new dimension in laparoscopic assisted electrosurgery. The well-known risks of using monopolar instruments in laparoscopy have been eliminated with the new instrumentation presented.
Electric Conductivity↗