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At least 739 records · Page 41Linked to original sources

PubMed1998

[Techniques of laparoscopic preparation and current-induced complications. Results of a survey in Germany].

138 surgical institutions in Germany retrospectively answered a questionnaire on available energy sources, techniques of preparation and complications due to the use of electric current in laparoscopic surgery. The median experience in this field of surgery was 6 years. For common laparoscopic operations the majority of surgeons use electrosurgery; only 8% never do so. Except in appendectomy, monopolar cautery is preferred for all operations. Other energy devices are of minor importance. The overall number of operations reported was nearly 138,000. The rate of complications due to the use of electric current was 0.1%. This figure is accounted for in equal part by intra- and postoperative burns. The complication rate is at the lower end of the range known from the literature. Even though the retrospective nature of this analysis may hide a certain number of injuries electric, current plays a minor role for complications in laparoscopic surgery.

Burns, Electric↗

PubMed1999

[Long-pulsed frequency-doubled neodymium:YAG laser in treatment of superficial varicose veins. Initial clinical experiences].

Many different therapeutic approaches are employed to treat small vessels on the leg. In recent years a variety of lasers (argon, Neodymium: YAG and dye lasers) have been used as well as sclerotherapy, cryosurgery and electrosurgery. None of these lasers are entirely satisfactory, and there are a number of side effects. Because of its special physical characteristics, the newly developed long-pulsed frequency-doubled neodymium: YAG laser has clear advantages in the treatment of vascular lesions compared to other laser systems. These include: no vessel rupture compared to dye laser, no epidermal lesions compared to argon laser. In clinical tests it shows a high rate of effectiveness with minimal side effects.

Adult↗

PubMed1998

[Argon plasma surgery (APC) in the upper aerodigestive tract. Initial results].

Cold knife surgery, electrosurgery and laser surgery all offer techniques, instruments, equipment and systems for resecting and destroying mucosal lesions and for hemostasis in the upper aerodigestive tract. When used in the head and neck, argon plasma surgery (APS) offers a new, contact-free, electrosurgical technique in which high frequency current is applied through ionized, and thus electrically conductive, argon(argon plasma) to the tissue undergoing treatment. Especially noteworthy in APS are its advantages for removing a lesion and controlling bleeding: the technique is easy to control, and the depth of the thermal tissue destruction is limited to a maximum of 3 mm even in wide-area application, so that damage to adjacent or submucosal tissues can be avoided. Initial results with APS in the reduction of hyperplastic nasal turbinates, treatment of hereditary hemorrhagic teleangiectasia (Osler's disease) in the nasal mucosa, and in treating progressive juvenile papillomatosis of the larynx have shown clear advantages for APS over other methods used.

Adolescent↗

PubMed1999

The development of urological endoscopy in America.

This article deals with the history of medicine in American urology, where endoscopy is a very important subject. The development of endoscopy in America unrolled in three phases: the acquisition of European techniques and instruments, realization of the ideas of American researchers, and original creations that forwarded endoscopy considerably. European instruments were acquired in the nineteenth century, culminating in the instruments developed by Max Nitze. When Wappler started the production of endoscopes in 1905, they were the basis for the development of numerous modifications and innovations such as electrosurgery, developed by Beer in 1910, with the Resonator created by Wappler; the resectoscope, invented by Stern and McCarthy in 1931; "cold light" using glass fibers for illumination, described by ACMI in 1960; the flexible fiber ureterorenoscope, described by Marshall in 1960; and fluorescence cystoscopy, introduced by I. M. Bush and W. F. Whitmore in 1964.

Diagnostic Techniques, Urological↗

PubMed2001

Ventricular fibrillation caused by electrocoagulation during laparoscopic surgery.

A 35-year-old man with morbid obesity was admitted to our hospital to undergo gastric banding gastroplasty by the laparoscopic approach. Aside from his morbid adiposity, with a body mass index (BMI) of 49.9 kg/m2, the patient was healthy. During the procedure, he developed ventricular fibrillation (VF) while a diathermic knife was being used. After defibrillation, his heart rate returned to normal. The postoperative clinical course was uneventful, and there was no evidence of permanent heart failure. Although the VF could have been caused by patient- or material-related variables, it was most likely the result of unwanted electrical effects. Specifically, the occurrence of an arc between the patient's tissue and the tip of the electrode during cutting in the coagulation mode can lead to low-frequency current. The modified low-frequency current may produce arrhythmias. Thus, the use of the coagulation mode to cut tissue in the cardiac region during laparoscopic procedures could increase the risk for arrhythmias. An understanding of the physical principles of electrosurgery, as well as familiarity with the equipment and its various functions, is essential for the patient's safety. In addition, cardioversion equipment should be readily available on every surgical unit.

Adult↗

PubMed2004

Midterm follow-up study of laparoscopic dissection of uterine vessels for surgical treatment of symptomatic fibroids.

BACKGROUND: This study aimed to assess laparoscopic dissection of uterine vessels (LDUV) for symptomatic fibroids in women. METHODS: A total of 69 women entered the study between March 2000 and June 2003. In this case series, 68 consecutive women underwent LDUV using ultrasonically activated sheers or electrosurgery for the treatment of fibroids over 3 years (median follow-up period, 14.5 months). Ultrasound or magnetic resonance imaging was carried out 3, 6, 12, 24, and 36 months after treatment. The tissue markers, gonadotropin, and estrogen levels were studied postoperatively. RESULTS: Almost all the patients (98.5%) had a successful LDUV with a low rate (7.3%) of postoperative complications. The time of surgery ranged from 15 to 50 min (mean, 30.8 min). The blood loss was minimal (mean, 14.7 ml), and the hospital stay was 2.4 days. Symptom improvement (menorrhagia or dysmenorrhoea) was 93.2%, and the average reduction in the dominant myoma was 57.8% during a follow-up period longer than 12 months. All the patients with anemia had normal red cell counts after 3 months. CONCLUSIONS: Uterine volume and the dominant fibroid were significantly reduced and symptoms were improved by LDUV. The laparoscopic procedure is associated with insignificant tissue damage and normal gonadotropin and estrogen levels.

Adult↗

PubMed1997

Production and systemic absorption of toxic byproducts of tissue combustion during laparoscopic surgery.

BACKGROUND: Among the potential hazards of laparoscopic surgery using electrocautery is the intraperitoneal release and subsequent absorption of byproducts of tissue combustion. In a porcine model of laparoscopic surgery with smoke production, our aims were to assess (1) the relationship between levels of intraperitoneal carbon monoxide (CO) and systemic carboxyhemoglobin (COHb) and methemoglobin (MetHb), and (2) intraperitoneal concentrations of other noxious gases, including hydrogen cyanide (HCN), acrylonitrile (Acr), and benzene (Bzn). METHODS: Seven pigs underwent laparoscopic resection of three hepatic wedges using monopolar electrocautery in a CO2 pneumoperitoneum. Sequential arterial samples were drawn to measure [COHb] and [MetHb] perioperatively, while gaseous intraabdominal [CO], [HCN], [Acr], and [Bzn] were assayed intraoperatively. RESULTS: The mean +/- SEM duration of operation was 90 +/- 2 min, and electrocautery was used for 68 +/- 4 min. Intraabdominal [CO] rose from 0 to 814 +/- 200 ppm (p < 0.01) while [COHb] increased from 2.9 +/- 0.1% to 3.5 +/- 0.1% (p < 0.001). Systemic [MetHb] remained unchanged intra- and postoperatively, ranging from 0.3 to 0.7%. Intraperitoneal [HCN] rose from 0 to 5.7 +/- 0.7 ppm (p < 0.001). [Acr], however, did not change significantly from preoperative values, ranging from 0 to 1.6 +/- 1. 0 ppm, and [Bzn] was undetectable. CONCLUSIONS: Laparoscopic tissue combustion increases intraabdominal [CO] to "hazardous" levels leading to minimal, yet significant, elevations of [COHb]. Systemic [MetHb] and intraabdominal [HCN], [Acr], and [Bzn] are not elevated to toxic levels. Production of intraperitoneal smoke during laparoscopic electrosurgery therefore may not pose a significant threat to the patient.

Absorption↗

PubMed1998

The use of bipolar cautery, laparosonic coagulating shears, and vascular clips for hemostasis of small and medium-sized vessels.

Advanced laparoscopic surgery requires a reliable method of hemostasis. In order to determine the efficacy of common hemostatic devices, we tested bipolar electrosurgery (BPES), laparosonic coagulating shears (LCS), and vascular clips (VC) on arteries of various sizes to compare the strength of hemostasis against elevated intraarterial pressure. The procedures were performed on a porcine model through a laparotomy. Segments of visceral arteries were isolated and cannulated with an angiocatheter that was linked to a pressure monitor. After hemostasis with the tested instrument and division of the vessel, the intraarterial pressure was elevated by infusion of saline solution through the angiocatheter. The pressure was recorded when bleeding occurred through the cut end of the vessel or when the pressure reached 300 mm Hg. All three devices were effective in maintaining hemostasis on small (diameter, 0.25-0.5 mm) and medium-sized arteries (diameter, 2-3.5 mm) with a success rate ranging between 75% and 100% (p = n.s.). Practice and technical finesse were required with the use of the LCS and BPES before excellent results could be obtained. The LCS has an advantage over BPES because it allows the surgeon to perform hemostasis and division simultaneously, thus keeping the operating field clean and avoiding instrument adhesion to the tissue.

Animals↗

PubMed1998

Tissue thermal damage caused by bipolar forceps can be reduced with a combination of plastic and metal.

BACKGROUND: We created a new 5-mm bipolar forceps. Thermo-insulating plastic was used for the creation of the jaws, while the metal conductor is buried deep inside the plastic. METHODS: A porcine model was used in experimental testing against a standard metallic 5-mm bipolar forceps at three different wattage settings (20, 40, 60 W). Histological sections were evaluated by a pathologist who was blind to the wattage and instrument tested. RESULTS: The new instrument was shown to cause statistically significant reduced thermal damage. In addition, its lateral thermal diffusion is superior to standard bipolar forceps. CONCLUSIONS: Thermo-insulating plastics can reduce thermal damage to tissue during electrosurgery.

Animals↗

PubMed2003

Xiphoidectomy.

Complex surgical procedures in the upper abdomen required ear exposure. To improve exposure xiphoidectomy is indicated; however, in the past there was an extensive time commitment and unpredictable bleeding. We describe a rapid and bloodless approach to xiphoidectomy, utilizing a self-retaining retractor, controlled osteotomy, and complete removal to the xiphisternal junction. The xiphoid bone is dissected with high-voltage electrosurgery, denatured, and resected completely. Bleeding points are easily controlled with electrocoagulation. This procedure allows optimal exposure to the most superior aspect of the abdominal cavity.

Diaphragm↗

PubMed1987

Nonpharmacologic treatment of life-threatening cardiac arrhythmias.

Numerous nonpharmacologic modalities have been introduced for the management of patients with life-threatening arrhythmias. These include cardiac pacing, insertion of an automatic internal cardiac defibrillator (AICD), cardiac electrosurgery, and catheter ablative techniques. Each modality is effective; AICD shows particular promise because it has demonstrated remarkable efficacy in decreasing the incidence of sudden cardiac death in patients with malignant ventricular arrhythmias. Each modality also has its limitations or contraindications. Nonpharmacologic antiarrhythmic therapy represents an important advance against the serious public health problem of sudden cardiac death.

Arrhythmias, Cardiac↗

PubMed1995

The medical and economic impact of laparoscopically assisted vaginal hysterectomy in a large, metropolitan, not-for-profit hospital.

OBJECTIVE: Our purpose was to evaluate the medical and economic impact of of operative laparoscopy on the surgical approach to hysterectomy for benign disease in a large, metropolitan, not-for-profit hospital. STUDY DESIGN: Retrospective analyses were performed on 2563 hysterectomies (without vaginal or bladder repair) for benign disease, performed by 37 gynecologists between January 1991 and December 1993. Disposable laparoscopic instruments and stapling devices were not used at any time during the study period. Electrosurgery and sutures were used for hemostasis. Parameters analyzed included surgical approach (total abdominal hysterectomy, vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy, and failed laparoscopically assisted vaginal hysterectomy), operative time, postoperative diagnosis, operative blood loss, length of stay, complications, uterine weight, and hospital changes. Charges in each of these parameters were analyzed and compared in 6-month increments. RESULTS: During the study period the percent of hysterectomies performed abdominally declined from 65% to 36%. Laparoscopically assisted vaginal hysterectomy increased from 12% to 45%, and vaginal hysterectomy varied from 23% to 19%. Average operative time was 82 minutes (+/- 2 minutes) for total abdominal hysterectomy, 102 minutes (+/- 2.3 minutes) for laparoscopically assisted vaginal hysterectomy, and 63 minutes (+/- 2 minutes) for vaginal hysterectomy. Hospital stay was 68 hours (+/- 1.5 hours) for total abdominal hysterectomy, 44 hours (+/- 1.2 hours) for laparoscopically assisted vaginal hysterectomy, and 43 hours (+/- 4.1 hours) for vaginal hysterectomy. The average hospital charge was $6552 (+/- $108) for total abdominal hysterectomy, $6431 (+/- $100) for laparoscopically assisted vaginal hysterectomy, and $5869 (+/- $116) for vaginal hysterectomy. CONCLUSIONS: Contrary to previously published studies, our study demonstrates (1) laparoscopically assisted vaginal hysterectomy is a cost-effective procedure when performed with reusable instruments, (2) laparoscopically assisted vaginal hysterectomy is a safe procedure, even when performed by a variety of gynecologists with different skill levels, and (3) the number of hysterectomies performed abdominally was decreased by 29% without incurring more complications or reducing the number of vaginal cases.

Blood Loss, Surgical↗

PubMed1988

Current progress in cryosurgery.

The 4-day sessions of the Eighth Annual Meeting of the American College of Cryosurgery in New Orleans, February 18-21, 1988, provided an intense overview of the position of cryosurgery in modern day medical practice. The variety of speakers demonstrated that interest in the therapeutic technique of cryosurgery remains high and that usage is greater, more diversified, and more selective than in past years. Emphasis at the meeting was placed on the selective use of cryosurgery, that is, defining the terms under which the physician would choose between diverse methods of local therapy, such as excision, electrosurgery, laser surgery, and cryosurgery. Most of the presentations were oriented clinically with emphasis on the results of cryosurgery. This brief report is intended to mention the important new developments in cryosurgery and to focus on some of the issues and needs that affect the future of the technique.

Cryosurgery↗

PubMed1990

Histologic evaluation of the width of soft tissue necrosis adjacent to carbon dioxide laser incisions.

This study evaluated the width of tissue necrosis lateral to carbon dioxide laser incisions on human intraoral excisional biopsy specimens. Measurements were made on specimens including epithelium, muscle, dense and loose connective tissue, and salivary gland. Results showed a mean width of tissue necrosis of 86 microns in epithelium, 85 microns in muscle, 51 microns in loose connective tissue, 96 microns in dense connective tissue, and 41 microns in salivary gland. The range of thermal necrosis in different tissue types is probably based on the water content within each type. A cellular partially homogenized zone of reversible thermal damage up to 500 microns in width was visible adjacent to the zone of thermal necrosis. The relatively narrow width of tissue necrosis with this technique may account for the claimed superior properties of laser-induced wounds compared with those created by electrosurgery.

Connective Tissue↗

PubMed1994

Bipedicled myomucosal flap for reconstruction of the lip after vermillionectomy.

Solar keratosis is a well-documented premalignant condition caused by actinic radiation on the vermillion. The usual treatment method consists of surgical removal of the damaged area by means of sharp dissection, electrosurgery, chemical peeling, or recently CO2 laser beam. The denuded area is left to reepithelize (in cases of superficial removal) or is reconstructed by advancing mucosal flaps. Most of these methods assure a satisfactory clinical cure and a good function. The main disadvantage is esthetic because of a narrowing and flattening of the vermillion and loss of the pout. To overcome these side effects, we use a bipedicled vascularized myomucosal axial flap. Between 1982 and 1989, 19 patients were treated with this method. In this article we present the clinical aspects of solar keratosis, describe the surgical technique step-by-step, and evaluate the long-term outcome of this method.

Adult↗

PubMed1988

Osteoarthrosis of the temporomandibular joint following experimental disc perforation in Macaca fascicularis.

The aim of this experiment was to study the sequela of experimental temporomandibular joint (TMJ) disc perforation. Each TMJ of four Macaca fascicularis adult monkeys was surgically exposed, and a 4- to 6-mm perforation at the posterolateral portion of the avascular disc was produced by electrosurgery. Four monkeys were used as controls. The animals were killed 11 weeks (two experimental and two controls) or 12 weeks (two experimental and two controls) after disc perforation. The perforations were increased in size in five joints, and healed in one joint. In addition, two joints of one animal showed complete loss of the disc, denudation of articular surfaces, and bone-to-bone contact. In contrast to control joints, the experimental joints exhibited the following changes histopathologically: thick, highly cellular and fibrillated fibrous coverings of articular surfaces (five joints); marked hyperplasia of synovial membrane; migration of synovial cells on the surfaces of the disc and margins of perforation; multiple adhesions of disc to articular surfaces; increase in cellularity and vascularity of discs; and chondrocytic clustering in temporal fibrous covering; and osteophytes of condylar and temporal components and focal or complete denudation of articular surfaces (2 joints). Most of these changes were consistent with the diagnosis of osteoarthritis. From this study, one can conclude that disc perforation can lead to osteoarthritis.

Animals↗

PubMed1991

Effects of irrigation fluid on human menisci: an experimental comparison of water, normal saline, and glycine.

A technique has been developed to demonstrate the macroscopic morphology of collagen fiber arrangement in human menisci. It was observed that 0.9% normal saline solution removed the ground substance of the meniscus, leaving intact collagen bundles. This suggests that meniscal damage may occur as a direct result of using normal saline for irrigation during knee arthroscopy. Experiments were conducted using demineralized water and 1.5% glycine for comparison. The disruption of collagen fiber binding in the meniscus by normal saline is time and temperature dependent. Glycine solution causes fibroblast lysis and a lesser degree of collagen alteration. Demineralized water can cause edema in the fibroblast but no notable change in collagen fibers. None of the irrigation solutions tested has proved to be completely safe. Demineralized water is not the ideal solution but is preferable to normal saline or glycine solution, especially when it can be used in conjunction with electrosurgery.

Adult↗

PubMed1992

Use of an electrocautery loop probe for arthroscopic meniscectomy: a five-year experience with results, indications, and complications.

Between 1984 and 1990, 952 patients had arthroscopic meniscectomies with a specially designed electrocautery loop probe. In all but 250 patients, 1.5% glycine was used as the nonconductive irrigating solution. Ninety-five patients had repeat arthroscopic procedures at a minimum of 6 months after their original procedure. Biopsies of the meniscal remnants were obtained in 21 patients. In all 21, there was no evidence of thermal damage in the area of the previous arthroscopic meniscal electrosurgery. In less than 4% of the patients, articular surface injuries occurred at the time of the original meniscectomy. Careful records were kept outlining the areas of contact damage with the exposed wire of the electrocautery loop probe. At repeat arthroscopies in 17 patients 9 months to 4 years after the initial procedure, there was no apparent evidence of significant permanent damage to the articular surface in the area of the original thermal injury. The electrocautery loop probe was effective for efficient resection of simple and complex tears of the medial or lateral meniscus.

Adolescent↗