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At least 757 records · Page 42Linked to original sources
PubMed2005

Hysteroscopic polypectomy in 240 premenopausal and postmenopausal women.

OBJECTIVE: To ascertain the therapeutic efficacy and safety of hysteroscopic polypectomy in 240 premenopausal and postmenopausal patients. DESIGN: Retrospective study. SETTING: Tertiary university hospital. PATIENT(S): Two hundred forty patients with intrauterine endometrial polyps, who mostly suffered from abnormal uterine bleeding and infertility. INTERVENTION(S): Hysteroscopic polypectomy using various instruments including microscissors, grasping forceps, or electrosurgery either with a monopolar probe or a resectoscope. MAIN OUTCOME MEASURE(S): Operating time, amount of glycine absorption, complications, resumption of normal menstruation, cumulative pregnancy rate, and recurrent rate of polyps after hysteroscopic surgery. RESULT(S): Resectoscopic polypectomy needed more operating time, had more glycine absorption and complications, but less recurrence than other hysteroscopic techniques. The resectoscope had a 0% recurrence rate and that grasping forceps had a 15% recurrence rate. A total of 21 (8.7%) complications occurred, but no major complications were noted. After long-term follow-up of 9 years and 2 months, those with abnormal uterine bleeding resumed normal menstruation in 93.1% and those with infertility had a cumulative pregnancy rate of 42.3%. There was no statistical difference in reproductive outcome between patients having polyps < or = 2.5 cm and >2.5 cm. CONCLUSION(S): We found hysteroscopic polypectomy to be effective, safe, minimally invasive procedure with low rate and mild complications. Restoration of reproductive ability did not depend on the size of the removed lesion. Resectoscopic surgery is more preferable to prevent recurrence of polyps.

Adult↗
PubMed2006

Obstetric and delivery outcome of pregnancies achieved after laparoscopic myomectomy.

OBJECTIVE: To assess the risks and outcome of pregnancies and deliveries after laparoscopic myomectomy (LM). DESIGN: Retrospective study. SETTING: Center of Reconstructive Pelvic Endosurgery, Reproductive Medicine Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. PATIENT(S): A total of 514 patients of fertile age that underwent LM at the Center were selected. INTERVENTION(S): All the surgical procedures were performed using the same technique employing a vertical uterine incision and avoiding the use of electrosurgery. MAIN OUTCOME MEASURE(S): Number and outcome of pregnancies achieved after surgery, abortion rate, preterm delivery, gestational age, malpresentation, spontaneous or cesarean delivery, and postpartum hemorrhage. We also paid particular attention to the occurrence of uterine rupture. RESULT(S): A total of 158 pregnancies were achieved. There were 43 (27.2%) spontaneous abortions, 4 (2.6%) ectopic pregnancies, and 1 (0.6%) therapeutic abortion. Only 27 patients (25.5%) had vaginal deliveries, whereas 79 (74.5%) underwent cesarean section. No instances of uterine rupture were recorded. CONCLUSION(S): Our preliminary results confirmed that LM, performed by an expert surgeon, can restore reproductive capacity, allowing patients to have a successful pregnancy.

Adult↗
PubMed2006

Electrocoagulation and hazardous damage to a dental prosthesis.

We report the case of 50-year-old patient who experienced minor damage to a dental prosthesis after undergoing bipolar electrocoagualtion during micrographic surgery for scirrhous basal cell carcinoma of the cheek. The melting defect in the covering resin of the prosthesis was caused by heating through a channeling effect as the prosthesis served as an intraoral electrode. Keeping a complete record of dental implants and removing prostheses with metal anchors are recommended to prevent similar injuries for electrosurgery on the face.

Basal Cell Carcinoma↗
PubMed1981

Carbon dioxide laser surgery in treatment of condyloma.

During the past few years there has been a marked increase in the occurrence of condyloma. A variety of treatment methods, including mental suggestion, local 5-fluorouracil, podophyllum, electrosurgery, and cryotherapy, has been used with varying success. An experience in 47 patients, some of whom were pregnant, treated with the carbon dioxide laser is presented. The possible relationship to malignancy and tracheobronchial papillomatosis in children is discussed.

Adolescent↗
PubMed1996

Endometrial ablation: a series of 568 patients treated over an 11-year period.

OBJECTIVE: Our purpose was to retrospectively review the intraoperative and long-term outcomes of 568 patients with abnormal uterine bleeding who were treated by endometrial ablation over an 11-year period. STUDY DESIGN: From 1893 to 1994, 401 endometrial ablations were performed with the neodymium-yttrium-aluminum-garnet laser and another 167 patients were treated by electrosurgery. The majority of the patients were treated for irregular, heavy menses. Fifty-seven had ablation because of abnormal bleeding associated with a serious medical disorder, 12 with a bleeding diathesis, and 50 with morbid obesity. All patients had preoperative endometrial sampling that demonstrated benign histology. Nineteen patients had submucous myomas that were resected at the time of hysteroscopic ablation. All patients received preoperative and postoperative suppression. The minimum follow-up period was 1 year. RESULTS: The average operative time was 32.5 minutes. The mean hospital stay was 8 hours. Four patients who received 32% dextran 70 in dextrose (Hyskon) as the distending medium had pulmonary edema postoperatively. One case of endometritis was also detected. No uterine perforations were observed. Amenorrhea developed in 58% of the patients, 34% reported light or normal menstrual flow, and 8% did not respond (continued heavy flow). CONCLUSION: This study represents one of the largest published series of endometrial ablation, with a mean follow-up of 4.5 years. It demonstrates that hysteroscopic endometrial ablation is a reliable, safe alternative to hysterectomy for the surgical management of abnormal uterine bleeding.

Amenorrhea↗
PubMed2000

Endometrial laser intrauterine thermotherapy: the first series of 100 patients observed for 1 year.

OBJECTIVE: To describe a new instrument (GyneLase) that offers a new approach (endometrial laser intrauterine thermal therapy [ELITT]) to treatment of menorrhagia and to evaluate the efficacy of ELITT in the management of dysfunctional uterine bleeding. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): 100 premenopausal women with dysfunctional uterine bleeding were observed for 1 year. INTERVENTION(S): Intrauterine laser thermotherapy with a diode laser. MAIN OUTCOME MEASUREMENT(S): Amenorrhea rate after 1 year. RESULT(S): The amenorrhea rate after 1 year of follow-up was 71%, and the rate of amenorrhea/severe hypomenorrhea rate was >90%; these rates are much higher than those in the literature after such procedures as electrosurgery or intrauterine thermal balloon therapy. The ELITT procedure is an inherently safe and simple alternative, providing controlled and effective treatment of the entire endometrium. In contrast to traditional endometrial ablation using a neodymium yttrium-aluminum-garnet laser, the ELITT procedure does not require intensive training or hysteroscopic control; it is also far less risky, because the power used per unit area is 1,000 times lower. CONCLUSION(S): The ELITT procedure is a new nonhysteroscopic technique for endometrial ablation. The technique is very safe and offers the highest amenorrhea rate to date in the literature.

Adult↗
PubMed1988

A teaching model for endoscopic surgery: hysteroscopy and pelviscopic surgery.

The tissue model described is readily available and can be manipulated in many ways to stimulate intraoperative conditions that may be approached by gynecologic endoscopic surgery. The value in using the sow uterus and bladder is that details of tissue management can be induced in the instructional course. The student can learn where and how to make incisions, to remove tissue from the cavity (abdomen or uterus), and to perform endoscopic suturing when indicated. The student can observed what happens to tissue under the influence of various energy forms such as bipolar or monopolar electrosurgery and lasers. The range of actual simulations is limited only by the imagination of the instructors and can probably be adapted to many other procedures not described in this report.

Animals↗
PubMed1998

Hysteroscopic endometrial ablation without endometrial preparation.

OBJECTIVE: To study the effectiveness of endometrial ablation by hysteroscopic resection without prior medical preparation for the treatment of women with persistent menorrhagia. METHOD: From January 1996 to January 1997, a total of 170 women with persistent menorrhagia and/or dysmenorrhea and who underwent hysteroscopic endometrial resection were included in the study. A thorough suction curettage was done before the procedure. The operation was conducted through a continuous flow hysteroscopic resectoscope with electrosurgery while the patient was under intravenous general anesthesia. The distention fluid used was 5% dextrose with a gravity feed infusion system consisting of a 2-1 bag between 1 and 1.5 m above the uterine cavity. After the procedure, the patients' conditions were followed for at least 6-18 months by telephone interview or at our clinic. RESULTS: A total of 127 women were available for a follow-up period of at least 6 months. Operative complications were 3%; three women had fever and received oral antibiotics; no uterine perforation occurred; one case of post-operative bleeding was controlled by intrauterine balloon inflation; the average operation time was 21 min; The mean fluid deficit was 435 ml. Ninety-nine out of 127 women (78%) had adequately controlled menorrhagia (18.1% had amenorrhea, 42.5% hypomenorrhea and 17.3% had normal menstrual flow), while 27 women (21.2%) were failed due to unchanged or heavier menstrual flow after surgery. Eleven (40%) out of the 27 failed cases had myoma with menorrhagia, whereas only five women (5%) out of the 99 adequately treated women had myomas (P < 0.05). Thirty-eight (54%) out of the 70 women with severe dysmenorrhea reported either lessening dysmenorrhea or no dysmenorrhea after the surgery. A total of 76 women (60%) were satisfied with the procedure. A second surgical procedure, either a resection or hysterectomy, was necessary in 13 women (10%) after ablation (seven received repeated ablations and six underwent hysterectomy). CONCLUSION: Endometrial ablation without endometrial suppression is a cheap, effective and acceptable procedure for treatment in women with persisted persistent menorrhagia.

Adolescent↗
PubMed1992

Carbon dioxide laser surgery for skin disease.

Since it was developed in the 1960s, the carbon dioxide (CO2) laser has had an important role in the practice of dermatology. The CO2 laser has some advantages over conventional techniques used in dermatologic surgical treatment. It routinely provides a bloodless surgical field as well as unusual surgical precision. Although the CO2 laser is specifically indicated for certain conditions, in other situations, only marginal benefit may be noted in comparison with standard techniques such as scalpel surgical procedures, dermabrasion, cryosurgery, and electrosurgery. In this article, we briefly review the history and physics of the CO2 laser, its operation, and safety principles and discuss dermatologic conditions that are treated with the CO2 laser. We also describe 8 representative cases from our experience with more than 800 cases of CO2 laser treatment in the practice of dermatology at the Mayo Clinic since 1986.

Adult↗
PubMed2002

The current status of curettage and electrodesiccation.

Curettage and electrodesiccation (CE) is a technique widely used in the destruction of benign and selected malignant cutaneous neoplasms. CE is used mainly by dermatologists and family practice physicians, whereas plastic surgeons and other surgeons excise most benign and malignant lesions. The use of CE for the treatment of skin cancer has been widely extolled and also fervently criticized. Some practitioners treat most non-melanoma skin cancers (NMSC) with CE, and others have called for abandoning the technique in the treatment of such lesions. A thorough review of the literature reveals that CE has both virtues and flaws. In taking a rational approach to the treatment of benign and malignant cutaneous lesions it is essential to learn the basis for CE, the likely cure rates for given lesions, the proper technique, and the expected level of cosmesis. As the surgical treatment of skin cancer has become firmly entrenched in the field of dermatology, it is valuable to examine this technique in depth and to come to some thoughtful conclusions about its use for patients with skin cancer and assorted benign skin lesions. Last year a remarkably complete and exhaustive favorable review of curettage, electrosurgery, and skin cancer was published by Sheridan and Dawber. This article is a must read for anyone performing curettage; however, the author is writing with a slightly different perspective, that of a dermatologic surgeon. Although the author believes that CE has value and he uses this technique frequently, he disagrees with some of the truisms expressed in the literature about CE and attempts to define carefully what he believes are the strengths and limitations of this technique.

Curettage↗
PubMed1996

Argon-enhanced cutting and coagulation confers advantages over conventional electrocautery for mastectomy.

In this prospective randomized study we have compared argon-enhanced electrosurgery with conventional diathermy in a consecutive series of 50 patients undergoing mastectomy. The groups were comparable in age, menopausal status, tumour size, stage and specimen size. Patients undergoing mastectomy using argon diathermy had significantly less blood loss intraoperatively (521 (67)ml vs 824 (59)ml; P<0.001) and a significantly lower transfusion requirement post-operatively. There were no significant differences in post-operative drainage (1350 (160) ml vs 1527 (169) ml; P=NS), length of hospital stay, incidence of seromas or other complications. Argon diathermy significantly reduces intraoperative blood loss and should be considered as the method of choice in patients undergoing mastectomy.

Argon↗
PubMed1993

Effect of irrigation fluids on the articular cartilage: a scanning electron microscope study.

Four irrigation solutions, two for general arthroscopic examination and two for electrosurgery, were evaluated for their effects on the ultrastructure of the articular cartilage surface using an animal model with a scanning electron microscope (SEM). The murine knee joints were irrigated continuously for 1 or 2 h with normal saline, Ringer's lactate, 3% sorbitol, or distilled water, respectively. The articular cartilage of the patella was evaluated in situ; that is, the cartilage was kept intact as it related to the underlying bone tissue, so that artifacts during the biopsy procedure could be prevented. Results of the study showed no significant differences among the four solutions and the unirrigated control group. We conclude that Ringer's lactate, normal saline, distilled water, and 3% sorbitol can all be safely used as irrigation solutions in arthroscopic surgery.

Animals↗
PubMed1985

Effect of electrocautery on fresh human articular cartilage.

The use of high energy devices has been suggested for intra-articular surgery. Experimental studies have been performed using the laser and electrocautery. However, clinical application has primarily been with the use of the electrocautery. Electrosurgery is currently being used for lateral retinacular release as well as meniscal surgery. Inadvertent damage to articular cartilage may occur, especially during meniscal resection. The objective of the current study is to assess the effect of the Concept electrocautery with the meniscal cutting electrode on fresh human articular cartilage. Twenty fresh tibial plateaus removed at the time of total knee arthroplasty were subjected to electrocautery currents ranging from 25 to 82.5 W. The articular cartilage was stained with hematoxylin and eosin. The extent of cartilage necrosis was quantitated as a percentage of the thickness of the articular cartilage. A dose response curve was developed. The extent of articular cartilage necrosis with the electrocautery setting of 20 (24.4 W) commonly used for meniscal resection resulted in only an 11.4%-injury to the articular cartilage. At the manufacturer's recommended setting of 24 (27 W), a 16% depth of laceration of the articular cartilage may be anticipated. We conclude that the lowest current setting possible should be utilized for meniscal surgery and the risk of articular cartilage damage from inadvertent injury is not excessive.

Cartilage, Articular↗
PubMed1987

[Reprogramming of a pacemaker induced by electrocautery].

A case is reported of reprogramming of a ventricular unipolar permanent pacemaker induced by electrocautery during biliary surgery. After skin incision and use of the unipolar electrosurgery unit, the CPI model 505 multiprogrammable pulse generator previously set at 70 b X min-1 abruptly fired at 120 b X min-1. Application of a magnet over the pacemaker reduced the heart rate to 100 b X min-1. After surgery, the pulse generator was successfully reprogrammed to a rate of 65 b X min-1. Based on the analysis of this case and of previous reports, it is suggested, so as to avoid such complications, that the unipolar electrocautery be avoided when the surgical field is near the pulse generator or lead: that the bipolar electrocautery be preferred; that a magnet and non-invasive programmer be available during and after surgery; and that a postoperative assessment of the pulse generator be carried out.

Aged↗
PubMed1995

Rollerball endometrial ablation.

Attempts at endometrial destruction to treat abnormal uterine bleeding unresponsive to medical therapy in women at risk to hysterectomy are not new. However, a practical and effective method was not introduced until the early 1980s, when the Nd:YAG laser was used through the hysteroscope for endometrial photocoagulation. Soon after, electrosurgery proved to be a good alternative for endometrial ablation, either by resection, coagulation, or both. Because of its relative simplicity, effectiveness, and low complication rate, the rollerball endometrial ablation has been attractive to physicians and patients alike as a good alternative to endometrial laser ablation. The overall results, particularly in properly selected patients who have been hormonally suppressed to thin the endometrium and permit good tissue penetration of the electrosurgical energy, have been most satisfactory.

Catheter Ablation↗
PubMed2001

Photodynamic therapy with topical delta-aminolaevulinic acid for the treatment of plantar warts.

Treatments currently employed for plantar warts are often painful (electrosurgery, cryotherapy) and not always effective (keratolytic agents). In this paper we investigate the effect of photodynamic therapy (PDT) with topical delta-aminolaevulinic acid (ALA) on plantar warts. In order to remove the superficial hyperkeratotic layer of the warts an ointment containing 10% urea and 10% salicylic acid was applied for 7 days. After gentle curettage, a cream containing 20% ALA was applied under an occlusive dressing for 5 h on 64 warts, while 57 warts (controls) received only the vehicle. Both the ALA-treated warts and the controls were irradiated using a visible light lamp (with a range of 400-700 nm, peaking at 630 nm). The light dose was 50 J/cm(2). Patients were followed-up for 22 months. Two months after the last irradiation session 48 (75.0%) out of 64 ALA-PDT treated warts had resolved. By contrast only 13 (22.8%) of the 57 control warts had done so. During the treatment a few patients complained of a mild burning sensation. The absorption of ALA by the verrucous tissue was demonstrated by in vivo fluorescence spectroscopy. This study shows that topical ALA-PDT can be an alternative treatment for plantar warts. Further studies will be necessary in order to optimize the concentration of ALA and duration of treatment.

Administration, Topical↗