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PubMed2001

Periodontal considerations in restorative and implant therapy.

The successful integration of periodontal and restorative dentistry for both natural teeth and implants requires knowledge and application of both mechanical and biological principles. In areas of aesthetic concern, an adequate band of attached gingiva can increase patient comfort, reduce the probability of gingival recession following tooth preparation and simplify restorative procedures. While some restorative margins need to be placed at or below the margin of the free gingiva, this should be considered to be a compromise, and margins should not be placed more than 0.5 mm into a healthy gingival sulcus. Approximately 2-3 mm of healthy, natural supra-alveolar tooth surface is needed for attachment of the gingival tissues to the tooth. This dimension is called the biological width. If adequate biological width does not exist, surgical or orthodontic procedures to expose healthy tooth structure are recommended before final restorations are placed. Retraction of soft tissues for impressions is best accomplished with mechanical methods rather than lasers or electrosurgery because of the potentially harmful effects of these devices to the cementum, bone and soft tissues surrounding the teeth. Implants function best and withstand occlusal forces optimally when loaded in a vertical direction. Therefore, planning implant placement is critical for success. Because of increased proprioception, it is suggested that natural teeth be used to guide the occlusion in partially edentulous patients. Cantilevers should be used with caution and with appropriate attention to occlusal forces. While occlusal trauma does not cause periodontal disease, it may contribute to bone loss around teeth and implants. In the opinion of the authors, provisional restorations are an integral part of dental and periodontal therapy. They can be used to establish aesthetic and physiological contours that can be easily cleaned by patients and they can also be used as a guide for any needed surgical tissue modification.

Crown Lengthening↗

PubMed2000

A history of dermatologic surgery in the United States.

BACKGROUND: Dermatologic surgery has a long and distinguished history in the United States. OBJECTIVE: To examine the specific contributions of American dermatologic surgeons. METHOD: The medical literature on cutaneous reconstructive and cosmetic surgery for the last century and a half was researched. RESULTS: Numerous American dermatologic surgeons have had a major impact on scientific and technological discoveries in cutaneous surgery. Dermatologic surgeons have been significantly involved in cutaneous surgery since the second half of the 19th century. Dermatologic surgeons have contributed many important advances to the fields of chemical peeling, cryosurgery, dermabrasion, electrosurgery, hair transplantation, soft tissue augmentation, tumescent liposuction, laser surgery, phlebology, Mohs chemosurgery, cutaneous reconstruction, wound healing, botulium toxin, blepharoplasty, and rhytidectomy. CONCLUSION: Dermatologic surgeons in the United States have contributed significantly to the history of reconstructive and cosmetic surgery. Dermatologic surgeons have been leaders in advancing this field and are poised to continue in the future.

Dermatology↗

PubMedDate not supplied

Use of electrocautery probes in arthroscopic removal of apical sesamoid fracture fragments in 18 Standardbred horses.

OBJECTIVE: To develop a technique for arthroscopic excision of apical sesamoid fracture fragments using electrocautery probes. ANIMALS OR SAMPLE POPULATION: A total of 18 Standardbred horses. METHODS: Arthroscopic removal of apical sesamoid fracture fragments using both hook and loop electrocautery probes was performed on 18 Standardbred horses. The fracture fragments were approached using either an ipsilateral (3) or contralateral (15) arthroscopic triangulation technique. Distension of the metacarpo- (metatarso)-phalangeal joints was achieved using a 1.5% glycine solution. Under arthroscopic guidance, both the suspensory and intersesamoidean ligament attachments to the abaxial and the axial margins of the apical fragment were transected using a hook electrocautery probe. Subsequently, the palmar (plantar) soft tissue attachments to the apical fragment were transected with a loop electrocautery probe. Once freed of soft tissue attachments, the apical fragment was removed with Ferris-Smith intervertebral disc rongeur. The arthroscopic portals were closed in a routine manner. RESULTS: Horse ages ranged from 2 to 8 years (median, 2.5 years). Eighteen apical sesamoid fracture fragments were removed from the left (8) and right (8) hind limbs and the left (1) and right (1) forelimbs. Apical fragments occured in 15 lateral and 3 medial proximal sesamoid bones. No major complications occurred during or after surgery. The electrocautery probes permitted an easy and precise dissection of all soft tissue attachments to the apical sesamoid fracture fragments in all horses. Follow-up time was 7 to 44 months (median, 26 months); 10 of 14 horses returned to racing. Seven of nine horses that raced before surgery raced again and three of five that had not raced before surgery, raced afterwards. CONCLUSION: Arthroscopic excision of apical sesamoid fracture fragments can be accomplished arthroscopically using electrocautery probes. CLINICAL RELEVANCE: Arthroscopic electrosurgery is an efficient and safe alternative for intra-articular dissection in horses.

Animals↗

PubMed1986

[Electrosurgical radical operation of vulvar cancer with postoperative irradiation of the inguinal lymph nodes].

Clinical data on 607 patients with invasive squamous cell carcinoma of the vulva seen between 1952-1980 are reported. All of these patients were eligible for 5-year evaluation. The crude survival for these patients was 60.3%, and the cleaned 5-year survival for 530 patients was 69% (stage I [n = 158]: 87.3%, stage II [n = 118]: 83%, stage III [n = 182]: 66.5%, stage IV [n = 72]: 12.5%). A series of 141 patients with vulvar squamous cell carcinoma was analysed with regard to treatment of the inguinal lymph nodes. Crude survival for N0-N1 patients was 67%, for N2-N3 cases 43%. All patients were treated with radical vulvectomy using warm knife and open wound technique. Treatment of the regional lymph nodes was performed by irradiation alone. This simple surgical technique in combination with radiotherapy applied only to the inguinal lymph nodes gives an excellent result without complications associated with aggressive surgery. Lymph node dissection was performed in 5% of cases only, if lymph nodes were more than 2 cm. The combination therapy of electrosurgery and irradiation of the inguinal lymph nodes and renunciation of groin dissection gave rise to few complications only. This factor must be interpreted as very important, in particular since our 5-year survival rate compared with other reports was not low and the median age of our patients was very high.

Aged↗

PubMed2003

Safety of the laparoscopy setup.

The safety of the laparoscopy setup is an important issue to guarantee continuous quality of laparoscopic interventions. Important issues are visualization, the insufflator and especially electrosurgery. Appropriate training of the OR personnel and clear responsibilities should be defined. Checklists are advised.

Journal Article↗

PubMed1999

Gastrointestinal injuries during gynaecological laparoscopy.

A retrospective case review study was carried out on gastrointestinal injuries which occur during gynaecological laparoscopy. Fifty-six patients with 62 gastrointestinal injuries were identified. One-third of the complications (32.2%) occurred during the installation phase for laparoscopy. Four of the six complications attributed to electrosurgery were secondary to the use of monopolar coagulation. Diagnosis of these gastrointestinal injuries was made during surgery in only 20 patients (35.7%). The mean time before diagnosis was 4.0 +/- 5.4 (range 0-23) days. Treatment of these complications was performed by laparoscopic surgery in 16.1% of cases. Prevention relies on the surgeon's experience, strict observance of the safety rules, perfect familiarity with the physical properties of the instruments used, systematic use of bowel preparation for patients presenting a risk of bowel complications, systematic supervision of the route taken by the trocars, meticulous inspection on completion of surgery of all areas where bowel adhesiolysis has been used and, in case of any doubt, tests for leakage involving the rectosigmoid. For patients with a risk of bowel complications, the creation of a pneumoperitoneum and performing a mini laparoscopy in the left hypochondrium can be the judicious option.

Adult↗

PubMed1999

Adhesion preventive effect of hyaluronic acid after intraperitoneal surgery in mice.

Prevention of intraperitoneal adhesion after gynaecological surgery is essential for maintaining postoperative fertility. In this study, the adhesion prevention effect was examined of a hyaluronic acid (HA) solution obtained from the fermentation method and having a molecular weight of 1.9x10(6) with high viscosity. Laparotomy was conducted on female mice 7 weeks old, whose menstrual periods were synchronized by pregnant mare serum gonadotrophin (PMSG) to injure the uterine horn surface. Intraperitoneal adhesions were favourably formed in 91.7% of cases induced with iodine abrasion, compared with 50% induced by electrosurgery. Intraperitoneal administration of HA was evaluated for its effect on the prevention of adhesions made by iodine abrasion. Adhesion prevention effects of HA were observed at concentrations of 0.3, 0.5, 0.75 and 1.0%, among which the most pronounced effect was with the use of a 0.3% solution (92.3% of cases). Compared with the control group adhesion score of 2.0 +/- 0. 8, significant decreases in adhesion scores were observed at all concentrations. HA with a molecular weight of 1.9x10(6) was recognized to have a definitive prevention effect on postoperative adhesions in mice after laparotomy and is considered to be a prospective material for future clinical use.

Animals↗

PubMedDate not supplied

Complications of laparoscopic pelvic surgery: recognition, management and prevention.

Laparoscopic surgery has many advantages but it is not without complications. The complexity of the surgery significantly influences the complication rate. Laparoscopic surgeons ought to be aware of the possible complications and how they could be prevented, recognized without delay, and managed safely and efficiently. Important complications include injuries to the vessels, bowel and urinary tract. Incisional hernia ought to be reduced by careful closure of the fascia whenever a trocar > or =10 mm is used at the extraumbilical site. Gas embolism is a rare but potentially life threatening complication. Shoulder pain is a minor complication but is exceedingly common; it is less likely to occur if as much gas as possible is removed at the end of the operation while the patient is still in head down Trendelenburg position. Rare complications include pneumothorax, subcutaneous and pre-peritoneal emphysema, cardiac arrhythmia, nerve injury and venous thrombosis. Laparoscopic surgeons should also understand the principles of electrosurgery and how to avoid complications arising from the use of electrical energy including capacitative coupling, direct coupling and insulation failure.

Blood Vessels↗

PubMed1988

Cervical surgery in infertility.

We wish to stress three original techniques among the numerous operations which can be performed on the uterine cervix for the treatment of infertility. The first treatment is for cervical dysplasia of the cervix, a conization performed by electrosurgery under local anaesthesia, using a metallic handle of 23 mm, associated with vaporization by a CO2 laser at the edges of the resection. This technique, used for 125 patients, has permitted adequate resection. The rate of incomplete resection is less than 10%. This method has preserved the possibility of pregnancies without abortion. The second technique is the surgical repair of a large post-obstetrical split of the cervix by an abdominal exposure. After dissection of the bladder, the vagina is opened longitudinally, the cervix exposed and repaired carefully. Four patients who had previously had four to six abortions between 4 and 6 months of gestation, succeeded in achieving a full-term pregnancy by this technique. The third technique is the resection of the isthmic septum by microscissors or micro-electrocautery under local or general anaesthesia by hysteroscopy. Twelve cases, five with primary infertility, seven with second infertility and habitual abortions, were operated on by this technique in 1986-87. Four pregnancies have resulted.

Adult↗

PubMed1991

Endometrial ablation to control excessive uterine bleeding.

The use of surgical techniques is described for the management of dysfunctional uterine bleeding by endometrial ablation as alternatives to hysterectomy. Current approaches include the neodymium yttrium aluminium garnet (Nd:YAG) laser and resection by electrosurgery using a ball-end electrode. Of 484 patients treated since 1985, 361 (74%) became amenorrhoeic with only occasional spotting 68 (14%) reported satisfactory results with 55 (12%) reporting an unsatisfactory outcome.

Electrocoagulation↗

PubMed2001

Radiofrequency transmission to monitoring devices in the operating room: a simulation study.

We evaluated radiofrequency (RF) transmission to various monitoring devices using circuits that simulated potentially hazardous conditions for patients in the operating room. Right heart ejection fraction (REF) pulmonary artery catheters, transesophageal atrial pacing stethoscopes, and temperature-sensing esophageal stethoscopes were subjected to RF transmission from an electrosurgery unit. Peak voltage and spark intensity were measured in circuits between the electrocautery dispersive pad and conductive elements of the various medical devices. All monitoring devices with an exposed conductive surface were found to have induced voltages and even spark generation. The ranking for peak voltage from least to most was as follows: disrupted esophageal stethoscope (620 volts), the transesophageal pacemaker (640 volts), and the REF pulmonary artery catheter (PAC) (680 volts). Peak voltage measurements of the REF PAC significantly decreased from 388 +/- 23 to 142 +/- 22 volts (P < 0.0001, Student's t-tests) in a fluid medium compared to air. In a fluid medium, peak voltage significantly decreased from 142 +/- 22 to 85 +/- 15 volts (P < 0.0001, Student's t-tests) when the REF PAC was connected to the cardiopulmonary monitor.

Humans↗

PubMed1984

Gastrointestinal neurofibromatosis.

Progressive anemia, melena, and sudden massive upper gastrointestinal bleeding in a man with cutaneous neurofibromatosis (von Recklinghausen's disease) since childhood prompted endoscopic demonstration of multiple gastric neurofibromas. One source of gastric bleeding removed by endoscopic electrosurgery proved to be a malignant schwannoma (spindle cell sarcoma). A pulmonary schwannoma, multifocal intracerebral spindle cell sarcomas, an extra-adrenal pheochromocytoma, and ocular neurofibromas were other features of this neuroectodermal dysplasia. Neurogenic tumors of the gastrointestinal tract are rare, commonly present with dyspepsia, abdominal pain, anemia, or hemorrhage, and should be suspect in the clinical setting of cutaneous neurofibromatosis. In the patient with systemic neurofibromatosis, endoscopic removal represents a safe method of diagnosis and treatment of bleeding neoplasms in the stomach or duodenum.

Adrenal Gland Neoplasms↗

PubMed2001

Long-term results of inferior turbinate reduction with argon plasma coagulation.

OBJECTIVES: Surgical reduction of the inferior turbinates is a commonly used therapy in patients with hyperplastic inferior turbinates when medical management remains ineffective. Current surgical methods have disadvantages (e.g., necessity of nasal packing, extended postoperative swelling, and high costs). Theoretical considerations render argon plasma coagulation (APC) a promising new therapeutic approach. STUDY DESIGN: In a prospective study, 121 patients with chronic nasal obstruction were treated for inferior turbinate reduction with APC. Hyperplasia of the nasal turbinates was diagnosed rhinoscopically and endoscopically and confirmed rhinomanometrically. The mean follow-up period was 12 months, ranging from 10 to 16 months. The treatment results were evaluated by a questionnaire, rhinomanometric findings, and electron microscopic studies of the nasal mucosa. In 50 patients a ciliary function test was performed preoperatively and postoperatively. METHODS: Argon plasma coagulation, a high-frequency electrosurgery, has been used for volume reduction of the inferior turbinate in local anesthesia. RESULTS: Seventy-six percent of the patients reported an improvement of the postoperative swelling within the first week. After 6 weeks, macroscopically the turbinates were re-epithelialized by normal mucosa in 63% of the patients. Electron microscopic studies after 3 months verified normal cilia. After 12 months, 83% of the patients stated that they had a better nasal airflow than preoperatively. Crust formation was minimal. No bleeding or impaired ciliary function occurred. Ninety-five percent of the patients were willing to undergo the same operation again. CONCLUSION: The long-term results have proved APC to be an effective and easy-to-perform alternative for inferior turbinate reduction with comparable results to other established surgical methods.

Adolescent↗

PubMed2002

Argon plasma coagulation (APC) in palliative surgery of head and neck malignancies.

OBJECTIVES: Surgical reduction of bulky disease is an important treatment option in patients with incurable head and neck malignancies. In general, conventional tumor ablation is associated with significant hemorrhage, and the resulting tumorous wound surface entails aftercare problems. Argon plasma coagulation (APC) represents a novel technique providing effective hemostasis and wound sealing. Thus, APC features requirements of particular interest in palliative surgery of the head and neck. STUDY DESIGN: Using APC, we performed 18 palliative tumor resections in a series of 8 consecutive patients with recurrent head and neck lesions. Five patients received repeated APC treatment up to five times. METHODS: APC as non-contact, high-frequency electrosurgery under inert argon plasma atmosphere allows dissection, hemostasis, and desiccation of tumor tissue in a one-step procedure. In consideration of the limited and heterogeneous group of patients, results are interpreted descriptively. RESULTS: In every case of palliative surgery, APC caused efficient hemostasis, which helped significantly to reduce both time exposure of the operation and intraoperative loss of blood. Only one APC-unrelated complication occurred (transient rhino-liquorrhea), and none of the patients developed postoperative hemorrhage. Finally, APC produced dry and clean wound surfaces facilitating surgical aftercare. The achieved esthetic and functional improvements strengthened the patient's autonomy and social acceptance. CONCLUSION: APC is highly recommended for palliative surgery of head and neck malignancies.

Adolescent↗

PubMed1998

Minimally invasive treatment for benign prostatic hyperplasia.

The armamentarium of minimally invasive treatment modalities for patients with benign prostatic hyperplasia has constantly increased during the past decade. The energy sources used range from micro-/radiofrequency waves to high-intensity focused ultrasound, laser vaporization/coagulation/resection and electrosurgical techniques. Each of these devices has its particular advantages and disadvantages. At present, the most intensively studied techniques are interstitial laser coagulation, holmium laser resection and new approaches to transurethral electrosurgery.

Journal Article↗

PubMed2006

Assessment of new technology in the treatment of idiopathic menorrhagia and uterine leiomyomata.

New technologies available for the treatment of idiopathic menorrhagia include five global endometrial ablation devices that use differing ablative methods, including thermal balloon, circulated hot fluid, cryotherapy, radiofrequency electrosurgery, and microwave energy. All have been compared with rollerball endometrial ablation by way of randomized clinical trials and are associated with high patient satisfaction rates, regardless of method, but a wide range of amenorrhea rates (13.9-55.3%). They are associated with low complication rates when performed by well-trained physicians following protocols in Food and Drug Administration trials. Some serious complications have been reported subsequently. Strict adherence to patient selection criteria and manufacturer protocols is strongly recommended. New technologies for the treatment of uterine leiomyomata include uterine artery embolization, magnetic resonance-guided focused ultrasonography, laparoscopic uterine artery occlusion, and cryomyolysis. There is sound evidence for shorter hospital stay, quicker return to work, and a similar major complication rate compared with hysterectomy. Uterine artery embolization appears to be effective for up to 5 years in reducing bulk symptoms and menorrhagia associated with leiomyomata. The chance of reoperation for leiomyoma-related symptoms within 5 years is 20-29%. Women who wish to become pregnant should be cautioned about potential complications during pregnancy. There is insufficient evidence to recommend uterine artery embolization in postmenopausal women. With regard to magnetic resonance-guided focused ultrasonography, cryomyolysis, and laparoscopic uterine artery occlusion, although the initial symptom reduction outcomes have been reported as favorable, more data are needed to better understand the durability of these results.

Catheter Ablation↗

PubMed2005

Treatment of multiple apocrine hidrocystomas with trichloroacetic acid.

The apocrine hidrocystoma is a benign adenomatous cystic proliferation derived from apocrine glands, which frequently occurs in periocular tissues. These cystadenomas may occur bilaterally, in multiple disfiguring confluent groups on both the upper and lower lids. Although these lesions have been treated successfully with meticulous surgical extirpation and electrosurgery, this report describes the successful treatment of two patients, each with multiple large (>7 mm) periocular apocrine hidrocystomas by either chemical ablation of the cystic epithelium with trichloroacetic acid (TCA) or surgical excision. Examination of the cysts at 1, 3, and 6 months after TCA treatment revealed well-healed lesions without cyst recurrence. Most of the TCA-treated cysts resolved completely, without leaving any trace to clinical examination. Treatment of cysts with TCA was technically simpler and much less time-consuming than surgical excision. The treatment of large apocrine hidrocystomas with TCA is an effective and expeditious method of treating these disfiguring and recalcitrant lesions.

Aged↗

PubMed1993

Electrical nerve and muscle stimulation by radio frequency surgery: role of direct current loops around the active electrode.

Tissue cutting by electrosurgery is often accompanied with stimulation of nerves and muscles, despite the high frequency of the alternating current being applied. The main source of this stimulation is thought to be the generation of low frequency current by the nonlinear sparking process. However, measurement of this low-frequency current, in the generator electrode's circuit, showed relatively small values, barely sufficient to support this hypothesis. In this study more powerful low frequency current could be identified, indeed also originating from the nonlinear sparking process. Local direct and low frequency currents, at a level of tens of milliamperes, appeared to be generated between different sites of the active electrode-tissue interface. Probably these local currents have not been noticed before as they cannot be detected in the outer chain of generator, electrodes, and connecting wires. This finding may explain why most measures, intended to prevent stimulation by modifying this outer chain, had only limited success.

Catheter Ablation↗