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PubMed1991

Potential errors in pulse oximetry. III: Effects of interferences, dyes, dyshaemoglobins and other pigments.

Electrosurgery, patient motion and some types of lighting can cause errors in saturation readout; it is recommended that probes should be shielded from ambient lighting. Intravenous dyes can introduce gross but transient errors, which may also be present in in vitro measurements. Carboxyhaemoglobin causes overestimation of fractional saturation by an amount less than, but possibly close to, the percent of carboxyhaemoglobin present. Methaemoglobin causes the pulse oximeter readout to tend towards 85%. Fetal haemoglobin and bilirubin introduce no significant error, although they may interfere with in vitro measurements. Skin pigmentation can result in a slight decrease in accuracy. Nail polish may cause up to 6% underestimation of saturation; it is recommended that probes should be mounted sideways on fingers with nail polish or long nails. Adhesive tape or a vinyl glove across the probe has no demonstrable effect on accuracy. A blood sample should be analysed by a multiwavelength in vitro oximeter when an erroneous pulse oximeter reading is suspected, although errors may be introduced in the in vitro reading by fetal haemoglobin, bilirubin and intravenous dyes.

Coloring Agents↗

PubMed2006

Complications and myoma recurrence after laparoscopic uterine artery occlusion for symptomatic myomas.

AIM: To determine the frequency and severity of complications and the recurrence of fibroids as a result of laparoscopic occlusion of the uterine artery (LOUA) in women with symptomatic fibroids. METHODS: One hundred and fourteen women with symptomatic fibroids were treated using ultrasonically activated shears, clips or electrosurgery. A retrospective evaluation of the complications and recurrence rate was carried out. For each patient, the analysis took place at least 3 months after the procedure was performed. Each complication was categorized using the complication classifications developed by the Czech Society of Gynecologic Endoscopy and a modified set of the classifications of the American College of Obstetricians and Gynecologists. All adverse events that occurred during the follow-up period were included, in addition to those that occurred after the 3 months minimum interval. RESULTS: A total of eight women (7.1%, 95% confidence intervals [CI], 3.3-14.4) experienced complications; one of these women had two complications, resulting in a total of nine adverse events. There were no intraoperative complications and no permanent injuries. Two women required supracervical hysterectomy and myomectomy, respectively, as a result of fibroid necrosis. One patient had an undiagnosed endometrial stromal sarcoma after 12 months of LOUA. The rate of fibroid recurrence was 9.0% (10 patients). The recurrence-free survival interval rate (no clinical failure, no recurrence) at 23.6 months (median) follow-up was 88.3% (CI 84.9-93.5). CONCLUSION: The rate of complications and fibroid recurrence was low in patients undergoing LOUA.

Adult↗

PubMed1996

A prospective study to evaluate oophorectomy at the time of vaginal hysterectomy.

OBJECTIVE: To assess the feasibility and safety of vaginal removal of ovaries at the time of vaginal hysterectomy. DESIGN: Prospective study. SETTING: London teaching hospital. POPULATION: Between March 1993 and March 1995, 40 women were admitted under the care of one consultant for vaginal hysterectomy and bilateral oophorectomy. METHODS: The success rate of removing the ovaries vaginally was calculated and the operative time, blood loss, intra- and post-operative complications and patient recovery were analysed and compared with 48 patients who had a vaginal hysterectomy but retained their ovaries during the same time period. RESULTS: Thirty-nine (97.5%) of the 40 women due to undergo removal of the ovaries were managed successfully via the vaginal route; one woman required laparoscopic removal of one of her ovaries containing an ovarian cyst which was not diagnosed pre-operatively. A variety of techniques were used for vaginal oophorectomy which included salpingo-oophorectomy, oophorectomy without salpingectomy, and transvaginal endoscopic oophorectomy utilising endoloop sutures or bipolar electrosurgery. Oophorectomy added a mean of 23.4 min (88.3 vs 64.9 min, 95% CI 10.2-36.7, P < 0.001) to the total operating time compared with vaginal hysterectomy alone. No laparotomies were required, and both the complication rate and post-operative inpatient stay were similar for the two groups. CONCLUSIONS: The need to perform oophorectomy should not be considered a contraindication to vaginal hysterectomy.

Adult↗

PubMed2002

Laser treatment of rosacea.

Rosacea is a common condition often resulting in persistent erythema and telangiectasia as well as rhinophyma in a number of patients. Over the last two decades lasers have been increasingly used in the treatment of these permanent changes. The literature is reviewed in terms of the different laser systems, side-effects and comparison with other surgical techniques. Laser studies on rosacea-associated telangiectasia and erythema are limited. Copper-bromide, krypton and KTP lasers have been used with good to excellent results. However, the most commonly applied system is the flash lamp-pumped pulsed dye laser. Rhinophyma can be treated with a variety of different surgical methods, including laser resurfacing. CO(2) lasers are the most widely used lasers, others are the Er:YAG and Nd:YAG lasers. Cosmetic end results are comparable to partial excision with a scalpel or electrosurgery. There does not appear to be an increased risk of infection or scarring, but the conventional surgical methods are quicker to perform and more cost effective.

Humans↗

PubMed1993

Treatment of facial telangiectasia with sclerotherapy, laser surgery, and/or electrodesiccation: a review.

BACKGROUND: Facial telangiectasia is extremely common in patients with fair complexion. Electrosurgery has been the primary form of treatment in the past. OBJECTIVES: The authors retrospectively evaluated over 300 patients treated with sclerotherapy for facial telangiectasias. METHODS: Retrospective analysis of over 300 patients with facial telangiectasia treated with sclerotherapy and 55 facial spider telangiectasias treated with laser. RESULTS: Sclerotherapy utilizing hypertonic saline, Sclerodex, polidocanol, and sodium tetradecyl sulfate resulted in-between 50 and 100% resolution of facial telangiectasia with minimal complications. CONCLUSION: The treatment of facial telangiectasia should include sclerotherapy and laser treatment modalities, which effect a higher rate of clearance with less adverse sequela.

Adolescent↗

PubMed1994

Treatment of common warts using the infrared coagulator.

BACKGROUND: The infrared coagulator (IRC) is an instrument that delivers a narrow beam of noncoherent infrared light to the skin surface. OBJECTIVE: The purpose of the study was to determine the utility of the infrared coagulator in treating common warts of the hands and feet. METHODS: Forty-four warts in 21 patients were treated with 1.25-second pulse durations. Thirty-one of the warts were recurrent after previous electrosurgery or cryosurgery. Average follow-up time was 11 months. RESULTS: Overall, 25 warts (57%) resolved after one treatment, 6 warts (14%) regressed and cleared with additional treatment, and 13 warts (30%) recurred, giving an overall cure rate of 70%. Eleven of the 21 patients (52%) were cleared of all their treated warts. CONCLUSION: The IRC is a useful therapeutic modality for common warts.

Adolescent↗

PubMed2005

Excision of malignant melanoma overlying a pacemaker.

BACKGROUND: With the increasing number of patients with implantable cardiac devices, dermatologic surgeons must be increasingly familiar with the types of devices and potential interference by surgical procedures. OBSERVATIONS: We report the excision of a 1 cm malignant melanoma in situ occurring on the skin directly overlying the patient's pacemaker. CONCLUSIONS: Successful excision of malignant lesions in the setting of implantable cardiac devices requires an understanding of pacemaker implantation anatomy following well-established guidelines for electrosurgery in the setting of implantable cardiac devices and careful coordination with cardiac and anesthesia specialists.

Aged↗

PubMed2006

Optimization of thermocautery in excisional dermatologic surgery.

PURPOSE: Electrosurgery is routinely used in cutaneous surgery for hemostasis. Thermocautery can be used in patients with implantable cardiac devices. This technique relies on heat without electrical current passing through the patient to produce hemostasis. The temperatures and utility of a commercially available, adjustable thermocautery unit are examined. METHODOLOGY: Tip temperature of the commercially available thermocautery unit was measured in air and tissue via a type E thermocouple (0.002 in. diameter) around the unit's tip. Time intervals of 20 to 30 seconds were recorded at device settings 1 to 9 in air and 3 to 8 on surgical patients (Institutional Review Board approval obtained). RESULTS: In vitro analysis demonstrated predictable temperatures at increasing settings in air: 350 to 900 degrees C. Analysis in vivo during surgery demonstrated similar findings. Tissue contact decreased tip temperature by approximately 50% from in vitro values, and use in a bloody field caused a further decrease in the tip temperature. CONCLUSION: The thermocautery unit examined is an effective and safe unit to achieve hemostasis. In addition, the temperature may be adjusted as opposed to hand-held units that operate at in vitro temperatures exceeding 1,400 degrees F. Hemostasis at approximately 100 to 400 degrees C provided optimal hemostasis.

Adolescent↗

PubMedDate not supplied

Arthroscopic removal of axial osteochondral fragments of the proximoplantar aspect of the proximal phalanx using electrocautery probes in 23 standardbred racehorses.

OBJECTIVES: To describe the outcome after arthroscopic electrosurgical excision of axial osteochondral (OC) fragments of the proximal plantar aspect of the 1st phalanx (P1) in horses. STUDY DESIGN: Retrospective study. POPULATION: Twenty-three Standardbred racehorses. METHODS: Medical records of Standardbred racehorses that had arthroscopic dissection of axial OC fragments of the proximal plantar aspect of P1 with electrocautery probes were reviewed. Horses were positioned in dorsal recumbency; a 1.5% glycine solution was used to maintain joint distension. The arthroscope portal was in the proximal plantar joint pouch and OC fragments were approached using either an ipsilateral or a contralateral triangulation technique. Dissection of the fibrous attachments was performed using loop and hook electrocautery probes. Follow-up was obtained by telephone questionnaire of owners or trainers and examination of race summary records. RESULTS: Thirty-three axial OC fragments were removed from 28 metatarsophalangeal joints (left, 14; right, 14). No major operative or postoperative complications occurred. Seven of 8 (79%) of horses that raced before surgery raced after surgery. Thirty-six percent (n=4) of horses that had not raced before surgery raced after surgery. CONCLUSION: Intra-articular electrosurgery is a safe, easy alternative to conventional excision of axial OC fragments of the proximal plantar aspect of P1. CLINICAL RELEVANCE: Arthroscopic excision using electrocautery probes is a valid alternate method for removal of axial OC fragments of the proximal plantar aspect of P1. In addition, the dorsal recumbency position facilitates removal of several fragments and multiple joint surgery.

Animals↗

PubMedDate not supplied

Laser fenestration of the mesial septum for treatment of guttural pouch chondroids in a pony.

OBJECTIVE: To describe removal of guttural pouch chondroids through a laser fenestrated mesial septum in a pony with an obstructed pharyngeal ostium of the left guttural pouch. STUDY DESIGN: Case report. ANIMALS: Pony. METHODS: Transendoscopic laser neodymium:yttrium aluminum garnet (Nd:YAG) fenestration of the mesial guttural pouch septum was made by contact method (bare fiber, 15-25 W, exposure time 4 seconds). Dissected tissue was removed by transendoscopic monopolar electrosurgery (loop electrode, cutting blade) and multiple chondroids of varying size were removed from the left guttural pouch through the fenestration. RESULTS: After removing all chondroids and repeated flushing of the left guttural pouch via the right side, inflammation of the guttural pouch membranes decreased remarkably. The pony was discharged with instructions for transendoscopic lavage once weekly and was reevaluated at 2 months. A permanent septal fenestration was observed and the pony was free of abnormal clinical signs and being used for carriage driving competitions. CONCLUSION: Nd:YAG laser fenestration of the mesial septum is an approach for access to guttural pouch chondroids. CLINICAL RELEVANCE: When guttural pouch empyema and/or chondroids is associated with adhesion of the pharyngeal ostium, laser fenestration of the mesial septum from the opposite guttural pouch should be considered as an alternative approach for access, rather than classic external surgical approaches.

Animals↗

PubMed2005

[Controlled layered removal of anogenital warts by argon-plasma coagulation].

BACKGROUND: According to guidelines of the German STD Association, appropriate treatment of extensive anogenital warts with comparable recurrence rates includes cryotherapy, surgical excision, electrosurgery, CO2- and Nd:YAG-laser vaporisation. All these procedures are associated with varying degrees of risk for bleeding, release of potentially infectious aerosol, deep thermal destruction, slow wound healing, and scarring. METHODS: Using argon-plasma coagulation anogenital warts can be removed in layers in a controlled manner. High frequency current flows through the argon plasma to the tissue, allowing well-controlled, superficial tissue destruction. RESULTS: From January 2001 to March 2003, 54 patients with extensive genital, anal or anogenital warts were treated. After one treatment, 66% of the pa- tients remained disease-free in the following 4 months. Thirteen patients (24%) showed early recurrence after 4 weeks, five patients (9%) at a later date. In these patients, further treatment, in 9 cases combined with topical imiquimod cream, were necessary for complete remission. CONCLUSION: Compared to other therapeutic procedures, argon-plasma coagulation is a better controlled, quick and low-risk option for the treatment of anogenital warts. Depending on the type of involvement and individual risk factors, postoperative treatment with topical imiquimod cream may be useful.

Adult↗

PubMed1994

Surgical diathermy is not suitable for vascular tissue welding.

The possibility of using radiofrequency energy (RFE) to produce a sutureless anastomosis is attractive both to the military surgeon and on the grounds of cost and simplicity. To investigate this, fresh rabbit aorta was divided lengthways into 4 mm strips and apposed, intima-to-itima. A Valleylab Force 30 Electrosurgery machine supplied RFE at 500 kHz. The energy was applied using standard bipolar forceps and 121 attempts were made to weld the tissue. Seventy seven welds resulted of which 36 were able to withstand a distraction force of greater than 0.1N: the strongest weld was disrupted at 0.35N. Intact tissue withstood a distraction force of greater than 2N, whilst sutured joints disrupted at 0.97 N. It is concluded therefore that radiofrequency energy at 500 kHz does not satisfactorily weld vascular tissue.

Anastomosis, Surgical↗

PubMed1985

Clinical application of in vitro studies for barium-enema examination following colorectal biopsy.

A total of 150 colorectal biopsies were performed in 71 patients and correlated with the barium-enema examination (BE). The investigation was divided into two parts. In the first part, involving 19 patients, the depth of each biopsy specimen was determined histologically prior to BE and potential complications related to the biopsy-BE sequence were evaluated. In the second part, involving all 71 patients, the depth of biopsy specimens taken from various colon lesions was determined histologically without regard to the timing of BE. The results confirm previous in vitro findings in pigs and dogs, namely: (a) BE may be performed without delay following a superficial biopsy, but should not be performed until at least 6 days after a deep biopsy; (b) transcolonoscopic biopsies are likely to be superficial, while transproctoscopic biopsies have the potential to be deep; and (c) BE should be delayed at least 6 days following polypectomy or polyp biopsy performed with electrosurgery.

Barium Sulfate↗

PubMed2002

CO(2) laser surgery for extensive, cauliflower-like anogenital condylomata acuminata: retrospective long-term study on 19 HIV-positive and 45 HIV-negative men.

BACKGROUND: Extensive 'cauliflower-like' condyloma acuminatum (CA) in males is commonly treated with CO(2) laser surgery or with electrosurgery. Studies on the long-term outcome in this specific situation are scarce. OBJECTIVES: To determine the cure and recurrence rate in relation to the HIV status and endoanal location of lesions. To determine the complication rate and patient satisfaction. METHODS: Questionnaire-based retrospective long-term study on 64 consecutive men (answer rate 60% or 64/107 addressed persons). The mean follow-up was 25 months (range 7-75). RESULTS: The overall cure rate after 1 intervention was 67%. The cure rate in HIV-positive versus HIV-negative patients was 58 versus 71% (odds ratio = 1.79; p = 0.38). Endoanal versus perianal location was associated with a cure rate of 56 versus 84% (odds ratio = 4.06; p = 0.03). After a second treatment session, the cure rate increased to 79% or higher in all subgroups. Painful defecation for an average of 4-5 weeks was the main postoperative complaint. Severe complications were not seen or reported. CONCLUSIONS: The CO(2) laser is a valuable and safe treatment to debulk extensive 'cauliflower- like' anogenital CA in males. The healing rate in HIV-positive patients is not significantly lower than in HIV-negative patients. Endoanal location of lesions is a risk factor for recurrence.

Adolescent↗

PubMed1984

Catheter ablation of the atrioventricular junction: a report of the percutaneous mapping and ablation registry.

An international registry was formed to collate data for patients undergoing attempted catheter ablation of the atrioventricular (AV) junction and insertion of a permanent pacemaker. Over the past 2 years, data was submitted for 127 patients who were followed for a mean of 9.9 +/- 8.2 months. The most common arrhythmia treated was chronic or paroxysmal atrial fibrillation or flutter (78 patients, 61%); the remainder had supraventricular tachycardia due to AV node reentry, ectopic atrial tachycardia, or incorporated an accessory pathway. A single shock of 150 to 400 J was effective in producing chronic third-degree AV block in 45 patients while two or more shocks were used in an additional 45 patients. There was no significant difference in the total cumulative energy used in successful and unsuccessful procedures. Immediate complications related to the shock included ventricular fibrillation (one patient), pericardial tamponade (one patient), and transient hypotension (one patient). No chronic sequelae occurred as a result of these complications. Late complications (1 day to 1 month) included ventricular tachycardia (three patients), sepsis involving the pacemaker pocket (two patients), staphylococcal sepsis from temporary pacing catheter (one patient), thrombophlebitis (one patient), thrombosis of the left subclavian vein (one patient), and hemothorax (one patient). Follow-up evaluation revealed chronic third degree AV block in 90 (71%) and AV conduction resumed but no drugs were required for arrhythmia control in eight (6.5%) and arrhythmia control was achieved with previously ineffective drugs in 16 (13%). Thirteen patients (10%) had no improvement and five of these patients underwent cardiac electrosurgery for direct His bundle ablation.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Arrhythmia Agents↗

PubMed2005

The hyfrecator: a treatment for radiation induced telangiectasia in breast cancer patients.

Radiation induced telangiectasia is a common problem in breast cancer survivors. By interfering with choice of clothing and acting as an unpleasant visible reminder of their disease, it negatively affects quality of life. The hyfrecator, based on the principles of electrosurgery, is a standard treatment modality for facial telangiectasia. This study aims to demonstrate the efficacy and tolerability of the hyfrecator as a treatment for radiation induced telangiectasia. Patients with radiation induced telangiectasia of breast or chest wall were prospectively identified from the breast cancer follow up clinic and offered treatment with the hyfrecator (sessions at 8 weekly intervals). Pre- and post-treatment photographs were obtained in a standardized manner and two blinded physician observers evaluated response. A linear analogue scale (LAS) was used by the patients to evaluate treatment response and any discomfort. At the end of treatment, patients completed a quality of life questionnaire. Of 16 patients enrolled, 15 completed the study. Treatment benefited all patients with severe or marked telangiectasia. Complete disappearance of telangiectasia was achieved in the majority (88%) of patients by the end of treatment. A median of six sessions (range 3-9) was required. All but one (93%) considered the treatment worthwhile. The majority (69%) judged the treatment to be painless or only mildly painful. 73% reported an improvement in self-confidence. The treatment was well tolerated by all the patients. All patients showed a remarkable clearance of vessels with a high degree of satisfaction with the results. Treatment with the hyfrecator is very effective for radiation induced telangiectasia. Three to four sessions achieve a substantial objective and subjective reduction in telangiectasia with a concomitant improvement in quality of life. It is a cost effective, ambulant out patient procedure requiring no local anaesthesia.

Adult↗

PubMed1993

Cryosurgery in bronchoscopic treatment of tracheobronchial stenosis. Indications, limits, personal experience.

Cryosurgery is one of the techniques available for bronchoscopic treatment of malignant and nonmalignant tracheobronchial stenosis; other techniques are electrosurgery, laser therapy, and endobronchial brachytherapy. Our experience began in 1976 and includes more than 300 patients treated with bronchoscopic cryosurgery either for malignant (the majority) or for nonmalignant tracheobronchial lesions. This study was performed on 234 patients treated in the years 1979 to 1988 subdivided as follows: 183 malignant tumors, 44 benign tumors, and 7 tumors of uncertain prognosis (adeno). The study demonstrated satisfying results in both (palliative in the first case, almost radical in the second one). The aim of our work was to report our personal data and to compare advantages and limits of this technique to others.

Bronchial Diseases↗

PubMed1995

Comparison of wedge to forceps videothoracoscopic lung biopsy. Gross and histologic findings.

BACKGROUND: The decreased morbidity and rapid recovery after thoracoscopic lung biopsy compared with open lung biopsy by thoracotomy is increasingly recognized, as is the ability to obtain satisfactory diagnostic material thoracoscopically. To our knowledge, however, there has been no systematic comparison of specimen quality using different thoracoscopic biopsy techniques. The purpose of this study was to compare histologic features of lung parenchyma obtained by videothoracoscopic forceps and wedge biopsy techniques. METHODS: Five adult swine were anesthetized, intubated, and ventilated. Sequential left and right videothoracoscopies were performed to obtain biopsy specimens of lung parenchyma using 5-mm endoscopic cupped forceps. Specimens were obtained from fully inflated lung and from partially atelectatic (deflated) lung. Electrosurgery was applied during forceps biopsy for airleak closure. Limited wedge biopsy specimens were obtained using an endoscopic stapler. One hundred thirteen forceps biopsy specimens (55 inflated, 58 deflated) and 24 sections from 8 wedge biopsy specimens were examined. Specimens were assessed for overall histologic quality and ease of microscopic interpretation. Specific histologic features were then evaluated including presence of artifact, congestion and hemorrhage, degree of alveolar inflation, and number of bronchioles and vessels per cross-sectional area. Whole lungs from two animals were examined for extent and depth of lung injury at the areas of biopsy. RESULTS: No major differences in overall microscopic specimen quality were detected among the different techniques nor were significant differences noted between lung inflated and lung deflated forceps biopsy technique. Wedge sections contained more vessels per unit area (p < 0.001), perhaps reflecting the more peripheral nature of forceps biopsy. Small amounts of thermal or crush artifact were noted on the surface of forceps biopsy specimens, but did not affect overall specimen quality. CONCLUSIONS: Multiple 5-mm forceps biopsy specimens were of comparable quality to single wedge biopsy specimens obtained by endoscopic stapling. Although greater numbers of vessels were present in endoscopic stapled wedge biopsy specimens, multiple forceps biopsy specimens in fact, contain amply sufficient vessels for histologic analysis.

Animals↗