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PubMed2002

New electroablation technique following the first-line stapling method for thoracoscopic treatment of primary spontaneous pneumothorax.

STUDY OBJECTIVES: A new tip for the electroablation of pneumocysts was examined clinically as a second-line method for stapled resection of pneumocysts during video-assisted thoracoscopic surgery (VATS). DESIGN: A trial to assess feasibility. SETTINGS: National referral hospitals. PATIENTS: One hundred seven patients were studied, of whom 99 patients were eligible for the study (85 men and 14 women; age range, 15 to 69 years; median age, 23 years), who had undergone VATS for primary spontaneous pneumothorax between July 1996 and June 1998. Apical pneumocysts were resected employing staplers, and residual pneumocysts, if present, were electroablated employing a new tip for the electrosurgery unit (ball shape, 8 mm in diameter, and made of stainless steel). MEASUREMENTS AND RESULTS: Thirty-three patients (33%) underwent electroablation only for small (< 2 cm in diameter) pneumocysts (group S), and 11 patients (11%) underwent electroablation for large (>/= 2 cm in diameter) pneumocysts (group L). The remaining 55 patients (56%) did not undergo electroablation because there were no residual pneumocysts (group N). There were no complications during surgery. The duration of the operation was significantly shorter (about 20 min on average) for group N, but there was no significant difference in the amount of blood loss, the number of applied staples, the duration of drainage, and the duration of hospital stay. Group S achieved a 100% relapse-free rate (33 of 33 patients), group L achieved a 64% relapse-free rate (7 of 11 patients), and group N achieved an 89% relapse-free rate (49 of 55 patients) [group S vs group N, p = 0.08; group L vs group N, p = 0.001; and group S vs group L, p = 0.002]. CONCLUSION: Electroablation with the M-tip is feasible as a second-line method for the treatment of small pneumocysts following the stapling technique during VATS.

Adolescent↗

PubMed1984

Multiple papillary projections on the alveolar mucosa and palate.

A patient with inflammatory papillary hyperplasia of the palate and edentulous ridges was treated by electrosurgery. The clinical and microscopic appearance of inflammatory papillary hyperplasia is discussed as well as the causes, treatment, and prevention.

Alveolar Process↗

PubMed1987

Removal of benign intraoral masses using the CO2 laser.

Benign soft tissue lesions of the mouth can be removed using the CO2 laser. This type of laser surgery is faster and offers less postoperative complication as compared with conventional surgery and electrosurgery. Presently, the CO2 laser can be used for intraoral biopsy of benign masses, gingivectomies, and frenectomies.

Adult↗

PubMed1999

Conization of the cervix using harmonic scalpel.

Conization, as a surgical treatment for cervical intraepithelial neoplasm (CIN), is a good method that preserves reproductive functions. Technological developments have introduced a wide variety of energy sources for surgical procedures. Traditional cold knife conization has been replaced by laser conization and by the loop electrosurgical excisional procedure (LEEP). However, laser conization and LEEP have some disadvantages. Laser conization requires expensive equipment. LEEP induces electrocautery artifacts and cannot excise the cervical tissue as a single-piece, because of the various extensions and depths of lesion, so that evaluation of the margins is sometimes not possible. Laser conization and LEEP both generate smoke. The presence of smoke is not only inconvenient, but also dangerous. Harmonic Scalpel (HS), ultrasonic cutting and coagulation system, is a new surgical tool that cuts and coagulates using ultrasonic mechanical vibrations. Eleven women with CIN III underwent conization using HS. HS eliminated the major disadvantages of electrosurgery and laser surgery. No complications during conization were observed. Postoperative hemorrhage was noted in only one patient. Histological diagnosis was not affected by heat or ultrasound. This surgical method using HS is characterized by negligible bleeding, a good visual field not obscured by smoke and resection of an ideal shape that fits the size of the lesion. It is concluded that this method overcomes most problems associated with conization using conventional methods.

Adult↗

PubMed2005

Iatrogenic trauma to oral tissues.

BACKGROUND: Iatrogenic trauma can be defined as any trauma that has been induced by the dentist's activity, manner, or therapy. The aim of this article is to present traumatic oral tissue lesions of iatrogenic origin. METHODS: Thirteen cases of chemical (due to ferric sulfate and formocresol), physical (due to orthodontic wires and appliances), and thermal (due to electrosurgery) injuries to the oral tissues are reported. RESULTS: Chemical, physical, and thermal injuries in the oral, gingival, or palatinal mucosa of iatrogenic origin can exhibit various clinical features. The management of traumatic injuries is dependent on the severity of the involvement in the periodontal tissues. While, in most cases, the elimination of the offending agent and symptomatic therapy were sufficient, in severe cases, or when the injury resulted in permanent defects, periodontal surgery and regenerative therapy may be necessary. CONCLUSIONS: The skill, experience, and up-to-date knowledge of dentists are the main factors to prevent possible iatrogenic traumas. Although "To err is human," careful practice is very important for the principle "Primum non nocere" ("First do no harm").

Adult↗

PubMed1999

Ultrasonic energy in endoscopic surgery.

The Harmonic Scalpel made by Ultracision is a system for endoscopic cutting. The energy source is vibration. The power box is attached to a forceps or blade, and the vibrational frequency of the blade approaches 55,500 cycles/second. This causes a knife-like action of the blade through tissue, with enough heating to create coagulation of small vessels. When this vibration energy is applied to the forceps configuration, coagulation occurs. By rotating the bottom blade of the forceps, the instrument becomes like a pair of scissors, and the tissue can divide. The Harmonic Scalpel allows the operator to cut using a tactile tissue. No smoke is created, only microaromized water droplets which are rapidly absorbed by the peritoneak surface. The instrument is extremely safe in that only tissue which is touched is cut; the energy source cannot travel through air, such as can happen with electrosurgery and laser surgery.

Animals↗

PubMed1998

[Urolithiasis].

Epidemiologic investigation did not show any special environmental combination causing urinary calculi creation. The disease concerns usually people between 25-50 year old. Most of the urinary calculi are compound of calcium oxalate and phosphate. In contaminated urine more often ammonia-magnesium phosphate. General constitutional factors having influence on urinary stones creation are specific gravidity, crystallization inhibiting factors concentration, hypercalcuria, urine acidity, hyperoxaluria and urinary tract infection. Unilateral, single urine stone is usually the effect of the local factors. Bilateral and multiple urinary stones are usually the effect of the local factors. Bilateral and multiple urinary stones usually are the effect of general constitutional and environmental factors. Complaints depend on the stone localisation, its dimensions and period of the disease. Nowadays most of the urinary calculi localised in the kidneys and ureters are treated with ESWL, PCNL and URS. Staghorn calculi are treated with the combination of PCNL and ESWL or operatively. Urinary stones localised in the bladder can be the consequence of descending ureteral stones, but usually they are created in the bladder as a consequence of the subvesical obstruction. The treatment is based on transurethral lithotripsy with simultaneous obstruction treatment by electrosurgery of the prostate or bladder neck or visual urethrotomy. Large and hard stones can be removed by cysto-lithotomy. Metafilaxis is the recurrences prevention, based first of all on diminution of crystalloid concentration and their solubility in the urine and providing crystallization inhibiting factors. Calculi composed of urine acid can be treated conservatively by their dilution.

Adult↗

PubMed1998

Follow-up of a decentralized colposcopy program for the investigation and management of cervical intraepithelial neoplasia in the central Canadian Arctic.

Cervical intraepithelial neoplasia (CIN) is the second leading cause of cancer in Canadian Inuit women, and the incidence ratio in this population is 3.1 times the Canadian average. In 1993 a program was developed in a regional northern health center (Churchill) to provide colposcopy and loop electrosurgery for women in the Keewatin District of the central Canadian Arctic. Data collected prospectively over the following 2.5 years are presented. One hundred and forty-six women were seen in 341 visits. Indication for referral included CIN I on Pap smear (54.1%), CIN II (34.9%), CIN III (9.6%), and carcinoma of the cervix (1.4%). Large loop excision of the transformation zone was performed at a rate of 9.7 procedures per 100 patient visits. Estimated travel cost-savings attributable to this northern program are $299,200 (Canadian). Use of portable colposcopy in patients' home communities is presently being considered in order to provide enhanced accessibility and further cost-effectiveness.

Arctic Regions↗

PubMedDate not supplied

Is it safe to allow smoke in our operating room?

Researchers have shown that the plume produced during electrosurgery is twice as harmful as laser plume. The smoke produced by ESUs is not routinely evacuated and rises into the air to dissipate haphazardly. Smoke evacuators remove surgical smoke from the operating suite in an efficient and safe manner.

Air Pollution, Indoor↗

PubMed1999

[Perioperative hemorrhage associated with laparoscopic hysterectomy: retrospective study].

OBJECTIVE: To evaluate perioperative bleeding during laparoscopic hysterectomy. DESIGN: Retrospective clinical study. SETTING: Department Gynaecology and Obstetrics, Baby Friendly Hospital Kladno, Kladno, Czech Republic. METHODS: Clinical data and cases of perioperative complications and bleeding of patients after laparoscopic hysterectomy were summarized and assessed. The primary hemostatic treatment was electrosurgery. Patients were assessed to efficacy, safety, utility and applicability of vasoconstrictive and local hemostyptic agents. RESULTS: From all laparoscopic procedure were 97.6% successfully completed. There were of nine conversions (2.4%) and twenty-six (6.9%) of severe perioperative complications. The total number of perioperative bleeding was 16 (3.7%) from 376 laparoscopic hysterectomies. The mean order of blood loss was 201.6 ml (range 50-800 ml). CONCLUSION: Clinical retrospective study demonstrates that hemorrhage during and after laparoscopic hysterectomy is most perioperative complication. The laparoscopic approach to hysterectomy appears to be safe and is seen as a good, effective procedure for women with gynaecological conditions of female pelvis organs. Laparoscopic hysterectomy could potentially decrease morbidity historically associated with hysterectomy performed abdominally. Large prospective studies are needed to evaluate the surgical trauma and optimal number of perioperative complications. In conclusion, we think the oozing from the damage tissue during laparoscopic surgery can be successfully arrested and controlled using the laparoscope to apply of local hemostyptic agent.

Adult↗

PubMed2000

Reproductive outcome following hysteroscopic lysis of intrauterine adhesions: a result of 65 cases at Ramathibodi Hospital.

We reported the reproductive outcome of 65 patients with varying degrees of IUAs who underwent hysteroscopic adhesiolysis between August 1994 and December 1996 at Ramathibodi Hospital. Of the 65 patients treated, 29 had mild adhesions, 26 had moderate adhesions, and 10 had severe adhesions. Adhesions were lysed with hysteroscopic scissors in 25, with biopsy forceps through hysteroscope in 10, with electrosurgery using a monopolar probe in 22 patients, and with resectoscope in 8 patients. The mean duration of the procedure was 15 +/- 2.1 minutes. The mean follow-up was 12 +/- 1.4 months. Of the 44 patients who originally presented with secondary amenorrhea, 40 (90.9%) have normal menses, 4 (9.1%) have hypomenorrhea. Of the 6 patients who had hypomenorrhea, 5 (83.3%) have normal menses. Cyclic abdominal pain disappeared after treatment in all patients. Of the 45 patients with IUAs and infertility, 16 (35.6%) conceived. Two (20%) of the infertile patients with initially severe adhesions conceived. Of the 5 patients with RPL treated, delivered a full term baby and the other delivered a premature baby at 29 weeks of gestation. All 18 patients who delivered, had live births. Adhesion reformation was absent in patients with initially mild and moderate adhesion but occurred in 2 out of 10 (20%) patients with severe adhesions. These two patients initially suffered from secondary amenorrhea but reported hypomenorrhea after surgery. Both of them had tuberculosis of the genital tract. There were no serious complications occurring in all 65 procedures. All 65 patients were discharged a few hours after the operation.

Adolescent↗

PubMedDate not supplied

The importance of intraoperative cholangiography during laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) using an electrosurgery energy source was successfully performed in 59 (95%) out of 62 selected patients. The procedures were performed by different surgical teams at Trakya University, Medical Fakulty, in the department of General Surgery and the Karl-Franzens-University School of Medicine, in the department of General Surgery. Cholangiography was routine at Karl Franzens University and selective at Trakya University. Laparoscopic intraoperative cholangiography (IOC) was performed in 48 (81.3%) patients, and open IOC was performed in 3 patients. Two patients had common duct stones; one of which was unsuspected preoperatively. These cases underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic papillotomy (EP). One patient had a choledocal tumor, unsuspected preoperatively. Anatomical anomalies were not identified. Cholangiography could not be performed in one case in which there was no suspected pathology. ERCP was performed on one patient 30 days after being discharged because of acute cholangitis. In this case, residual stones were identified in the choledocus. Four patients underwent open cholecystectomy because of tumor, unidentified cystic duct or common bile duct pathology that could not be visualized on the cholangiogram. Our study suggests that cholangiography performed via the cystic duct before any structures are divided can prevent the most serious complication of laparoscopic cholecystectomy--common duct injury. We recommend that cholangiography be attempted on all patients undergoing LC.

Adolescent↗

PubMed2000

Hemostasis using tissue glue in laparoscopy: discussion and review.

OBJECTIVES: To discuss the usefulness of tissue glue and TachoComb (TC), a new hemostyptic agent which combines the advantages of two reliable hemostyptic products-collagen fleece and fibrin glue in local hemostasis during laparoscopy. SETTING: Department of Gynecology and Obstetrics, Endoscopic Training Centre, Hospital Kladno. DESIGN: Review. METHODS: Analysis of literary and clinical data. RESULTS: In recent years, collagen fibers, gelatin sponges, oxidized cellulose and fibrin glue has been developed, which are now widely used in postoperative hemostasis in laparoscopy. An efficient use of these preparations shortens the duration of intervention procedures and reduces patient strain. CONCLUSIONS: Clinical studies demonstrate that hemorrhage from damage tissue important pelvic structures can be successfully arrested and controlled using the laparoscope to apply tissue glue. At Czech study, sixteen patients have been effective treated with collagen-fibrin agent during laparoscopic operations. The elimination of hemorrhages after primary laparoscopic electrosurgery and the effectiveness of this drug have been successfully tested.

Aprotinin↗

PubMed2001

Warts of the nail unit: surgical and nonsurgical approaches.

BACKGROUND: Warts are the most common nail tumor and mostly affect children and young adults. Periungual warts are usually due to HPV-1, 2, and 4. Development of periungual warts is favored by maceration and trauma, especially nail biting. OBJECTIVE: To discuss the biology, clinical features, and medical and surgical treatment of periungual warts. METHODS: Review of the literature and personal experience. RESULTS: The natural course of warts makes aggressive approaches restricted to selected cases. Medical treatments, usually topical, include keratolytic agents, virucidal agents, and immunomodulators. All choices have been utilized successfully, but keratolytic agents are the best first-line approach. Surgical treatments include cryotherapy, surgical excision, electrosurgery, infrared coagulation, localized heating with a radio-frequency heat generator and laser therapy, especially the Er:YAG laser, which has an excellent safety profile. CONCLUSIONS: Definitive cure is not guaranteed by any therapy and periungual warts can recur and become larger after correct treatment.

Diagnosis, Differential↗

PubMed2001

[Endometriosis of the abdominal wall: diagnosis and treatment techniques].

An analysis of abdominal wall endometrioma management was performed. History of cesarean section and/or uterine surgery and ultrasound are important in the diagnosis. Danazol test may confirm the diagnosis as well as reduce tumor size before operation. HF Electrosurgery, including spray coagulation technique are recommended in all cases. Hormonal therapy, including Danazol, Medroxyprogesterone or Lynestrenol gives poor effects in cases of endometrioma.

Abdominal Muscles↗

PubMed2001

Effectiveness of the ultrasonic coagulating shears, LigaSure vessel sealer, and surgical clip application in biliary surgery: a comparative analysis.

Advancements in laparoscopic surgery are often dictated by the limitations of technical instrumentation. Energy sources other than electrosurgery have become popular with the promise of quick and effective vascular control. With their success surgeons have begun using these on structures other than blood vessels with little or no data establishing their efficacy or safety. This study evaluates alternative energy sources in sealing ductal structures for possible use in liver or gallbladder surgery. After elective cholecystectomy cystic ducts (n = 45) were resealed ex vivo with surgical clips (n = 14), ultrasonic coagulating shears (n = 16), or electrothermal bipolar vessel sealer (n = 15), and bursting pressures were measured. Nineteen additional human cystic ducts were randomized to seal by ultrasonic coagulating shears (n = 9) or electrothermal bipolar vessel sealer (n = 10) and fixed in 10 per cent buffered formalin for histologic evaluation of thermal spread (mm). After this nine adult pigs were randomized to laparoscopic ligation and transection of the common bile duct using surgical clips (n = 3), ultrasonic coagulating shears (n = 3), or electrothermal bipolar vessel sealer (n = 3). The animals underwent necropsy for assessment of seal integrity on the sixth postoperative day. In the ex vivo study the mean cystic duct bursting pressure was 621 mm Hg with surgical clips and 482 mm Hg with the electrothermal bipolar vessel sealer (P = 0.39). The mean cystic duct bursting pressure after ultrasonic coagulating shears was 278 mm Hg, which was statistically less than surgical clips (P = 0.007) and electrothermal bipolar vessel sealer (P = 0.02). The mean thermal spread was 3.5 mm for ultrasonic coagulating shears and 13.4 mm for electrothermal bipolar vessel sealer (P = 0.0002). All animals undergoing ligation and transection of the common bile duct with ultrasonic coagulating shears and electrothermal bipolar vessel sealer developed bile peritonitis by postoperative day 6 as a result of seal leak. All animals undergoing surgical clip ligation and transection of the common bile duct maintained seal integrity. The mean common bile duct pressure above the surgical clip was 12 mm Hg (range 10-14). In conclusion the acute ex vivo study demonstrated a significant difference in the cystic duct bursting pressure between surgical clips and ultrasonic coagulating shears and between electrothermal bipolar vessel sealer and ultrasonic coagulating shears. The ultrasonic coagulating shears and electrothermal bipolar vessel sealer failed to maintain seal integrity in the in vivo animal study. Given the failure of the ultrasonic coagulating shears and electrothermal bipolar vessel sealer in the animal model these energy sources should not be used for transection of the cystic duct or major hepatic ducts during hepatobiliary surgery.

Animals↗

PubMedDate not supplied

The lower limits of flammability of halothane, enflurane, and isoflurane.

Halothane, enflurane, and isoflurane, generally regarded as nonflammable, can be ignited under laboratory conditions. Attainment of similar conditions during clinical anesthesia is most unlikely. Nevertheless, early in the course of anesthesia while the concentration of the agent is still high, electrosurgery is best avoided if nitrous oxide is part of the anesthetic mixture and the operative field is exposed directly to the inflowing gases (as during certain laryngeal procedures).

Anesthesia, Inhalation↗

PubMed2001

Laser bronchoscopy.

Because the lung cancer epidemic shows no signs of abating, little doubt exists that the need for interventional bronchoscopists will persist for many years to come. The Nd:YAG laser and the rigid bronchoscope remain crucial weapons in the fight against lung cancer. With more than 4000 published interventions pertaining to it, this combination is ideal for treating central airways obstruction. The safety and efficacy of laser bronchoscopy has been well established, and the reported incidence of complications is impressively low. If complications were to arise, a skilled bronchoscopist can manage them easily by using the beneficial attributes of the rigid bronchoscope. Many complications can be avoided by implementing the established safety procedures and techniques. A solid understanding of laser physics and tissue interactions is a necessity to anyone performing laser surgery. The team approach, relying on communication among the bronchoscopist, anesthesiologist, laser technician, and nurses, leads to a safer and more successful procedure. It is important to remember, however, that this is typically a palliative procedure, and therefore the focus should be on alleviating symptoms and improving quality of life. Unfortunately, because not every patient is a candidate for laser bronchoscopy, there are specific characteristics of endobronchial lesions that make them more or less amenable to resection. Each year a promising new technology is being developed, such as argon plasma coagulation, cryotherapy, and endobronchial electrosurgery. Although it is unclear what role these technologies will have, prospective controlled studies must be done to help clarify this question. The future may lay in combining these various technologies along with Nd:YAG laser bronchoscopy to maximize the therapeutic, palliative, and possibly even curative effect. As the experience of the medical community with Nd:YAG laser bronchoscopy continues to grow and as more health-care professionals are made aware of its therapeutic capability, fewer patients with cancer will need to suffer and die from the complications of airway obstruction.

Anesthesia↗