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Expanded clinical uses of a novel tissue-retraction material.

Impression making for all fixed prostheses requires access to the prosthetic margin while minimally traumatizing the tissue, so that clinicians can provide as much clinical information as possible to the laboratory technician. This information allows the technician to design the prosthesis to meet the criteria of the periodontium and allow the gingival tissues to recover to their original state. Until now, there have been three traditional options in the armamentarium for retraction procedures: packing cord, electrosurgery, and laser surgery. These procedures all have degrees of trauma that vary based on the experience of the clinician. The gingival tissue may be very delicate and susceptible to recession if too much trauma occurs. This article describes an expanded use of Expa-syl, a newly introduced tissue retraction material, as it relates to minimally invasive tissue management, while still providing an ideal gingival tissue environment for long-term health.

Aluminum Chloride↗

Ingrown toenail removal.

Ingrown toenail is a common problem resulting from various etiologies including improperly trimmed nails, hyperhidrosis, and poorly fitting shoes. Patients commonly present with pain in the affected nail but with progression, drainage, infection, and difficulty walking occur. Excision of the lateral nail plate combined with lateral matricectomy is thought to provide the best chance for eradication. The lateral aspect of the nail plate is removed with preservation of the remaining healthy nail plate. Electrocautery ablation is then used to destroy the exposed nail-forming matrix, creating a new lateral nail fold. Complications of the procedure include regrowth of a nail spicule secondary to incomplete matricectomy and postoperative nail bed infection. When performed correctly, the procedure produces the greatest success in the treatment of ingrown nails. Basic soft tissue surgery and electrosurgery experience are prerequisites for learning the technique.

Ambulatory Surgical Procedures↗

Use of the PumpVac Plus Suction Irrigation System at Gynecologic Endoscopy.

At both laparoscopy and hysteroscopy, controlled movement of fluids is necessary. In addition, at laparoscopy, suctioning of accumulated smoke from lasers or electrosurgery is an essential venting technique to enhance visibility. This chapter will describe and discuss a unique, simple, cost-effective system that can be used for both hysteroscopy and laparoscopy to accomplish movement of fluids and management of smoke. Aquadissection or hydrodissection has been used for many years as an adjuvant to operative laparoscopy.' It has been found useful for operative laparoscopic treatment of conditions such as endometriosis, pelvic adhesions, and tubal obstructron. Most current systems are cumbersome, wastefully use large volumes of fluid, and often require a mechanical pump for pressurizing the fluid suction and irrigation systems. Usually, during combined laparoscopy and hysteroscopy, a separate system is used for accomplishing uterine distention when fluids are used for the hysteroscopic portion of surgery. The Pump Vac Plus can be used for both hysteroscopic distention and laparoscopic suction and irrigation. This article will describe our techniques for using the Pump Vac for both of these endoscopic approaches.

Journal Article↗

Laparoscopic management of paratubal and paraovarian cysts.

OBJECTIVES: To define the proportion, methods of diagnosis, and a simplified laparoscopic technique for treating paratubal and paraovarian cysts. METHODS: We conducted a prospective cross-sectional study in the Gynecologic Endoscopy Unit of Assiut University Hospital in Assiut, Egypt in 1853 patients undergoing video-assisted laparoscopy. Transvaginal ultrasonography (TVS) was performed to detect paratubal or paraovarian cysts. Tubal shape and patency were evaluated with hysterosalpingography (HSG) in the infertile group. Diagnostic laparoscopy was performed to confirm the diagnosis of paratubal or paraovarian cysts. Small cysts were punctured and coagulated, and larger cysts required cystectomy and extraction of the cysts by using bipolar electrosurgery. Cystectomy was preceded by endocystic visualization in all cases. The primary outcomes measured included (1) correlation of the preoperative TVS, HSG, or both of these, with the laparoscopic diagnosis; (2) estimation of the success of the laparoscopic management of paratubal cysts; (3) assessment of the value of endocystic visualization prior to cystectomy; and (4) evaluation of tubal patency after laparoscopic management. RESULTS: Laparoscopically, only 118 patients (15.7%) were proved to have paratubal or paraovarian cysts. Preoperatively, TVS confirmed paratubal or paraovarian cysts in 52 (44%) patients. Cysts less than 3 cm in size (34 cases) were treated with simple puncture and bipolar coagulation of the cyst wall, whereas larger cysts (84 cases) were treated by cystectomy. Endocystic visualization using the 4-mm rigid hysteroscope was performed in 84 (71%) patients with large cysts. Statistically significant improvement occurred in tubal patency after laparoscopic management. CONCLUSIONS: Sonographic diagnosis of not uncommon paratubal and paraovarian cysts is not always feasible and requires greater awareness and accuracy. The characteristic laparoscopic differentiation of ovarian cysts is the crossing of vessels over them. Endocystic-endoscopic visualization is a simple, valuable step prior to cystectomy. Bipolar coagulation or extraction of these cysts diagnosed at laparoscopy is easy, not time-consuming, and should be routinely performed in all cases following microsurgical laparoscopic principles.

Adult↗

Bronchoscopic laser photodestruction of benign tumours in the trachea and large bronchi.

Potentialities and results of laser bronchoscopic surgery of exophytic benign tumours of the trachea and bronchi are described. The material includes 37 patients (33 men and 4 women) aged 28-69 (mean age 51 years). Tumours were removed by the Nd-YAG laser. In six patients laser photodestruction was combined with electrosurgery. In 31 patients manipulations were done via bronchofiberscope under local anaesthesia and in six patients via a rigid bronchoscope under general anaesthesia. Complete removal of pathologic tissues was achieved in all patients. During 1-5 years of follow-up none of the patients developed recurrent tumours.

Adult↗

[Does electromagnetic interference not occur to a bipolar pacemaker during TUR-P?].

It has been reported that a unipolar pacemaker is more sensitive to electromagnetic interference (EMI) than a bipolar pacemaker. However, we experienced cases in which electrosurgery device interfered with a bipolar pacemaker, but not with a unipolar pacemaker during TUR-P. It has been suggested that EMI occurs to a bipolar pacemaker depending on sensitivity and electric resistance of a patient.

Aged↗

[Diagnosis and treatment of bladder cancer].

The authors present a retrospective analysis of the results of transurethral conservative and radical operations in 125 patients with invasive cancer of the urinary bladder (UB) treated in the Research Institute of Urology throughout 1992-2002. Transurethral resection (TUR) of the UB was made in 72 patients. Stages pT2a, pT2b, T3 and T4 were diagnosed in 23 (31.9%), 18 (25%), 14 (19.5%) and 17 (23.6%) cases, respectively. 53 patients with advanced invasive UB cancer have undergone radical cystectomy varying by the method of urine derivation. Stages pT2N0M0, pT3aN0M0, pT3bN0M0, pT4aN0M0 and N1-2 were registered in 4 (7.5%), 13 (25%), 21 (40%), 7 (12.5%) and 8 (15%) patients, respectively. UB cancer recurrences after TUR occurred in 12 (16.7%) patients with stage pT2a, in 8 (11.1%) patients with stage pT2b. Three-year overall and recurrence-free survival after TUR at stage T2 reached 97.5 +/- 3.2 and 47.4 +/- 2.8, respectively, at stage T3 and T4--57.1 +/- 4.3 and 26.6 +/- 3.4%, respectively. Postcystectomy distant metastases to the lungs, bones and iliac lymph nodes after treatment were detected in 3, 2 and 3 patients, respectively. One patient had a local pelvic recurrence. For all 53 patients a 2-year corrected survival made up 68 +/- 12.0%. Thus, transurethral electrosurgery is an effective treatment of invasive UB cancer; the only radical surgical treatment for invasive UB cancer is cystectomy.

Cystectomy↗

Minimally invasive surgery via laparoscopy for intra-abdominal biopsy in obese rhesus macaques (Macaca mulatta).

PURPOSE: To determine the safety and effectiveness of laparoscopy for repeated intra-abdominal biopsy of liver and omental adipose tissue (AT) in obese rhesus monkeys (Macaca mulatta). METHODS: Nine obese rhesus monkeys were studied by use of 18 laparoscopic procedures (two procedures each, approx. six weeks apart). Time-sensitive liver and omental AT specimens were obtained from monkeys under general anesthesia, using a three-port approach with a roticulating endoscopic stapler/divider and a monopolar electrosurgery for hemostasis. RESULTS: All subjects tolerated the initial and repeat laparoscopic procedures well. Liver specimens weighed a mean +/- SEM of 3.8 +/- 0.5 g, and omental AT specimens weighed 16.6 +/- 0.8 g. Compared with previous studies of conventional laparotomy with liver wedge resection, the monkeys experienced faster postoperative recovery via laparoscopy, with rapid return to normal food intake and activity. Minimal to no adhesions were observed by use of the repeat procedure in all monkeys, with no major complications. CONCLUSIONS: Laparoscopy in obese rhesus monkey (ranging from young to older-aged), with repeated intra-abdominal liver and omental AT biopsy, was an excellent minimally invasive surgical method. In contrast to laparotomy with wedge resection, this approach greatly decreases operative time and stress, provides generous tissue specimens in a time-efficient manner, and facilitates rapid and full recovery of the nonhuman primate.

Adipose Tissue↗

[Experimental study of the effect of the Argon Beam Coagulator on organic tissues from the viewpoint of surgical utilization].

The Argon Beam Coagulator has gained his space in surgery thanks to its operative characteristics, that are very useful in sealing the bleeding parenchymal tissue with minimal injury to the surroundings. The aim of the present study is that of evaluate the physical properties of the instrument in its coagulation action. The experimental study with the Birtcher 6000 Argon Beam Coagulator has been designed to measure the top temperature that develops right where the Argon beam meets the tissue, while operating. Using a laser guided telethermometer, the searching of that temperature was uneasy right on the operatory field because of the unwilling movements of the operator hand and those of the patient himself. Therefore a similar protocol was made on a piece of meat coming from the butcher. At the longest application of the beam coagulation on the same point the developed temperature was never higher than 100 degrees C whilst a complete coagulation effects. The advantage of the Argon Beam coagulation are therefore to seal the diffuse bleeding without injury to this adjacent tissues, never exposed to a temperature higher than that of boiling water. The advantages are also evident in comparison with the more usual spray electrosurgery that is instead characterized by a wide carbonisation also with this spray option.

Animals↗

Reattachment of a fractured maxillary tooth: a case report.

A 14-year-old male patient reported with a horizontal fracture of almost the entire crown of a maxillary incisor, extending subgingivally at the palatal side. After root canal therapy and electrosurgery, the tooth fragment was reattached using a total-etch dentin-bonding system and a hybrid composite. Due to enamel cracks and the necessity for more retention, the labial surfaces of the teeth were veneered with a micro-filled composite. The clinical situation of the reattached teeth was confirmed successful by radiographic and photographic assessment after 1, 3, 6, and 12 months. The restoration of an anterior tooth with original tooth fragment in young patients has advantages over conventional composite or prosthetic restorations. However, reattached teeth with fracture extending subgingivally, require long-term follow-up.

Adolescent↗

Initial experience with hysteroscopic endometrial resection/ablation using a new specialized tissue aspirating resectoscope.

Hysteroscopy is gaining increasing acceptance among surgeons as the initial surgical treatment of choice for managing abnormal uterine bleeding and submucous fibroids. With refinements in electrosurgery and laser ablation instruments, and the development of continuous-flow resectoscopes, hysteroscopic techniques are proving to be cost-effective alternatives to hysterectomy for an ever expanding range of treatment indications.

Journal Article↗

Laparoscopic abdominal cysts fenestration using harmonic scalpel.

The use of ultrasonically activated scalpel for tissue cutting and coagulation is a potential replacement for electrosurgery, which can be related to different complications. Its working principle is to transform the electric power into the mechanical longitudinal movement of the working part of the instrument, by a piezoelectric transducer situated in the hand piece. Between October 2000 and June 2004, six patients with abdominal cysts were treated by laparoscopy, using the harmonic scalpel. The average age was 40.8 (ranging from 15-60) years. Laparoscopic abdominal cyst fenestration was performed in five patients, and laparoscopic cholecystectomy and abdominal cyst fenestration were done in one patient during the same operation. The average duration of the operation was 40 (ranging from 25-70) minutes and hospital stay was 2.8 (ranging from 1-5) days. Laparoscopic abdominal cyst fenestration using the harmonic scalpel is a safe and successful operation, with good results including all the advantages of the minimally invasive surgery.

Abdomen↗

[Soft tissue surgery with the diode laser--theoretical and clinical aspects].

Currently laser light of different wavelengths is used for all kinds of surgical procedures in oral and maxillofacial surgery. In this regard especially the diode laser is mainly used, because of its excellent effects on oral soft tissues. On the basis of various oral soft tissue lesions in 40 patients the benefits of the diode laser in daily practice are demonstrated. Intraoperative and postoperative clinical findings were excellent due to the sufficient cutting abilities, the good coagulation effect and the extremely small zone of thermal necrosis to surrounding tissues. By this the diode laser has proven as an alternative solution to conventional electrosurgery and scalpel. The precise treatment in the contact application mode, which allowed an easier and more controlled guidance of the laser beam, was another advantage of the fiber-assisted laser system. In conclusion the results show that the diode laser is a useful instrument in oral soft tissue surgery.

Fibroma↗

Laparoscopic treatment of cul-de-sac obliteration secondary to retrocervical deep fibrotic endometriosis.

One hundred women with cul-de-sac obliteration secondary to retrocervical deep fibrotic endometriosis (48 partial, 52 complete) were treated laparoscopically for infertility (46 cases), pain (46), hypermenorrhea (7) and a mass (1). The surgical techniques included aqua-dissection, electrosurgery, CO2 laser, scissors, probes to identify the upper posterior vagina and rectum, and multiple rectovaginal examinations. In all the procedures the anterior rectum was freed to the loose areolar tissue of the rectovaginal septum prior to excising deep fibrotic endometriosis. The viable intrauterine pregnancy rate among patients with infertility was 70% (32/46). Of patients presenting with pain, 89% (41/46) reported significant relief. The average operating time was 178 minutes. Laparoscopic cul-de-sac dissection, though time intensive, offers increased fertility potential and significant symptom relief.

Adult↗

Carbon dioxide laser laparoscopy for endometriosis.

In conclusion, the CO2 laser has been useful for the vaporization and excision of endometriosis through the laparoscope. Removal through the laparoscope, however, requires recognition of the lesion. Microscopic lesions may not be seen through the laparoscope, and deep invasive lesions may be more palpable than visual. Furthermore, small lesions are probably more rapidly coagulated with bipolar electrosurgery or with thermal coagulators (desiccators) than with the laser technique, and lesions of this size do not require the technology associated with lasers. Deep lesions may require laparotomy for recognition prior to excision. Even though the CO2 laser is an excellent and precise tool, bipolar electrosurgical units, bipolar coagulation, unipolar electrosurgical units, thermal coagulators, and fiber-equipped lasers may be more relevant in certain clinical situations. The exact role of all these types of equipment is still developing.

Carbon Dioxide↗

[Methods aimed at lengthening the clinical crown: a review].

This review deals with the different methods of lengthening the clinical crown and discusses the advantages and/or disadvantages of each method. Different flap procedures, including ostectomy and osteoplasty, reduce the height of the alveolar crest aiming at a distance of about 3 mm to a future reconstruction margin. Root planing may avoid reattachment of surgically separated fibers. Other methods like gingivectomy, electrosurgery, intra-alveolar transplantation, and forced eruption might contain considerable biological disadvantages. However, if the extrusion is combined with regular fiberotomy, this method becomes the most conservative with respect to the periodontal tissues of neighboring teeth. On the other hand, not all situations which require lengthening of the clinical crown can be solved by orthodontic extrusion and fiberotomy. Therefore, depending on the clinical problem, either the surgical lengthening of the clinical crown or the orthodontic extrusion with separation of the fibers are the recommended procedures.

Alveolectomy↗

Dermatologic surgery--its scope and some practical aspects.

Dermatologic surgery is of increasing interest to both dermatologists and other medical practitioners. It includes procedure like biopsy, excisional surgery, laser surgery, electrosurgery, curettage surgery, nail surgery, cryosurgery, minigrafting, sclerotherapy, collagen implant, punch grafting, Moh's micrographic surgery, dermabrasion and hair transplant. This article highlights the important aspects of the various procedures and some of the more important practical points.

Dermatologic Surgical Procedures↗

["Inoperable" deep rectal cancer].

Rectal carcinoma usually requires surgery. In 1981-1988 43 (8.5%) of 504 patients were considered inoperable for medical, prognostic or technical reasons. Surgery should take the removal of urogenital organs, if necessary, into consideration. Electrosurgery, cryosurgery and laser surgery can be used to reestablish local passage. Twenty-one pelvic exenterations were performed during 52 operations for tumor recurrence. Adjuvant chemotherapy and radiotherapy were applied when needed. Each therapy must be individualized.

Combined Modality Therapy↗