Bipolar Coagulation Research Articles

The use of bipolar coagulation forceps prevented salivary fistula in patients with parotidectomy: a retrospective study

BackgroundSalivary fistula is a relatively common complication in patients who have undergone a parotidectomy. The purpose of this study was to investigate the effects of bipolar coagulation forceps use on salivary fistulas.MethodsFrom March 2015 to June 2020, 177 patients who underwent a parotidectomy in the Department of Oral and Maxillofacial Surgery at the Second Xiangya Hospital of Central South University were recruited. The patients were divided into an experimental group and a control group based on whether bipolar coagulation forceps or sutures were used, respectively.ResultsThe drainage output of the experimental group was significantly lower than that of the control group (p = 0.04). The duration of dressing pressure applied in the experimental group was significantly shorter than that in the control group (p = 0.0003). Moreover, the incidence of salivary fistula in the experimental group (9.8%, 8/82) was notably lower than that in the control group (34.7%, 33/95) (p < 0.0001). In the logistic regression model for salivary fistula development, both the use of bipolar coagulation forceps (p = 0.0021) and drainage output (p = 0.0237) were associated with the presence of salivary fistulas.ConclusionsOur findings indicate that the use of bipolar coagulation forceps decreases the incidence of salivary fistula in patients who have undergone a parotidectomy. The use of bipolar coagulation forceps is a safe, effective, and convenient method to prevent salivary fistulas in patients who undergo a parotidectomy.Trial registration: Current Controlled Trials ChiCTR2100044722, Date: 26/03/2021, Retrospectively registered.

The treatment of chronic low back pain using annuloplasty with percutaneous endoscopic discectomy

Abstract Introduction: Percutaneous endoscopic discectomy (PED) is often used to treat patients with chronic discogenic low back pain (LBP) (DLBP). In this technique, after selective discectomy of the degenerated disc, the posterior annulus fibrosus and tear site are modulated by thermal annuloplasty (TA) using a bipolar radiofrequency coagulator (PED/TA). PED/TA has been shown to be effective for treating DLBP. Patient Concerns: The patient was a 40-year-old man who visited our hospital with complaints of chronic LBP (CLBP) and buttock pain, left-sided sciatica, and sensory disturbance affecting his left thigh. Diagnoses and interventions: He was diagnosed as having discogenic LBP with a high intensity zone in the L4–5 disc, so discography was performed combined with steroid and lidocaine injection at the affected site. He recovered from LBP with 80% effective rate. He again reported concordant LBP with leg pain and numbness, which was treated effectively by intradiscal injection. However, the pain gradually recurred, so we decided to perform PED/TA. Outcomes: After PED, the high intensity zone site was ablated with a coagulator. Following surgery, the patient's severe LBP in the seated position resolved, his leg pain and sensory disturbance improved, and has experienced no difficulties in carrying out activities of daily living. Conclusions: This case suggests that PED/TA is potentially advantageous for treating DLBP, CLBP and severe sitting intolerance. Also, PED/TA may allow lumbar interbody fusion to be avoided in patients with CLBP and severe sitting intolerance.

Acute haemoperitoneum caused by endometriosis infiltrating the uterine artery - Two case reports and a literature review

We report 2 cases of haemoperitoneum due to a bleeding of the uterine artery caused by infiltrating endometriosis. We have also conducted a literature review on endometriosis-related intra-abdominal haemorrhage and wrote a practical guideline on how this entity can be recognized and handled.Case 1: A 49-year-old multiparous woman presented with intense stabbing pain in the lower abdomen during her menstruation. CT angiography showed a bleeding from a side branch of the internal iliac artery. Laparoscopy was performed and an active bleeding from the right uterine artery was confirmed, clearly caused by infiltrating endometriosis lesions. Haemostasis was achieved by bipolar coagulation. Case 2: A 29-year-old nulliparous woman was admitted for observation because of heavy stabbing pain in the right lower quadrant and presence of free fluid on CT abdomen. The day after the admission, laparoscopy was performed because of a decreasing haemoglobin level. An arterial bleeding from the right parametrium was observed, probably originating from the right uterine artery. Histopathological examination of a biopsy of the right parametrium proved the presence of endometriosis. Haemostasis was achieved by bipolar coagulation.Although endometriosis-related haemoperitoneum is a rare entity, this diagnosis should be considered when a patient presents with an intra-abdominal haemorrhage during menstruation or withdrawal bleeding - especially in case of a history or suspicion of endometriosis. Laparoscopy is the cornerstone of the treatment.

The course of pregnancy and childbirth in women with a scar on the uterus after myomectomy using endoscopic technologies

The objective: to study the features of the restoration of reproductive function, the course of pregnancy and childbirth in women with a scar on the uterus after myomectomy using endoscopic technologies.Materials and methods. The study was conducted in three stages. At the first stage, the course of the postoperative period after myomectomy in 180 women of reproductive age was analyzed, of which 80 patients (1 group) underwent laparotomy myomectomy with suturing of the bed with two-row synthetic sutures; 50 patients (2 group) – laparoscopic myomectomy with suturing of the bed with two-row synthetic sutures and 50 women (3 group) – laparoscopic myomectomy with bipolar coagulation of the bed. In the second stage, 6 months after surgery, all patients were examined to rule out signs of inferiority of the myometrial scar and predict the possibility of natural childbirth. The diagnostic complex included ultrasound (US), hysteroscopy and hysterosalpingography. During the third stage, the course of pregnancy and the method of delivery in 115 (63,8%) women out of 180 in whom the desired pregnancy occurred in the range from 6 months to 5 years were analyzed.Results. Analysis of the postoperative period showed that the use of electrocoagulation worsens its course. So, in 12% of patients in group 3, subfebrile condition persisted for 6 days, which is 3,2 times more than in 1, and 3 times more than in 2 groups. ESR and leukocyte index were also significantly higher in 3 group. Against the background of an increase in leukocytes in patients of 3 group, unfavorable scar formation was also observed, which manifested itself in the form of a larger relative area of the vascular component. At the border of the myometrium and scar after myomectomy, leukocyte infiltrates were found in 18,2% of patients in 1 group and in 30,7% in 2 group, and after coagulation of the bed – in 100%. Therefore, it is advisable to plan natural childbirth in patients after myomectomy with suturing of the uterine wall, regardless of surgical access. However, there are some advantages of laparoscopic access with coagulation of the bed – the shortest duration of the operation and less intraoperative blood loss.After pre-pregnancy complex of diagnostic manipulations in 47 pregnant women out of 115 revealed signs of inferiority of the scar on the uterus after myomectomy, which was an indication for routine caesarean section (CS). But the frequency of detection of a defective scar was different in each group: in 1 groups and 2, the planned CS was performed for every fourth woman, in 3 group - for every second. These data indicate an adverse effect of laparoscopic coagulation of the fibroid bed on the healing of the myometrial scar. In the structure of indications for emergency CS in all comparative groups prevailed anomalies of labor, and in 3 group this fact was entirely associated with the threat of uterine rupture and scarring, while in parturients 1 and 2 groups - almost 2 times less often.In 35 patients with a scar on the uterus after myomectomy there were spontaneous preterm births by live full-term infants without asphyxia, of which 18 gave birth to group 1, 15 – 2 group, and only 2 women from 3 group gave birth per vias naturalis.Conclusions. The method of carrying out myomectomy does not affect the onset and course of pregnancy in the future, but it does matter on the ability of independent childbirth. In women who have not completed the reproductive program, it is necessary to suture the walls of the uterus during myomectomy, regardless of access. Electrocoagulation of the bed after removal of fibroids contributes to an increase in the frequency of threatening uterine rupture by 2 times. The decisive role in the management of childbirth with a myometrial scar is played not by the thickness of the lower segment, but by the presence of clinical manifestations of its failure (local soreness of the lower segment of the uterus, spotting from the genital tract, fetal hypoxia).

Clinoidal Meningioma with Cavernous Sinus Invasion.

We present a-49-year old female presenting headache and progressive right eye visual loss in the last 6 months. Magnetic resonance imaging showed a large clinoidal meningioma on the right side, invading the superior, lateral and medial aspects of the cavernous sinus, the optic canal, and the clinoidal segment of the internal carotid artery (ICA).A cranio-orbital approach was performed. The anterior clinoid process was removed extradurally to achieve devascularization of the anterior clinoidal meningioma, followed by the peeling of the middle fossa to decompress V2 and open the superior orbital fissure. We open the dura in a standard fronto-temporal flap to access the lower portion of the skull base allowing retractorless dissection. We complete the removal of the anterior clinoid process and optic strut through an intradural approach. It allows safer dissection of the clinoidal segment of the ICA and avoids its injury by adherent and hard consistency tumor.Intraoperative neurophysiological monitoring, sharp dissection, and avoiding the use of bipolar coagulation when dissecting the cavernous sinus are essential to minimize the risk of cranial nerve injury. We also like to point that cranial nerve deficit caused by surgical manipulation without primary lesion of the nerve can be recovered postoperatively. The link to the video can be found at: https://youtu.be/ozUCsnUGxyM .

Is the postoperative discomfort after connective tissue harvesting from the palate influenced by the use of a bipolar coagulator? A randomized controlled trial.

ObjectivesThis study aimed to determine the effect of the use of a bipolar coagulator on postoperative pain and complications when used during connective tissue harvesting from the palate.Material and methodsA randomized controlled clinical trial was conducted with 57 sequential patients requiring a connective tissue graft for periodontal or implant surgery. All samples were harvested superficially and de‐epithelized outside the mouth. The patients were randomly allocated to two groups: in one group, the bipolar coagulator was used before suturing to control bleeding, and in the other group, the coagulator was not used. The surgeon was unaware of the randomization until the end of the harvesting phase. Self‐reported maximum pain, number of painkillers used, bleeding events, emergency visits at the clinic were recorded 7 days after surgery.ResultsFifty patients were randomized and treated (seven were excluded for different reasons). The mean harvested area was 75.24 mm2 (SD, 33.96), and the mean thickness of the samples was 2.47 mm (SD, 0.75). The mean self‐reported pain value on the visual analog scale was 3.37 (SD, 2.30), and the mean number of pain medications used was 7.1 (SD, 6.60). Seven patients made an emergency visit each, and 17 delayed bleeding events were reported by 15 patients. No statistically significant differences were reported in postoperative pain, postoperative bleeding, and emergency visit to the clinic between the groups that did and did not use the bipolar coagulator. When smoking habits were taken into consideration, the number of pain medications was higher among male smokers and older smokers than among male non‐smokers and younger smokers. This study was not able to find a relationship between harvested sample dimension or thickness and postoperative discomfort.ConclusionsThe bipolar coagulator can be used during connective tissue harvesting from the palate to control bleeding without influencing postoperative pain.

A randomized controlled trial of ovarian reserve preservation and hemostasis during ovarian cystectomy

The preservation of ovarian reserve during laparoendoscopic single-site (LESS) ovarian cystectomy is crucial for reproductive-age women. This study was a single-blinded, single-center, and randomized controlled trial to evaluate the effect of hemostatic agents on the preservation of ovarian reserve and hemostasis during LESS ovarian cystectomy. Patients with unilateral ovarian cyst were randomized to the hemostatic agent and coagulation groups according to the hemostasis method. Afterwards, the patients underwent LESS ovarian cystectomy, and hemostasis was performed after ovarian cyst excision according to the assigned hemostasis method. If hemostasis was not completed within 10 min. After discharge, the patients were followed until 3 months after surgery. We compared the hemoglobin, anti-Müllerian hormone (AMH) levels, and ovarian volumes before surgery, and 2 days, 1 week, and 3 months after surgery (3 M-POST), and the decline ratio between the two groups. The decline ratio of serum AMH levels was greater at 3 M-POST in the coagulation than in the hemostatic agent group (median intention-to-treat [ITT], − 36.7 vs. − 13.3%; per-protocol [PP], − 36.8 vs. − 13.3%; P < 0.05). Notably, the difference of the decline ratio of serum AMH levels was only shown in endometriosis patients (median; ITT, − 50.7 vs. − 14.4%; PP, − 50.7% vs. − 14.4%; P < 0.05), while there was no difference in non-endometriosis patients. In conclusion, Hemostatic agents may be non-inferior to bipolar coagulation for preserving ovarian reserve and hemostasis during LESS ovarian cystectomy, in particular, for endometriosis patients. (Trial registry: ClinicalTrials.gov Identifier NCT03374397).

In Reply: Management of Sigmoid Sinus Injury: Retrospective Study of 450 Consecutive Surgeries in the Cerebellopontine Angle and Intrapetrous Region.

Background The sigmoid sinus is the biggest obstacle when approaching the posterior fossa and temporal bone. Adequate sinus exposure is required to obtain a sufficient operative field, but sinus injury is a potentially life-threatening complication. Objective To present our experience of sigmoid sinus injury and its management during surgeries in the cerebellopontine angle and intrapetrous region, with operative videos. Methods A total of 450 consecutive surgeries (385 retrosigmoid and 65 transmastoid approaches) over a 4-yr period were retrospectively investigated, focusing on sigmoid sinus injury, its repair technique, and long-term patency of the sinus. Results Pinhole-sized bleedings were controlled sufficiently by bipolar coagulation or fibrin glue-soaked hemostatic fabric. For lacerations of smaller than 3 mm, the sinus wall was reconstructed by suturing. For larger or unsuturable holes, patching a Gore-Tex membrane on a fibrin glue sheet (without any suturing) was used for the reconstruction. Hemostatic agents were not used for large lacerations to avoid any potential risks of delayed sinus occlusion. Major sinus injury requiring suturing or Gore-Tex patching occurred in 13 cases (2.9%). The bleeding was immediately controlled without sinus clamping, and surgery was not discontinued owing to the injury in any of them. The patients had no postoperative symptoms associated with sinus injury. In all the reconstructed sinuses, patency was confirmed on magnetic resonance imaging at the final follow-up. Conclusion Sigmoid sinus injury can be well managed with long-term patency by utilizing different repair techniques. Initial safe and adequate exposure around the injury site was essential for all of these repair procedures.

Outcomes of treatment of haemorrhoidal disease with KLS Martin maXium marClamp® CUT IQ thermal tissue fusion instrument based on offset electrode technology compared to the Milligan-Morgan procedure with bipolar coagulation for the excision of grade III and IV haemorrhoids

Introduction. The study compared the effects of surgical treatment of grade III and IV haemorrhoids achieved with a conventional operative technique and by using a thermal tissue fusion instrument based on offset electrode technology. A total of 60 patients with grade III and IV haemorrhoids were operated on in the Department of General and Oncologic Surgery, Municipal Hospital in Siemianowice Śląskie, and in the On-Clinic Medical Centre in Chorzów, between October 2011 and September 2015. Aim. The aim of the study was to compare the outcomes of treatment of haemorrhoidal disease using KLS Martin maXium marClamp® CUT IQ thermal tissue fusion instrument based on offset electrode technology and the Milligan-Morgan surgical procedure with bipolar coagulation for the excision of grade III and IV haemorrhoids. Material and methods. The patients were divided into two groups: Group 1 – patients operated on using KLS Martin maXium marClamp® CUT IQ thermal tissue fusion instrument based on offset electrode technology. Group 2 – patients operated on using the conventional Milligan-Morgan technique with electrocoagulation. The evaluated parameters included the length of hospital stay after surgery, duration of the surgical procedure, level of pain on the postoperative days 1 and 2 rated on a 10-point VAS scale, and postoperative wound healing time. Results. A reduction in postoperative pain, shorter procedure duration and hospital stay, and more rapid postoperative wound healing were observed in Group 1 compared to Group 2. Conclusions. In our study material, the application of a thermal tissue fusion instrument using offset electrode technology in surgeries to remove grade III and IV haemorrhoids, compared to the conventional Milligan-Morgan procedure with electrocoagulation, brought the following results: – less postoperative pain, – shorter duration of surgical procedure, – reduced length of hospital stay, – faster healing of postoperative wound.

Radiofrequency VS Cold Surgery to Treat Oral Papillomatous Lesions.

Introduction:The aim of this study is to analyse different surgery (radio frequency and cold instrumentation) of oral benign papillomatous lesions.Materials and Methods:A retrospective study was carried out in our section of Otorhinolaryngology from 2014 to 2018. 112 patients with oral benign papillomatous lesions were enrolled and divided into 2 groups. Group A of 62 patients treated with excision of lesions using radio frequency using a bipolar coagulation electrode (CelonLabENT). Group B of 50 patients treated with excision of the lesion using traditional cold instruments (scalpel and surgical forceps). All patients were evaluated for intraoperative bleeding, discomfort and recurrence rate. Results:112 patients (of which 37 males and 75 females) with mean age 32.9 ranged from 10 to 61 years. The HPV types associated with oral benign papillomatous lesions were HPV 6 (17%), 11 (23,3%), 13 (10,7%), 32 (34%), 2 (10%) and 57 (5%). There are no statistically significant differents among patients operated with radio frequency (Group A) and cold instrumentation (Group B) regarding intraoperative bleeding (P= 0.08), recurrence rate after 1 year from surgery (P=1), intraoperative discomfort (P=0.7) and postoperative discomfort (P=0.6).Conclusion:Radiofrequencies and surgery with scalpel and surgical forceps are equal valid methods for the treatment of benign papillomatous.

Mechanism of hypertensive crisis during energy device ablation of the adrenal gland: An experimental animal study.

To elucidate the mechanism of hypertensive crisis during energy device ablation of the adrenal gland. Electrocoagulation on the adrenal glands of six pigs was carried out with the same energy device (VIO300D) using four methods: (i) monopolar coagulation; (ii) monopolar soft coagulation using IO-advanced ball-type electrodes; (iii) bipolar soft coagulation by pinching; and (iv) bipolar soft coagulation by non-pinching (surface contact) using Bipolar forceps Premium. After electrocoagulation for 5s, blood pressure and pulse changes were monitored, and adrenal hormones were measured from a central vein. The adrenal glands were removed, and the degree of tissue damage was scored histologically. Hypertensive crisis occurred with electrocoagulation of the adrenal gland by the monopolar coagulation, monopolar soft coagulation and bipolar soft coagulation pinching methods. Blood pressure did not change with the bipolar soft coagulation non-pinching method. Pathologically, tissue damage to the adrenal medulla was associated with elevated blood pressure and adrenaline and noradrenaline release. Hypertensive crisis caused by energy device ablation to the adrenal gland is caused by the release of catecholamines due to heat damage to the adrenal medulla rather than the type of energy device. Proper use of an energy device that does not cause thermal degeneration of the medulla is required to prevent hypertensive crisis.

Use of Oxidized Regenerated Cellulose as a Hemostatic Agent in Neurosurgery: Appraisals and Recommendations to Prevent Postoperative Complications and Facilitate Follow-Up

Neurosurgical hemostasis can be performed with bipolar coagulation and with the support of several dedicated biomaterials including oxidized regenerated cellulose (ORC; e.g., Surgicel®, Johnson &amp; Johnson, New Brunswick, NJ, USA). Oxidized regenerated cellulose is a sterile absorbable fibrous biomaterial that has become a major local hemostatic agent thanks to its ease of use, favorable biocompatibility and bioabsorption characteristics. However, some postoperative issues associated with its use, such as allergic reaction, seroma, foreign-body reaction with compressive neuropathies and misdiagnosis during follow-up, have been reported. These complications could compromise clinical outcomes with a negative impact on patient quality of life and sometimes require risky major surgical procedures. An understanding of the specific properties of ORC combined with adequate surgical expertise and compliance with some basic rules are needed to optimize clinical outcomes and minimize postoperative issues.

Optimized SEEG-guided radiofrequency thermocoagulation in the treatment of pediatric hypothalamic hamartomas

PurposeThis study investigated the role of one-stage stereo-array radiofrequency thermocoagulation based on stereotactic electroencephalography in the treatment of pediatric hypothalamic hamartomas. MethodsWe analyzed the clinical data of 28 patients with hypothalamic hamartoma. A high-density focal stereo-array electrode implantation strategy was adopted. Stereotactic electroencephalography guided bipolar coagulations were performed between two contiguous contacts of the same electrode, or between two adjacent contacts of different electrodes. Patients with hypothalamic hamartoma were divided into two groups based on hamartoma size (maximum diameter < 15 mm vs maximum diameter ≥ 15 mm). Numbers of implanted electrodes and contacts used for thermocoagulation were documented. Seizure outcome was evaluated according to Engel’s classification. ResultsSurgical procedures were well tolerated and no repeated surgery was performed. The median number of electrodes implanted in the two groups was significantly different (p = 0.0009), as well as the median number of contacts where radiofrequency thermocoagulation was applied (p = 0.0006). Moreover, the number of implanted electrodes and contacts used for thermocoagulation were positively correlated with the hamartoma volume (Spearman's rho = 0.7074, p＜0.0001 and Spearman's rho = 0.7435, p＜0.0001, respectively). The overall seizure-free rate was 82.1 %, with 92.9 % of the patients having favorable outcomes for at least 12 months of follow-up. Seizure outcomes between two groups were not statistically significant (p = 0.3138). ConclusionOne-stage high-density focal stereo-array stereotactic electroencephalography guided radiofrequency thermocoagulation using cross-bonded electrode contacts for ablation range expansion is a safe and effective surgical approach for children with hypothalamic hamartoma.

Basilar Artery Injury During Endonasal Surgery: Stepwise to Control Bleeding.

Intraoperative injury during endoscopic endonasal surgery of the carotid artery has been previously described in the literature. However, the accidental damage of the basilar artery in such scenario is not defined. To define the protocol of action for massive bleeding from an artery in the posterior fossa. The reported patient was diagnosed with a partially calcified clival chordoma featured by a huge intradural component. An endoscopic endonasal transpterygoid transclival approach was selected for the treatment of this tumor. During the surgical procedure, the basilar artery injury was injured, causing intense bleeding. We present and discuss the surgical maneuvers that could save a patient's life after this dramatic complication. Different techniques were performed in order to control the massive bleeding, including injection of hemotastic matrix with thrombin (Floseal©), bipolar coagulation, and vessel reconstruction by means of a vascular clip. Finally, an autologous muscle graft reinforced with an overlying fibrin sealant patch (Tachosil©) was chosen and was an effective technique. Afterwards, the patient was treated with a flow diverter device to occlude an iatrogenic pseudoaneurysm. A monoplegia of the right upper limb was the only remarkable sequel 6 mo after surgery. The muscle graft together with the coordinated action with interventional neuroradiology for the reconstruction of the vessel are possibly the best options to try to preserve the neurological function. In such a scenario, the assumption of potential ischemic events prevails over the intraoperative death of the patient.

Evaluation of a Minimally Invasive Bipolar Coagulation System for the Treatment of Grade I and II Internal Hemorrhoids.

Hemorrhoids are common and affect mainly the young and middle-aged populations. Current guidelines recommend treating grade I and II hemorrhoids with office-based procedures. These therapies usually require multiple applications. Hemorrhoid energy therapy treats the hemorrhoids at 1 treatment session. The purpose of this study was to evaluate the safety and efficacy of hemorrhoid energy therapy. This was a prospective pilot study evaluating patients with symptomatic grade I and II internal hemorrhoids. The study was conducted at a tertiary academic center. Patients over the age of 18 years with chronic, symptomatic grade I and II internal hemorrhoids who failed 2 weeks of conservative therapy were enrolled between July 2015 and January 2019. Exclusion criteria included patients with grade III or IV internal hemorrhoids, external hemorrhoids, nonhemorrhoidal GI bleeding, active proctitis, and IBD. Hemorrhoid energy therapy was administered in clinic, and 2 postprocedure visits were completed. A pretreatment hemorrhoid symptom score was obtained from each patient. A visual analog score was assessed posttreatment. The primary end point was to evaluate the effect of hemorrhoid energy therapy on hemorrhoid symptoms and its safety. The secondary end point was evaluation of postprocedural pain. A total of 35 patients were enrolled. The mean duration of hemorrhoid symptoms was 3.3 ± 6.4 years, and rectal bleeding and hemorrhoidal prolapse were the most common symptoms. After the procedure, patient hemorrhoid symptom scores decreased from mean 5.5 to 1.4. The mean immediate postprocedural visual analog score was 2.4 ± 2.1 and decreased to <1.0 after 14 days. The limitations include lack of comparative groups, single-center design, and small cohort of patients. The application of hemorrhoid energy therapy in the treatment of grade I and II internal hemorrhoids is safe and results in reduction of symptoms, low rate of short-term complications, and minimal pain. See Video Abstract at http://links.lww.com/DCR/B491. EVALUACIÓN DE UN SISTEMA DE COAGULACIÓN BIPOLAR MÍNI-INVASIVA PARA EL TRATAMIENTO DE HEMORROIDES INTERNAS GRADOS I Y II: La enfermedad hemorroidal es muy común y afecta principalmente poblaciones jóvenes y de mediana edad. Las guías actuales recomiendan tratar las hemorroides de grado I y II con procedimientos en el consultorio. Estos tratamientos suelen requerir múltiples aplicaciones. La aplicación de energía para tratar las hemorroides requiere de una sola sesión.Evaluar la seguridad y eficacia del tratamiento hemorroidal con una fuente de energía.Estudio piloto prospectivo que evalúa los pacientes con hemorroides internas de grado I y II sintomáticas.El estudio se realizó en un centro académico terciario.Entre julio de 2015 y enero de 2019 se inscribieron pacientes mayores de 18 años con hemorroides intomáticas internas crónicas grado I y II que fracasaron luego de 2 semanas de tratameinto conservador. Los criterios de exclusión incluyeron pacientes con hemorroides internas de grado III o IV, hemorroides externas, sangrado de orígen gastrointestinal no hemorroidal, proctitis activa y enfermedad inflamatoria intestinal.Se realizó la aplicación de energía sobre las hemorroides en el consultorio y se completó el procedimiento con dos visitas posteriores. Se obtuvo una puntuación analógica de síntomas hemorroidarios en cada paciente antes del tratamiento. Se evaluó la puntuación analógica visual luego del procedimiento.El principal criterio final fué evaluar el efecto de la terapia energética hemorroidaria con relación a los síntomas y la seguridad del dispositivo. El segundo criterio final fué el evaluar el dolor posoperatorio.Se registraron un total de 35 pacientes. La duración media de los síntomas hemorroidarios fué de 3,3 ± 6,4 años, el sangrado rectal y el prolapso hemorroidal fueron los síntomas más frecuentes. Después del procedimiento, las puntuaciones de los síntomas hemorroidarios disminuyeron en una media de 5,5 a 1,4. La puntuación analógica visual media inmediatamente posterior al procedimiento fue de 2,4 ± 2,1 y disminuyó a <1 después de 14 días.Las limitaciones incluyen la falta de grupos comparativos, el diseño de un solo centro y una pequeña cohorte de pacientes.La aplicación de energía como tratamiento de la enfermedad hemorroidal interna grado I y II es segura y da como resultados la reducción de los síntomas, una baja tasa de complicaciones a corto plazo y mínimo dolor. Consulte Video Resumen en http://links.lww.com/DCR/B491. (Traducción-Dr Xavier Delgadillo).

МОРФОЛОГИЧЕСКИЕ ИЗМЕНЕНИЯ ТКАНЕЙ ПРИ ПРИМЕНЕНИИ БИПОЛЯРНОЙ КОАГУЛЯЦИИ И НЕОДИМОВОГО ЛАЗЕРА В ГИНЕКОЛОГИИ

The article is devoted to a comparative analysis of morphological changes in the tissues of the reproductive system of women under the influence of a neodymium laser and bipolar coagulation during laparoscopic operations. The results of assessing the reliability of differences in morphometric indicators of tissue damage (sections of the fallopian tubes, fragments of ovarian tissue, membranes of benign cystic formations of the ovaries, leiomyomatous nodes of the body of the uterus) under the influence of electro magnetic radiation of various wavelengths are presented. The recorded changes directly depend both on the applied heat or light energy, and on the histological structure of the tissue under study. Fundamental differences in artifactual changes in tissues of the reproductive system were revealed when using bipolar coagulation and laser radiation in surgical practice, and the dependence of morphological changes on the wavelength of a neodymium laser was established for the first time.

Surgical Treatment for Serious Complications of Portal Biliopathy

Introduction: Surgical treatment for complication of portal biliopathy is an exception. It implies a high risk of bleeding given the prominent collaterals present in the hepatoduodenal pedicle secondary to portal cavernomatosis. Methods: Descriptive study of 4 patients who presented serious complications linked to portal biliopathy that required surgical management within the Clinical Hospital of Universidad Católica. Results: Woman 59 years, with necrohemorrhagic pancreatitis (1996), biliodigestive bypass (2001) and portal cavernomatosis (2004) was presenting repeated episodes of hemobilia, one with hypovolemic shock. A Warren's shunt was tried (2005), but it failed. Then, a choledochal devascularization and hepatic-jejunal re-anastomosis intervention was made. Man 57 years, with HIV positive and serious pancreatitis (2007), developed portal thrombosis post inflammatory and cavernomatosis and presented repeated cholangitis. Roux-en-Y reconstruction was made (2012). Woman 47 years, with V Leiden factor deficit and portal cavernomatosis (2012), presented repeated cholangitis. After multiple endoscopic stent treatments, given recurrence of cholangitis and jaundice, a Roux-en-Y biliary reconstruction was performed (2015). Man 47 years, with neonatal trombosis and cavernomatosis for omphalitis, had portal devascularization surgery made at 7 and 14 years old, he had repeated cholangitis despite multiple endoscopic attempts. Roux-en-Y was performed. All anastomosis was made in biliary conducts with multiple collateral veins that were handled with bipolar coagulation, ligatures and stiches. On the long term, none repeated episodes of hemobilia or cholangitis. Conclusion: The surgery could be a definite solution for portal biliopathy complications. However, it has only been made for selective cases because it implies high complexity and risk.

Pre-peritoneal tissue transfer: a novel laparoscopic and open surgical technique for resection margin and anastomotic reinforcement

Presenter: Casey J Ward MD | University of California, San Francisco Background: Vascularized tissue flaps are useful adjuncts in hepatopancreaticobiliary (HPB) surgery for both enteric and vascular anastomotic reinforcement. One of the most commonly used tissue flaps includes the ligamentum teres hepatis and falciform ligament. The aim of this video is to describe a novel technique, in both open and laparoscopic surgery, wherein the full pre-peritoneal fat pad is dissected in addition to the ligamentum teres hepatis. The supplementary vascularized and peritoneal tissue obtained by this technique can be utilized for a broad array of anastomotic and resection margin reinforcements. Methods: We performed a totally laparoscopic left lateral sectionectomy for a 73 year old male with a segment 2 hepatocellular carcinoma. We utilized a combination of laparoscopic harmonic scalpel, Bovie electrocautery, bipolar coagulation and 1.5-2.25mm laparoscopic staple loads in order to dissect our pre-peritoneal fat pad and perform our hepatic parenchymal transection. The pre-peritoneal fat pad was utilized to reinforce our hepatic resection margin and secured using endoclips. Results: After completion of a totally laparoscopic left lateral sectionectomy, the fully mobilized pre-peritoneal fat pad vascularized tissue flap is used to reinforce the hepatic resection margin under no tension. No drains were placed at the completion of the procedure. Routine follow-up CT scan showed no evidence of post-operative fluid collection and the patient was discharged home with no post-operative complications on post-operative day number five. Conclusion: We describe a novel surgical technique, for use in both open and laparoscopic surgery, wherein the full pre-peritoneal fat pad is dissected in addition to the ligamentum teres hepatis in order to provide supplementary vascularized and peritoneal tissue coverage for anastomotic and resection margin reinforcement.

Sutureless Excision of Benign Bartholin’s Gland Cyst using Hydrodissection and Bipolar Forceps Haemostasis

Aim: To avoid recurrence and scarring following surgical treatment, the present study demonstrated a sutureless excision of the Bartholin’s gland cyst or abscess using hydro-dissection and bipolar coagulation hemostasis. Materials and methods: In a retrospective case series, we studied consecutive cases who had received surgical treatment of the Bartholin’s gland cyst or abscess for benign indications in our private hospital. Results: Of the total 28 cases, Seven cases received incision and drainage of the Bartholin’s abscess, 21 cases underwent excision of Bartholin’s cyst or abscess by the described procedure using hydro-dissection and bipolar coagulation haemostasis.No suture was used for layer closure of the wound. There were no major intraoperative complications. All cases experienced less postoperative pain. Spontaneous apposition of the vaginal wound margins was observed 24 hours after operation in all cases. None of the cases developed a postoperative hematoma, severe cellulitis, or abscess of the operation site requiring readmission. Postoperative-ly, five cases developed postoperative pyrexia, that sub-sided with broad-spectrum antibiotics. None of the cases developed severe postoperative scarring at the operation site following sutureless excision. None of the cases complained of difficulty in sexual function after 6 weeks. The median operation time was 17 min (13–23 min). None of the 21 cases reported recurrence of the cyst or abscess. All those seven cases who received incision and drainage of Bartholin’s abscess developed recurrence. Conclusion: Sutureless excision of Bartholin’s gland cyst using hydro-dissection with bipolar coagulation hemostasis can be performed to avoid postoperative scarring and recurrence.

Effects of Two Anesthetic Methods on Stress Response to Laparoscopic Cholecystectomy of Elderly Patients

This paper aims to compare the effects of electrocoagulation and suture hemostasis on ovarian reserve function after laparoscopic ovarian cystectomy. According to the random double blind method, 220 patients who underwent laparoscopic ovarian cystectomy in our hospital between March 2014 and March 2016 were divided into two groups. 110 cases of observation group received suture hemostasis and 110 cases of control group received bipolar coagulation. Follicle stimulating hormone, luteinizing hormone, estradiol and antral follicle count were compared between the two groups at 1 mo and 3 mo after surgery respectively. 3 mo after the operation, the patients were follow up for ovulation and menstruation. The ovarian function of the two groups was compared. The results at 1 mo after operation showed that all the observation indexes of the two groups had a certain degree of improvement and there was significant statistical change (p<0.05) after the treatment (p>0.05). 3 mo after the operation, there was no significant difference in the observation group compared with the situation at 1 mo after the operation (p<0.05), but there was significant difference in the control group (p<0.05) and there was significant statistical significance between the two groups (p<0.05). For the observation group, abnormal ovulation, hypomenorrhea and prolonged menstrual period were less than those in the control group. There was statistical difference between the two groups (p<0.05). For patients receiving laparoscopic ovarian cystectomy, effect of suture hemostasis on ovarian function after surgery is less and there is a certain superiority compared with bipolar wound electrocoagulation. Thus, suture hemostasis is recommended as priority selection in the clinics.