Bipolar Coagulation Research Articles

Brainstem Pilocytic Astrocytoma, a Surgical Disease: 2-Dimensional Operative Video.

Brainstem pilocytic astrocytomas are benign lesions that frequently develop in the medulla with an often exophytic component.1-3 These lesions develop in children and young adults and are revealed by lower cranial nerves dysfunction and long tracts involvement. Medulla pilocytic astrocytomas have a better overall prognosis than pontine and midbrain lesions, particularly after surgical resection, which can be curative, allowing the control of the disease and avoiding adjuvant treatments in young patients.2-5 The transcondylar approach with mobilization of the vertebral artery offers the necessary ventral exposure for the resection of such medulla oblongata lesions.6 After exposure, the initial step of resection starts with the cerebellopontine angle occupying exophytic portion after identification of cerebrovascular landmarks. Ultrasonic aspiration on a low setting allows to progressively debulk the tumor and identify the normal medulla tissue while closely following the electrophysiological neuromonitoring. Preservation of the small medulla perforators is the key for successful resection, including minimal use of bipolar coagulation in the vicinity of brainstem tissue. We demonstrate these principles through the case of a 33-year-old woman presenting with a large left medulla oblongata exophytic tumor, with an MRI presentation consistent with pilocytic astrocytoma. The patient consented to the procedure and publication of her images.

Comparison of operative outcomes between monopolar and bipolar coagulation in hepatectomy: a propensity score-matched analysis in a single center

BackgroundVarious hemostatic devices have been utilized to reduce blood loss during hepatectomy. Nonetheless, a comparison between monopolar and bipolar coagulation, particularly their usefulness or inferiority, has been poorly documented. The aim of this study is to reveal the characteristics of these hemostatic devices.MethodsA total of 264 patients who underwent open hepatectomy at our institution from January 2009 to December 2018 were included. Monopolar and bipolar hemostatic devices were used in 160 (monopolar group) and 104 (bipolar group) cases, respectively. Operative outcomes and thermal damage to the resected specimens were compared between these groups using propensity score matching according to background factors. Multivariate logistic regression analysis was performed to identify predictive factors for postoperative complications.ResultsAfter propensity score matching, 73 patients per group were enrolled. The monopolar group had significantly lower total operative time (239 vs. 275 min; P = 0.013) and intraoperative blood loss (487 vs. 790 mL; P < 0.001). However, the incidence rates of ascites (27.4% vs. 8.2%; P = 0.002) and grade ≥ 3 intra-abdominal infection (12.3% vs. 2.7%; P = 0.028) were significantly higher in the monopolar group. Thermal damage to the resected specimens was significantly longer in the monopolar group (4.6 vs. 1.2 mm; P < 0.001). Use of monopolar hemostatic device was an independent risk factor for ascites (odds ratio, 5.626, 95% confidence interval 1.881–16.827; P = 0.002) and severe intra-abdominal infection (odds ratio, 5.905, 95% confidence interval 1.096–31.825; P = 0.039).ConclusionsAlthough monopolar devices have an excellent hemostatic ability, they might damage the remnant liver. The use of monopolar devices can be one of the factors that increase the frequency of complications.

The Effect of High-Quality Nursing Management on Thyroid Tumor Patients after Bipolar Coagulation.

Objective To evaluate the effect of high-quality nursing on thyroid tumor patients after bipolar coagulation and its impact on nursing satisfaction. Methods From January 2019 to January 2020, 90 patients with thyroid tumors treated with bipolar coagulation in our hospital were identified as the study objects and randomized to the control group (n = 45) and the experimental group (n = 45) random number table method. Both groups received conventional nursing, and the experimental group additionally adopted high-quality nursing. The incidence of postoperative complications and nursing satisfaction between the two groups was compared. The Exercise of Self-Care Agency Scale (ESCA) was used to assess the self-care ability of patients after the intervention, and the Generic Quality of Life Inventory-74 (GQOLI-74) was used to evaluate the quality of life of the two groups of patients after the intervention. The Hospital Anxiety and Depression (HAD) scale was adopted to evaluate the emotional state of the patient before and after the intervention, and the Numerical Rating Scale (NRS) was employed to evaluate the pain intensity of the patient after the intervention. Counting data was analyzed by the X2 test, and the measurement data was analyzed by t-test. Results After the intervention, the total incidence of postoperative complications in the experimental group was significantly lower than that in the control group (11.11% versus 33.33%, P < 0.05). The experimental group obtained remarkably higher nursing satisfaction (93.33% versus 71.11%), ESCA scores, and GQOLI-74 scores than the control group (P < 0.05). Lower HAD scores were observed in the experimental group than those of the control group (P < 0.001). Lower HAD scores were observed in the experimental group than those of the control group (P < 0.001). The NRS score of the experimental group was significantly lower than that of the control group 12 h and 24 h after the intervention (P < 0.001). Conclusion High-quality nursing for patients with thyroid tumors can effectively alleviate the negative emotions, improve the quality of life, and contribute to a harmonious nurse-patient relationship, which is worthy of promotion and application.

Twin-Twin Transfusion Syndrome (TTTS) in dichorionic-diamnionic twin pregnancy: A case report

Twin-to-Twin Transfusion Syndrome (TTTS) is a serious complication of twin pregnancy, which develops in approximately 10 to 15 percent of monochorionic twin pregnancies while it is very rare in dichorionic pregnancies. At present, fetal laser surgery has become the preferred treatment for stage II to IV TTTS. It has been reported that fetal laser therapy after early diagnosis of TTTS can improve neonatal outcome. From May 2018 to December 2021, there are a total of 140 cases which underwent fetoscopic laser surgery in the Third Affiliated Hospital of Zhengzhou University. Among them, one case of twin-twin transfusion syndrome was dichorionic twins. The patient with dichorionic-diamnionic twin pregnancy was diagnosed with TTTS Stage II at 23 weeks and 4 days of Gestational Age (GA). After fetoscopic laser surgery and bipolar coagulation, the patient delivered vaginally two viable male infants at 31 weeks GA. Follow-up showed that the two infants survived. Keywords: TTTS; dichorionic twins; fetoscopic; placenta

Outcome of Monochorionic Pregnancies after Selective Feticide with Bipolar Cord Coagulation: A German Single Center Experience.

Objectives: To review the outcome of complicated monochorionic pregnancies after fetoscopic selective feticide with bipolar cord coagulation in an experienced German center. Methods: All cases that underwent selective feticide using fetoscopic bipolar umbilical cord occlusion (and simultaneous dissection in monoamniotics) at the University of Bonn in the past 10 years were retrospectively analyzed for antenatal and neonatal course and outcome. An adverse outcome was defined as either intrauterine death (IUD), neonatal death (NND), preterm prelabour rupture of membranes (PPROM), or preterm delivery (PTD) before 32.0 weeks of gestation. Results: We diagnosed 56 monochorionic pregnancies, including 43 diamniotic and 8 monoamniotic twins, as well as 5 triplets, complicated by discordant fetal anomalies (n = 10), selective intrauterine growth restriction (n = 29), twin-to-twin transfusion syndrome (n = 13), twin reversed arterial perfusion sequence (n = 3), or severe early twin anemia polycythemia sequence (n = 1), that underwent fetoscopic selective feticide in the 10 years study period. Selective feticide was performed by bipolar cord coagulation at a median gestational age of 21.2 weeks. PPROM occurred in 11 cases, 7 (12.5%) before 32.0 weeks and 4 (7.1%) between 34.0 and 36.0 weeks, respectively. There were five (8.9%) co-twins IUDs at a median of 2 weeks after the intervention. We observed 12 (21.4%) PTDs before 32.0 weeks of gestation and 2 (3.6%) NNDs. Mean gestational age at delivery was 37.1 weeks, with an overall survival of the co-twin of 87.5%. Conclusion: In experienced hands, fetoscopic selective feticide is an effective treatment in complicated monochorionic pregnancies. By sacrificing a sick fetus that jeopardizes the entire pregnancy, a higher survival rate of the co-twin can be achieved.

Twin reversed arterial perfusion sequence managed by bipolar cord coagulation and amniopatch: Case report.

Introduction and importanceTwin Reversed Arterial Perfusion (TRAP) Sequence is a rare condition that occurs in monochorionic twin pregnancies, resulting in the coexistence of a normal “pump” twin and an acardiac twin. Indonesia is implementing fetal therapy centers that are starting to treat fetal cases such as TRAP Sequence.Case presentationAn 18 years old pregnant woman with monochorionic diamniotic pregnancy was detected by ultrasonographic examination. A live fetus with normal fetal heart rate estimated fetal weight was 661 g, and consistent with 25 w gestational age. Additionally, an acardiac twin with polyhydramnios and EFW of 1829 g. Bipolar cord coagulation, amniopatch, and amnioinfusion were performed. The patient's condition was stable and managed closely.Clinical discussionThis is the first procedure reported in Indonesia for TRAP sequence case. It reduces cardiac strain on the pump twin and increases the chance of survival.ConclusionThe patient was diagnosed with TRAP Sequence and bipolar cord coagulation to interrupt blood supply to the non-viable twin, amniopatch with autologous platelet concentrate followed by cryoprecipitate amnioinfusion were reported for the first time in Indonesia.

Combining Pre-operative Diffusion Tensor Images and Intraoperative Magnetic Resonance Images in the Navigation Is Useful for Detecting White Matter Tracts During Glioma Surgery.

PurposeWe developed a navigation system that superimposes the fractional anisotropy (FA) color map of pre-operative diffusion tensor imaging (DTI) and intraoperative magnetic resonance imaging (MRI). The current study aimed to investigate the usefulness of this system for neurophysiological monitoring and examination under awake craniotomy during tumor removal.MethodA total of 10 glioma patients (4 patients with right-side tumors; 5 men and 5 women; average age, 34 years) were evaluated. Among them, the tumor was localized to the frontal lobe, insular cortex, and parietal lobe in 8, 1, and 1 patient, respectively. There were 3 patients who underwent surgery on general anesthesia, while 7 patients underwent awake craniotomy. The index of DTI anisotropy taken pre-operatively (magnetic field: 3 tesla, 6 motion probing gradient directions) was analyzed as a color map (FA color map) and concurrently co-registered in the intraoperative MRI within the navigation. In addition to localization of the bipolar coagulator and the cortical stimulator for brain mapping on intraoperative MRI, the pre-operative FA color map was also concurrently integrated and displayed on the navigation monitor. This white matter nerve functional information was confirmed directly by using neurological examination and referring to the electrophysiological monitoring.ResultsIntraoperative MRI, integrated pre-operative FA color map, and microscopic surgical view were displayed on one screen in all 10 patients, and white matter fibers including the pyramidal tract were displayed as a reference in blue. Regarding motor function, motor-evoked potential was monitored as appropriate in all cases, and removal was possible while directly confirming motor symptoms under awake craniotomy. Furthermore, the white matter fibers including the superior longitudinal fasciculus were displayed in green. Importantly, it was useful not only to localize the resection site, but to identify language-related, eye movement-related, and motor fibers at the electrical stimulation site. All motor and/or language white matter tracts were identified and visualized with the co-registration and then with an acceptable post-operative neurological outcome.ConclusionCo-registering an intraoperative MR images and a pre-operative FA color map is a practical and useful method to predict the localization of critical white matter nerve functions intraoperatively in glioma surgery.

Evaluation of Bone Wax Coated Bipolar Coagulation Forceps: Performance and Safety Assessment.

BackgroundImproving the performance of bipolar coagulation forceps is crucial for safer and more accurate neurosurgery. In our department, we found that bone wax (BW) melted by thermal effect of bipolar electrocoagulation can achieve more efficient hemostasis and reduce the amount of BW in neurosurgical procedures associated with bleeding from emissary and diploic veins. Nevertheless, relevant studies are still lacking to verify our finding.ObjectiveThe study objectives were to evaluate the performance and safety in electrocoagulation: (1) compare the performance of BW coated bipolar coagulation forceps and the conventional anti-stick forceps in vivo, and (2) assess the safety of electrocoagulation with BW coated bipolar coagulation forceps in rat primary motor cortex.MethodsTissue adhesion was evaluated by comparing the wetting tension and the amount of protein adhered to the forceps tips after electrocoagulation. Thermal damage was assessed by analyzing the thermography and H&E staining of coagulated rat brain tissues. The hemostatic efficiency was reflected by the number of electrocoagulation until complete hemostasis and the condition of damaged common carotid arteries. The safety of BW coated forceps in electrocoagulation was assessed by evaluating the inflammation of coagulated rat primary motor cortex and the motor functions at the 7th day postoperatively.ResultsBone wax coated forceps had a significantly higher contact angle and adhered less coagulum. Thermography was acquired at 3 s, 6 W units in rat primary motor cortex in vivo. The highest temperature recorded during BW coated tips application was significantly lower than the uncoated. In addition, there was a relatively smaller tissue injury area produced by the BW coated forceps. Additionally, BW coated forceps improved the hemostatic efficiency and caused fewer injuries on the damaged arteries (3 s, 10 W units). More importantly, electrocoagulation with BW coated forceps led to no significant motor function impairments and less glial and microglia responses.ConclusionThis study reveals that BW coated bipolar coagulation forceps can provide a convenient, cost-efficient, safer, and more efficient way for hemostasis. More research is needed to evaluate the electrocoagulation with BW in the long term and verify our finding in human beings.

Collagen sponge is as effective as autologous fat for grade 1 intraoperative cerebral spinal fluid leakage repair during transsphenoidal surgery

ObjectiveTo compare the efficacy of collagen sponge graft versus autologous fat graft in repairing grade 1 intraoperative CSF leakage and identify potential risk factors for failure repairing. MethodsWe retrospectively recruited patients with grade 1 intraoperative CSF leakage repaired either with a collagen sponge (Group A), with autologous fat graft (Group B), or with only bipolar coagulation and gel foam packing (Group C). Patients with previous radiotherapy, repaired with additional materials, received postoperative lumbar drainage or without sufficient follow-up data were excluded. The primary outcome was the incidence of postoperative CSF leakage. We used propensity score matching to adjust for confounding when comparing Group A and Group B. Results459 patients (277 female and 182 male) were recruited. Among them, 296 patients were in Group A, 146 patients were in Group B, and the other 17 patients were in Group C. After propensity score matching, 146 and 146 patients were included in group A and group B, respectively. No difference was observed for the primary outcome in the matched cohort (p = 0.654) with three patients in Group A (1.0% and 2.1% before and after matching, respectively) and two patients in Group B (1.4% and 1.4% before and after matching, respectively) developed postoperative CSF leakage, respectively. Patients repaired only with gel foam and/or bipolar coagulation (OR 770.5, p < 0.001) and older age (OR 1.16, p < 0.001) were associated with a higher likelihood of postoperative CSF leakage. ConclusionsCollagen sponge is as effective as an autologous fat graft for grade 1 intraoperative CSF leakage repair during transsphenoidal surgery. Repair with gel foam and/or bipolar coagulation and older age are associated with a higher likelihood of postoperative CSF leakage.

Piezo-assisted Turbinoplasty Versus Partial Turbinectomy in External Septorhinoplasty: A Prospective Comparative Study in 100 Patients

The purpose of this study was to compare the outcome of the piezo-assisted turbinoplasty with a partial turbinectomy technique in the treatment of chronic nasal obstruction due to inferior turbinate enlargement. This is a prospective randomized single-center study in a cohort of 100 consecutive patients which underwent external septorhinoplasty and concomitant hybrid type of turbinoplasty. Patients were randomly assigned into two groups. The first group included 50 patients who underwent piezo-assisted outfracturing of the inferior turbinates in combination with bipolar coagulation. The second group included 50 patients who underwent a treatment based on turbinate bipolar coagulation and partial resection of the inferior border of the turbinate. The severity of nasal obstruction was measured in both patient groups with a patient-related outcome questionnaire (NOSE) and objective measures (anterior rhinomanometry and acoustic rhinometry). Assessments were conducted prior to surgery and 3 months after the surgery. There was a significant improvement in the values of the NOSE questionnaire with no relevant difference between the two study groups. Acoustic rhinometry and rhinomanometry also showed no statistically significant differences between the two study groups. No differences in postoperative healing were found, and postoperative complications were comparable low in both groups. However, the piezo-assisted procedure was quicker to perform with only minimal bleeding. During septorhinoplasty, the combination of thermo-coagulation with piezo-assisted turbinoplasty was as efficient as with partial turbinectomy to establish normal nasal breathing. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Usefulness of Oxidized Regenerated Cellulose Powder in stopping bleeding during laparoscopic ovarian cystectomy to protect ovarian reserve

Objective: The treatment strategy for ovarian tumors is often uncertain when a patient wishes to have children. Especially in the case of endometriotic cysts, although pre-assisted reproductive technology ovarian cystectomy does not improve the live birth rate, surgery may be selected considering the symptom and the infertility treatment course. In such cases, it is necessary to pay attention to selecting the hemostatic method for ovarian reserve. It has been reported that hemostasis with suture / hemostatic sealant has a smaller decrease in serum anti-Müllerian hormone (AMH) level than with bipolar coagulation. We focused on this method using a hemostatic sealant.

A Case of Recurrent Massive Secondary Postpartum Haemorrhage following Caesarean Section Due to the Eroded Left Uterine Artery Sealed by Laparoscopic Bipolar Coagulation

Background: Recurrent massive secondary postpartum haemorrhage (PPH) due to uterine wound dehiscence with uterine artery erosion following LSCS causes management challenges.

Selective Reduction in Complicated Monochorionic Pregnancies: A Systematic Review and Meta-analysis of Different Techniques

This systematic review and meta-analysis aims to compare the perinatal outcomes of complicated monochorionic (MC) pregnancies after selective reduction by radiofrequency ablation (RFA), bipolar cord coagulation (BCC) and interstitial laser (IL).

QOLP-25. PERFORMANCE STATUS OF PEDIATRIC PATIENTS WITH CENTRAL NERVOUS SYSTEM TUMORS TREATED IN A TERTIARY CENTER IN MEXICO, A SINGLE-CENTER EXPERIENCE

Abstract BACKGROUND Central nervous system (CNS) tumors are the most common solid neoplasms in the pediatric age. Despite this, there are no reports of results focused on the performance status of pediatric patients who are treated in a multidisciplinary setting. OBJECTIVE Describe the Performance Status of CNS pediatric patients after being treated with a multidisciplinary approach in a tertiary center. METHODS We review the chart of the pediatric patients at the Teleton Children Oncology Hospital from December 2014 to December 2019. The performance status was evaluated either using ECOG, Karnofsky, or Lansky scores. The multidisciplinary approach at our hospital includes: A Well-Equipped Diagnostic Center, integrated by a CAP-accredited laboratory, a Molecular Biology Unit, and the Imaging Unit, including a high-quality 2 tesla MRI. The surgical equipment comprises a surgical microscope, bipolar coagulation equipment, microsurgical instruments, and craniotomy equipment. For deep biopsies or functional surgery, we use Frame-Based Stereotactic Systems (FBSS) and neuronavigation systems. We provide first-line chemotherapy protocols and have a radiotherapy unit that can start treatment within a week. We have an Intensive Care Unit for oncologic patients with a 93% of overall survival. We provide ludic therapy and cognitive behavioral therapy, as well as emotional support. The Physical Rehabilitation Clinic uses the Bobath concept, proprioceptive and neuromuscular techniques as well as follow-up visits according to needs. RESULTS Of the 56 patients treated, 35 were evaluated with ECOG/Lansky performance status scale during the last follow up visit, resulting in 74.2% with a fully active performance, able to carry on all pre-disease activities without restriction. CONCLUSION A multidisciplinary approach is essential in the management of pediatric patients with CNS tumors. Efforts should be aimed at reducing post-surgical morbidity and early rehabilitation to reintegrate patients into society in the long term as we described many of them have an excellent performance status.

The Strategy of Facial Nerve Preservation in Acoustic Neuroma Surgery via Suboccipital Retrosigmoid Approach

Acoustic neuroma is a common intracranial tumor, with a prevalence of 80~90% in the lesions of cerebellopontine angle. Microsurgical removal remains its main therapy, and the retrosigmoid approach continues to be the most widely employed strategy for the surgical resection of acoustic neuromas, with preservation of facial nerve to be the important goal. In order to preserve the facial nerve, the facial nerve's function should be evaluated accurately before and after the operation. The course of the facial nerve and its variation in cerebellopontine cistern and internal auditory canal should be well understood. Adequate drilling of the posterior wall of the internal auditory canal is necessary. Sufficient decompression of intracranial pressure and the tumor is imperative. The principle of subperineural and bidirectionary dissection should be followed. The use of bipolar coagulation should decrease to the greatest extent, and facial nerve monitoring should be used throughout exposing and removal of the acoustic neuroma.

Cinelaparoscopy - the Remarkable Early Progress in Video-Documentation of Laparoscopic Surgery.

Study Objective Historical presentation of Cinelaparoscopy to document surgery and educate physicians and patients in minimally invasive gynecologic surgery (MIGS). Design Presentation of an award-winning paper on the utilization of the technique in MIGS. Setting Armed Forces Hospital. Patients or Participants Case reports of gynecologic patients opting for minimally invasive gynecologic surgery. Interventions Developing and utilizing the equipment, including 8mm cameras, to document laparoscopic gynecologic surgery. Measurements and Main Results An 8mm movie camera was attached to a laparoscope to document gynecologic procedures including ovarian biopsy, retrieval of an intrauterine device (IUD) that had perforated the uterus, monopolar Fallopian tube coagulation for sterilization and survey of the pelvis, appendix, intestines, liver and gall bladder. After the film was developed, it was edited and spliced for presentation at a national meeting of obstetricians and gynecologists. One can imagine the excitement that the pioneers in MIGS experienced when seeing these films. Metaphorically, the world of MIGS experienced "Moore's Law" in the 1970′s with the rapid development of safer techniques, better instrumentation, bipolar coagulation devices, improved optics, and innovative performances of standard gynecologic procedures, e.g., Laparoscopic Hysterectomy. Conclusion This award-winning presentation was instrumental in the planning, the documentation, and the distribution of the 1976 and 1977 Hawai'i AAGL endoscopic teaching videos. Those videos increased the awareness of MIGS, spurred the development of MIGS procedures, and encouraged the promulgation of MIGS as the preferred route of most gynecologic surgery. Historical presentation of Cinelaparoscopy to document surgery and educate physicians and patients in minimally invasive gynecologic surgery (MIGS). Presentation of an award-winning paper on the utilization of the technique in MIGS. Armed Forces Hospital. Case reports of gynecologic patients opting for minimally invasive gynecologic surgery. Developing and utilizing the equipment, including 8mm cameras, to document laparoscopic gynecologic surgery. An 8mm movie camera was attached to a laparoscope to document gynecologic procedures including ovarian biopsy, retrieval of an intrauterine device (IUD) that had perforated the uterus, monopolar Fallopian tube coagulation for sterilization and survey of the pelvis, appendix, intestines, liver and gall bladder. After the film was developed, it was edited and spliced for presentation at a national meeting of obstetricians and gynecologists. One can imagine the excitement that the pioneers in MIGS experienced when seeing these films. Metaphorically, the world of MIGS experienced "Moore's Law" in the 1970′s with the rapid development of safer techniques, better instrumentation, bipolar coagulation devices, improved optics, and innovative performances of standard gynecologic procedures, e.g., Laparoscopic Hysterectomy. This award-winning presentation was instrumental in the planning, the documentation, and the distribution of the 1976 and 1977 Hawai'i AAGL endoscopic teaching videos. Those videos increased the awareness of MIGS, spurred the development of MIGS procedures, and encouraged the promulgation of MIGS as the preferred route of most gynecologic surgery.

Comparison of the effect of bipolar coagulation and fibrillar structured oxidized cellulose on formation epidural fibrosis in rats

Background/aim Epidural fibrosis (EF) is a common cause of failed back surgery syndrome seen after spinal surgeries. The most frequent reason for the formation of EF is accumulated blood and its products in the operation zone. On the development of EF, the effect of bipolar coagulation and fibrillar oxidized cellulose, which are used frequently to control bleeding, was investigated.Materials and methodsIn the study, 45 male Sprague Dawley rats were divided into three groups (control, fibrillar, and bipolar). Lumbar laminectomy was applied to all rats under sterile conditions. In the control group, the epidural area was washed with saline solution. Bleeding was controlled with fibrillar oxidized cellulose in the fibrillar group, with bipolar coagulation in the bipolar group. The area to which laminectomy had been applied was removed as a block 6 weeks later and evaluated histopathologically and genetically in terms of EF development. Fibrosis degree was determined histopathologically by counting fibroblasts using the modified Lubina and EF He grading systems. Interleukin-6 (IL-6), transforming growth factor beta-1 (TGFβ-1), and mRNA levels were measured by the droplet digital polymerase chain reaction method.ResultsThe number of epidural fibroblasts, percentage of modified Lubina, amount of IL-6, and He grading rates were significantly lower in the fibrillar group than in the bipolar and control groups (p ˂ 0.05). On the other hand, there was no significant difference among the control, fibrillar, and bipolar groups in terms of TGFβ-1 values (p= 0.525).ConclusionThe use of fibrillar oxidized cellulose was more effective for hemostasis than bipolar coagulation in reducing the development of EF.

Development and validation of the metric-based assessment of a robotic vessel dissection, vessel loop positioning, clip applying and bipolar coagulation task on an avian model.

The evolution of robotic technology and its diffusion does not seem to have been adequately accompanied by the development and implementation of surgeon training programs that ensure skilled and safe device use at the start of the learning curve. The objective of the study is to develop and validate performance metrics for vessel dissection, vessel loop positioning, clip applying and bipolar coagulation using an avian model. Three robotic surgeons and a behavioral scientist characterized the performance metrics of the task according to the proficiency-based progression methodology. Fourteen experienced robotic surgeons from different European countries participated in a modified online Delphi consensus. Eight experienced surgeons and eight novices performed the robotic task twice. In the Delphi meeting, 100% consensus was reached on the performance metrics. Novice surgeons took 26min to complete the entire task on trial 1 and 20min on trial 2. Experts took 10.1min and 9.5min. On average the Expert Group completed the task 137% faster than the Novice Group.The amount of time to reach the vessel part of the task was also calculated. Novice surgeons took 26min on trial 1 and 20min on trial 2. Experts took 5.5min and 4.8min. On average the experts reached the vessel 200% faster than the novices. The Expert Group made 155% fewer performance errors than the Novice Group. The mean IRR of video-recorded performance assessments for all metrics was 0.96 (95% confidence intervals (CI) lower = 0.94-upper = 0.98). We report the development and validation for a standard and replicable basic robotic vessel dissection, vessel loop positioning, clip applying and bipolar coagulation task on an avian model. The development of objective performance metrics, based on a transparent and fair methodology (i.e., PBP), is the first fundamental step toward quality assured training. This task developed on the avian model proved to have good results in the validation study.

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.