Bipolar Energy Research Articles

Hysteroscopy in an outpatient setting–38 months experience

INTRODUTION: Hysteroscopy is one the main diagnostic and therapeutic tools of modern Gynecology, allowing a direct visualization of the uterine cavity for diagnosis and minimally invasive intervention with sampling or removal of any structural abnormalities. At our unit office-based diagnostic hysteroscopy is not available; as such the pre-operative imaging diagnosis is largely based on transvaginal or pelvic ultrasound, often with hysterosonography. OBJECTIVE: Evaluate de correlation between the pre-operative diagnosis, hysteroscopic findings, and histological analysis, concerning all hysteroscopies performed at our Outpatient Surgery Unit during 38 months of activity. METHODS: The authors performed a retrospective study based on the review of medical files from patients who underwent hysteroscopic procedures at our institution's Outpatient Surgery Unit from November 1st 2012 to December 31st 2015. RESULTS: During the study period 644 hysteroscopies were performed, all under sedation. The patients’ average age was 55 years (27 to 87), 60% were post-menopausal and 77% presented co-morbidities, 8% having a history of breast cancer with current or previous treatment with tamoxifen. All patients had an ultrasound evaluation, 66% at our ultrasound unit (55% with hysterosonography). The main indications for hysteroscopy were: suspected post-menopausal asymptomatic polyps (34%); suspected pre-menopausal polyps (31%); suspected post-menopausal symptomatic polyps (12%); post-menopausal endometrial thickening (12%); retained trophoblastic products (2%). The main findings were: endometrial polyp(s) (70%); endometrial thickening/irregularities (6%); polypoid/secretory endometrium (2%); submucosal leiomyoma (1,2%); suspicious vegetative formations (0,5%); no abnormalities, normal endometrium (11%). Cervical dilation was used in 14% of the procedures; in 0,8% the endometrial cavity was not accessed due to cervical stenosis. Globally, intra-operative findings were concordant with the presumptive diagnosis by ultrasound in 77% of cases, 82% when hysterosonography was previously used. Bipolar energy was used in 39% of the operative procedures; curettage was performed in 37% of the cases. There was four cases of endometrial adenocarcinoma and two of complex hyperplasia with atypia. The diagnosed complications were: uterine perforation (n = 5); bowel injury (n = 1); moderate uterine bleeding (n = 3). CONCLUSION: The indications and complications rate were similar to other centers described in literature. The previous detailed ultrasound study with hysterosonography resulted in a high rate of agreement between the presumptive diagnosis and intra-operative findings, resulting in a more accurate referral to operative hysteroscopy and obviating a previous diagnostic hysteroscopy. This strategy has been previous advocated by other authors, which reduces the number of hysteroscopies per patient, and is particularly relevant in centers without the possibility of office-based procedures.

Design Improvement For Preventing Discharge During Fabrication Of Electrostatic Energy Harvester

This paper reports an improvement of structure design of bipolar charged electret energy harvester to prevent an electrical discharge during a corona charging process on electret. We confirmed that differential output power of 33μW is obtained with 8.8 g at 350 Hz sinusoidal vibration from the developed device. By using a commercially available power management IC, regulated voltage of 1.8 V is properly obtained and can drive a load resistance more than 500 kΩ.

Needleoscopic Conservative Staging of Borderline Ovarian Tumor

Study ObjectiveTo investigate the safety and technical feasibility of needleoscopic fertility-sparing staging of borderline ovarian tumors. DesignVideo article and review of the literature (Canadian Task Force classification Level III). SettingThis 29-year-old woman had a right ovarian cyst suspicious for borderline ovarian tumor on preoperative magnetic resonance imaging and ultrasound showing the presence of a right unilocular ovarian cyst with a papillary projection. Informed consent for abdominal or laparoscopic approach was obtained from the patient in accordance with the local legislation. The patient also provided informed consent to use images and videos of the procedure. Institutional Review Board approval was not required for this kind of procedure. InterventionsTreatment involved conservative staging with right ovarian cystectomy, peritoneal biopsies, infracolic omental biopsy, and peritoneal cytology. Instrumentation included two 2.4-mm needleoscopic instruments. The total operative time was 62 minutes, and estimated blood loss was <10 mL. No intraoperative complications were recorded. At the end of the surgical procedure, the outer diameter of the incision was increased by only up to 3 mm. The patient was discharged the day after the procedure. Histopathological analysis confirmed a serous borderline ovarian tumor.A 30 days postoperative follow-up, a satisfactory cosmetic result was reported by both the patient (score of 10 of out of a possible 10) and the surgeon (10 of 10). ConclusionTo the best of our knowledge, there are no previously published reports of needleoscopic treatment of borderline ovarian tumor, which represents a great challenge for ultra-minimally invasive approaches [1-3]. Based on our initial experience, the needleoscopic instruments could prove to be a beneficial tool in adnexal benign or borderline disease. At present, only a hybrid operative setting should be considered to overcome the lack of bipolar energy [4-6]. Further studies are needed to define the benefits, advantages, and costs of this novel approach.

LAPAROSCOPICALLY ASSISTED ANORECTOPLASTY AND THE USE OF THE BIPOLAR DEVICE TO SEAL THE RECTAL URINARY FISTULA.

ABSTRACTBackground: The anorectal anomalies consist in a complex group of birth defects. Laparoscopic-assisted anorectoplasty improved visualization of the rectal fistula and the ability to place the pull-through segment within the elevator muscle complex with minimal dissection. There is no consensus on how the fistula should be managed. Aim: To evaluate the laparoscopic-assisted anorectoplasty and the treatment of the rectal urinary fistula by a bipolar sealing device. Method: It was performed according to the original description by Georgeson1. Was used 10 mm infraumbilical access portal for 30º optics. The pneumoperitoneum was established with pressure 8-10 cm H2O. Two additional trocars of 5 mm were placed on the right and left of the umbilicus. The dissection started on peritoneal reflection using Ligasure(r). With the reduction in the diameter of the distal rectum was identified the fistula to the urinary tract. The location of the new anus was defined by the location of the external anal sphincter muscle complex, using electro muscle stimulator externally. Finally, it was made an anastomosis between the rectum and the new location of the anus. A Foley urethral probe was left for seven days. Results: Seven males were operated, six with rectoprostatic and one with rectovesical fistula. The follow-up period ranged from one to four years. The last two patients operated underwent bipolar sealing of the fistula between the rectum and urethra without sutures or surgical ligation. No evidence of urethral leaks was identified. Conclusion: There are benefits of the laparoscopic-assisted anorectoplasty for the treatment of anorectal anomaly. The use of a bipolar energy source that seals the rectal urinary fistula has provided a significant decrease in the operating time and made the procedure be more elegant.

Techno-Economic Modeling and Analysis of Redox Flow Battery Systems

A techno-economic model was developed to investigate the influence of components on the system costs of redox flow batteries. Sensitivity analyses were carried out based on an example of a 10 kW/120 kWh vanadium redox flow battery system, and the costs of the individual components were analyzed. Particular consideration was given to the influence of the material costs and resistances of bipolar plates and energy storage media as well as voltages and electric currents. Based on the developed model, it was possible to formulate statements about the targeted optimization of a developed non-commercial vanadium redox flow battery system and general aspects for future developments of redox flow batteries.

Efficacy and Safety of Combined Ultrasonic and Bipolar Energy Source in Laparoscopic Surgery

AimEnergy devices represent an alternative to clips and staplers for vessel sealing. Outcome data of patients undergoing laparoscopic surgery with use of a novel combined ultrasonic and bipolar energy device (TB, Thunderbeat™) was gathered. MethodsConsecutive patients undergoing laparoscopic surgery using TB were prospectively included between November 2011 and January 2016. Large vessels were dissected using the energy device without additional clips or staplers. The type of procedure, operative time, length of stay, complications, blood transfusions, number and type of vessels being dissected, and need for additional clips were noted. ResultsSix hundred eighty-three patients underwent 758 procedures with dissection of 1310 large vessels. No additional hemoclips or vascular staplers were used. There were 0.7 % (5/758) intraoperative and 2.6 % (20/758) postoperative bleeding complications. Eleven bleeding occurred at the stapler line of anastomosis, leaving 1.8 % (14/758) bleeding that were potentially related to inadequate hemostasis. Failure of large vessel dissection occurred in two cases (0.15 %, 2/1310) and device-related complications in 1.1 % (8/758). Two of 42 conversions (5.5 %) were bleeding-related. ConclusionTB provides a reliable and effective hemostasis. However, ligation failure may occur. As with any kind of electrosurgery, the hot tip of the instruments bears the risk of potentially fatal thermal injuries.

Laparoscopic Management of Heterotopic Istmocornual Pregnancy: A Different Technique

Study ObjectiveTo present a modified technique for laparoscopic cornual resection for the surgical treatment of heterotopic istmocornual pregnancy. DesignA step-by-step explanation of the surgery using video (Canadian Task Force Classification III-c). SettingHeterotopic pregnancy is the coexistence of pregnancy in both the intrauterine and extrauterine sides. The incidence is 1 in 30 000 in spontaneous pregnancies; however, the incidence increased to 1 in 100 to 1 in 500 pregnancies with the increasing number of artificial reproductive technologies [1,2]. Although management is controversial, there are 2 main approaches classified as surgical and nonsurgical. The administration of potassium chloride, methotrexate, and/or hyperosmolar glucose is a nonsurgical intervention; however, there are some limitations such as systemic side effects and the possible adverse effect on a live fetus [1–3]. For this reason, surgical intervention involving cornual resection is the main treatment option. Case ReportA 32-year-old patient was admitted to our clinic with sudden-onset pain at the left groin. She was at the 11th week of gestation. She had a diagnosis of infertility for 7 years, and she became pregnant after an in vitro fertilization cycle. At sonographic examination, 2 gestational sacs were detected, 1 with a live fetus settled into the uterus and the second (20-mm length) on the left cornual side without a yolk sac and embryo and the left adnexa accompanied with coagulated blood. Immediate laparoscopic surgery was planned. At the laparoscopic exploration, left istmocornual pregnancy that was ruptured and bleeding were observed. We performed a modified technique for laparoscopic cornual resection in which the uterine corn was tightened with the noose twice, and the corn was sutured circularly to avoid excessive bleeding. Initially, the mesosalpinx was coagulated and transected with bipolar energy. Afterward, the uterine corn was tightened with the noose twice, and the fallopian tube was removed. To reduce the bleeding during remnant cornual tissue extraction, a permanent 0 monofilament suture was passed deep into the myometrium and tightened to achieve better hemostasis. Then, the remnant cornual tissue was extracted with harmonic scissors, and the uterine wound was repaired with continuous suture to reduce the risk of uterine rupture during the ongoing pregnancy. Depot progesterone was administered just before the surgery and the day after. She was discharged on the first postoperative day. At the follow-up, she did not experience any problems during pregnancy, and she was delivered with cesarean section at 39 weeks’ gestation. ConclusionIn conclusion, laparoscopic surgery is a safe and feasible option for the treatment of heterotopic pregnancy, and control of bleeding can be achieved better with our modified technique.

2D RADIATION-HYDRODYNAMIC SIMULATIONS OF SUPERNOVA SHOCK BREAKOUT IN BIPOLAR EXPLOSIONS OF A BLUE SUPERGIANT PROGENITOR

ABSTRACT A two-dimensional special relativistic radiation-hydrodynamics code is developed and applied to numerical simulations of supernova shock breakout in bipolar explosions of a blue supergiant. Our calculations successfully simulate the dynamical evolution of a blast wave in the star and its emergence from the surface. Results of the model with spherical energy deposition show a good agreement with previous simulations. Furthermore, we calculate several models with bipolar energy deposition and compare their results with the spherically symmetric model. The bolometric light curves of the shock breakout emission are calculated by a ray-tracing method. Our radiation-hydrodynamic models indicate that the early part of the shock breakout emission can be used to probe the geometry of the blast wave produced as a result of the gravitational collapse of the iron core.

Clinical utility of a novel ultrasonic vessel sealing device in transecting and sealing large vessels during laparoscopic hysterectomy using advanced hemostasis mode

Objective(s)The ultrasonic advanced energy study device (AH device) is the first surgical device indicated to seal vessels up to and including 7mm using ultrasonic technology alone. This study assesses clinical experience during total laparoscopic hysterectomy (TLH) using advanced hemostasis mode (AHM). Study designThis was a prospective, non-randomized, single arm, multicenter, observational study which did not modify or influence current surgeon technique for elective TLH for benign disease.Each surgeon assessed hemostasis, defined as the hemostatic transection of the uterine vasculature (left/right) with at least one use of the AH device in AHM without the use of additional hemostatic measures other than the AH device. Patients were followed for 4–6 weeks after surgery.Vessel sealing performance was quantitatively assessed for transection and sealing of the uterine artery (UA), the uterine pedicle (UP; defined as cases where the UA could not be ‘isolated’) and the ovarian pedicle (OP) (when indicated). Adverse events (AEs) related to the AH device or procedures were collected. ResultsForty patients underwent the procedure. Mean age was 49 years and mean body mass index was 28kg/m2. Mean surgical duration was 88min. None required conversion to open procedure. Using only the AH device, hemostasis was achieved and maintained in 119 (94.4%) transections (both left and right sides of the UA/UP and OP). Additional hemostasis was achieved in 5 patients using conventional bipolar (4) or monopolar (1) energy. No patient required a blood transfusion postoperatively. Only one adverse event of pain was considered to be related to the use of the ultrasonic AH device during this study. ConclusionThese results support that the AH device with its AHM has clinical utility in sealing named vessels in TLH. The new algorithm to deliver energy in the AHM has the potential to reduce the need for additional hemostatic devices or products as well as the potential to reduce the need for multiple instrument changes during surgery.

Evaluation of the Thunderbeat™ device in hepatic resection

Objective: The Thunderbeat™ is a new device combining bipolar energy and ultrasonic technologies. The purpose of this study is to evaluate this device in hepatic surgery. Methods: This was a retrospective review of the last 204 patients operated for liver resection between June 2012 and December 2013 with either Thunderbeat™ (Th) or Ligasure™ (Li). Groups were matched according to the following criteria: sex, diagnosis and procedure. Results: Both groups were comparable in terms of age, personal medical history and diagnosis. Operative time (201 min Th vs 191 min Li), estimated blood loss (EBL) (580 cc Th vs 523 cc Li) or R0 resection (91 Th vs 87 Li) were not statistically different between both groups. Mortality rate was 0.98% (1 patient died in each group). Overall severe complication rate (Clavien-Dindo grade 3 or more) was 7.8% in each group (p = 1.000). Biliary leak (17 Th vs 14 Li), post-operative bleeding/hematoma (3 Th vs 4 Li) and abscess formation (11 Th vs 14 Li) were not statistically different between devices. Post-operative liver function tests (ALT = 244 Th vs 196 Li, bilirubin = 26 Th vs 20 Li) and INR (1.16 Th vs 1.18 Li) were similar in both groups. Conclusion: For hepatic resection, the use of the Thunderbeat™ device seems to be as safe and efficient as the Ligasure™ device. Post-operative bleeding and biliary leak rate does not differ in a statistically significant way between both devices.

PD43-01 RESULTS OF TWO RANDOMIZED TRIALS FOR THE PREVENTION OF LYMPHOCELES AFTER ROBOTIC PELVIC LYMPH NODE DISSECTION FOR PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI1 Apr 2016PD43-01 RESULTS OF TWO RANDOMIZED TRIALS FOR THE PREVENTION OF LYMPHOCELES AFTER ROBOTIC PELVIC LYMPH NODE DISSECTION FOR PROSTATE CANCER Sean Henderson, Daniel Gilbert, Janice Rosenthal, Ronney Abaza, and Jatin Gupta Sean HendersonSean Henderson More articles by this author , Daniel GilbertDaniel Gilbert More articles by this author , Janice RosenthalJanice Rosenthal More articles by this author , Ronney AbazaRonney Abaza More articles by this author , and Jatin GuptaJatin Gupta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1779AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lymphoceles (LC) occur in up to 30-50% of patients after pelvic lymph node dissection (PLND) for prostate cancer. Most are asymptomatic and go undetected as imaging after prostatectomy is infrequent, but serious infections can occur even months later. We performed 2 randomized studies to determine whether LC can be prevented with imaging of all patients to detect even silent LC. One trial involved a hemostatic agent (Arista®AH), and a second trial involved use of advanced electrosurgical bipolar energy (da Vinci® EndoWrist® One Vessel Sealer®). METHODS Patients undergoing robotic prostatectomy with PLND were enrolled into one of two studies with IRB approval. Each patient served as their own internal control with one PLND side randomly chosen for intervention. In study 1, Arista was placed over the field of PLND on one side randomized to treatment only after bilateral PLND was completed. In study 2, PLND was randomly performed in standard fashion using clips and standard instruments while the other side was performed with the Vessel Sealer instead of clips. All patients underwent screening CT scan 3 mos later with radiologists blinded to interventions. A significant LC was defined as a fluid collection ≥3cm in any plane. RESULTS No symptomatic lymphoceles occurred in either study. Of 100 patients enrolled in the Arista trial, 88 completed the study. Only 14 screening-detected LCs occurred with all unilateral (16% of patients or 8% of 176 PLND sides). Five occurred on the side where Arista was used vs 9 on untreated sides (5.7% vs 10.2%, p=0.248). There was no statistically significant difference in LC size (mean 4.6cm) between treated and untreated sides (p=0.44). Of 120 patients enrolled in the Vessel Sealer trial, 114 completed the study. LCs were identified in 21 patients (18%), one of which was bilateral (9% of 240 sides). Ten occurred on the Vessel Sealer side vs 12 on the standard side (8.8% vs 10.5%, p=0.41) with no difference in LC size (4.3cm vs 3.6cm, p=0.35). Operative time was the same for standard PLND vs Vessel Sealer (mean 11.3 vs 11.1min, p=0.62). CONCLUSIONS No difference in screening-detected LCs was seen using a hemostatic agent or an advanced bipolar energy device. This may guide surgeons on their use given the costs. The unusually low baseline LC rate compared with the literature underpowered the study and precluded statistical significance in the hemostat trial despite almost 50% LC reduction such that a larger study may be warranted. Also, while advanced energy did not reduce LCs, it was equally efficacious and efficient as use of clips. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e992-e993 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Sean Henderson More articles by this author Daniel Gilbert More articles by this author Janice Rosenthal More articles by this author Ronney Abaza More articles by this author Jatin Gupta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Outcome of stand-alone thoracoscopic epicardial left atrial posterior box isolation with bipolar radiofrequency energy for longstanding persistent atrial fibrillation.

IntroductionCatheter ablation of longstanding (> 1 year) persistent atrial fibrillation (AF) is associated with poor outcome. This might be due to remodelling and fibrosis formation, mainly located in the posterior left atrial (LA) wall. Therefore, we adopted a thoracoscopic epicardial box isolation of the posterior left atrium using bipolar RF energy with intraoperative testing of conduction block.Methods and resultsBilateral thoracoscopic box isolation was performed with a bipolar RF clamp. Entrance block was defined as absence of a conducted electrogram within the box, while exit block was confirmed by pacing at 10.0 V/2 ms. Ablation outcome was evaluated after 3, 6, 12 and 24 months with 12-lead ECGs and 24-hour Holter recordings.Twenty-five consecutive patients were included (58 ± 7 years, persistent AF duration 1.8 ± 0.9 years). Entrance block was achieved in all patients and exit block confirmed if sinus rhythm was achieved. After 17 ± 7 months, 76 % of the patients (n = 19) were free of AF recurrence. One patient died within 1 month and was considered an ablation failure. Four patients with AF recurrences regained sinus rhythm with additional catheter ablation or antiarrhythmic drugs.ConclusionsTreatment of longstanding persistent AF with thoracoscopic epicardial LA posterior box isolation using bipolar RF energy with intraoperative testing of conduction block is feasible and highly effective.

Electromagnetic Initiation and Propagation of Bipolar Radiofrequency Tissue Reactions via Invasive Non-Insulated Microneedle Electrodes.

Radiofrequency (RF) energy can be emitted into the skin, either non- or invasively, via a monopolar mode that utilizes an active electrode and a grounded electrode or via a bipolar mode that employs two active electrodes. In this experimental study of RF tissue reactions, bipolar RF energy was emitted in vivo to micropig skin at varying microneedle penetration depths, signal amplitudes, and conduction times. Immediately after RF treatment, skin samples exhibited RF-induced coagulation columns of thermal injury, separately generated around each microneedle in the dermis. In ex vivo bovine liver tissue, the thermal coagulation columns were found to be concentrated maximally around the pointed tips of each electrode. After a RF conduction time of 2 seconds, the individual areas of thermal coagulation began to converge with neighboring RF-induced coagulation columns; the convergence of coagulation columns was found to start from the tips of neighboring electrodes.

Cold loops applied to bipolar resectoscope: A safe "one-step" myomectomy for treatment of submucosal myomas with intramural development.

To assess the safety and efficacy of cold loop myomectomy applied to bipolar resectoscope to perform "one-step" myomectomy of submucosal myomas with intramural involvement. Seventy-two patients with at least one symptomatic G1 or G2 myoma (Wamsteker's classification) underwent cold loop myomectomy from January 2011 to January 2013. All surgical procedures were performed using a 26Fr resectoscope and bipolar energy source. At one month after the procedure, all patients underwent an office hysteroscopy check-up. A subgroup of seven infertile patients underwent an office hysteroscopy every two-weeks to evaluate recovery time of the myometrial fovea. Resectoscopic myomectomies were successfully performed in one surgical step in 70 out of 72 patients without any significant complications. Overall, the mean diameter of resected myomas was 32.2 ± 9 mm. Median operative time was 34.2 ± 24.1 min. Median fluid deficit was 761.22 ± 480.34 ml. The fovea was almost completely restored (>80%) six weeks after surgery in six of the seven infertile patients who underwent repeated follow-up office hysteroscopies every two weeks. Data from the present study show that the use of cold loops applied to bipolar resectoscope represent an effective, safe technique for "one-step" myomectomy of G1-G2 myomas, allowing rapid recovery of the myometrial fovea.

Outpatient hysteroscopic polypectomy: bipolar energy system (Versapoint®) versus diode laser – randomized clinical trial

Objective: To compare the resection of endometrial polyps with two different devices: the Versapoint biopolar electrode and the Diode Laser.Methods: One hundred and two patients diagnosed with endometrial polyps were randomly assigned to undergo hysteroscopic polypectomy: one group (n = 52) performed with Versapoint bipolar electrode through a 5Fr working channel and the other group with Biolitec Diode Laser (n = 50) using a specific fiber for polyps in a 7Fr working channel. All cases were managed on an outpatient basis, without anesthesia and using a rigid 30o hysteroscope and saline solution as a distention medium.Main outcome measures: Complete resection rate, operative time, complications, intraoperative pain and relapse rate after three months.Results: Intraoperative pain and polyp resection time was similar in both groups. Upon second look hysteroscopy at 3–month, a higher percentage of women of the Versapoint group presented polyp relapse (32.6 versus 2.2%, p = 0.001). Elimination of the polyp after incomplete resection was higher in the Laser group. A significantly higher number of patients in the Laser group considered the procedure to be highly recommendable (p = 0.02).Conclusion: Polypectomy with Diode Laser resulted in fewer relapses and a higher procedure satisfaction rate as compared to Versapoint.

Monopolar versus Plasmakinetic™ Energy Effect on Prostatic Tissue Damage in Terms of PSA Levels: A Prospective Randomized Trial

Introduction: We investigated the monopolar and bipolar energy effects on prostate and correlated the results with the type of pathology, thus determining the relationship between tissue damage and the PSA level. Material and Methods: One hundred and twenty four patients underwent TURP and according to the energy source, 2 groups were designed as monopolar (Group 1) and bipolar energy (Group 2). Hemoglobin and free and total PSA were measured preoperatively and 6 hours postoperatively, and differences were calculated. The weight of resected tissue and operation time were also recorded. Two groups were also formed later according to the pathology as chronic prostatitis (CP) and BPH. The findings were analyzed. Results: There were no statistical differences between the groups in terms of age; prostate volumes; resected tissue; operation times; pre- and postoperative Hb, total-free PSA, IPSS, PVR, and quality of life scores; or postoperative maximum flow rates. Changes in total-free PSA (25.7 and 10.8 ng/dl for PSA; 13.2 and 5.76 ng/dl for free PSA for Groups 1 and 2, respectively) were significantly different between Groups 1 and 2. There was a statistical difference in total PSA between the groups among CP patients (28.18 and 11.73 ng/dl for Groups 1 and 2, respectively). But no statistical difference existed among BPH patients. The change in Hb differed based on pathological results. Conclusion: Bipolar TURP is less invasive than monopolar TURP on the basis of postoperative PSA levels. In addition, bleeding during TURP is affected not by the kind of energy, but by the pathology.

Antenna Coupling Explains Unintended Thermal Injury Caused by Common Operating Room Monitoring Devices

Unintended thermal injury from patient monitoring devices (eg, electrocardiogram pads, neuromonitoring leads) results in third-degree burns. A mechanism for these injuries is not clear. The monopolar "bovie" emits radiofrequency energy that transfers to nearby, nonelectrically active cables or wires without direct contact by capacitive and antenna coupling. The purpose of this study was to determine if, and to what extent, radiofrequency energy couples to common patient monitoring devices. In an ex vivo porcine model, monopolar radiofrequency energy was delivered to a handheld "bovie" pencil. Nonelectrically active neuromonitoring and cardiac-monitoring leads were placed in proximity to the monopolar pencil and its cord. Temperature changes of tissue touched by the monitoring lead were measured using a thermal camera immediately after a 5-second activation. The energy-device cords were then separated by 15 cm, the power was reduced from 30 W coag to 15 W coag and different cord angulation was tested. An advanced bipolar device, a plasma-based device, and an ultrasonic device were also tested at standard settings. The neuromonitoring lead increased tissue temperature at the insertion site by 39 ± 13°C (P<0.001) creating visible char at the skin. The electrocardiogram lead raised tissue temperature by 1.3 ± 0.5°C (P<0.001). Decreasing generator power from 30 W to 15 W and separating the bovie cord from the neuromonitoring cord by 15 cm significantly reduced the temperature change (39 ± 13°C vs. 26±5°C; P<0.001 and 39 ± 13°C vs. 10 ± 5°C; P<0.001, respectively). Lastly, monopolar energy increased tissue temperatures significantly more than argon beam energy (34 ± 15°C), advanced bipolar energy (0.2 ± 0.4°C), and ultrasonic energy (0 ± 0.3°C) (all P<0.001). Stray energy couples to commonly used patient monitoring devices resulting in potentially significant thermal injury. The handheld bovie cord transfers energy via antenna coupling to neuromonitoring leads that can raise tissue temperatures over 100°F (39°C) using standard settings. The most effective ways to decrease this energy coupling is to reduce generator power, increase the separation between wires, or utilize lower voltage energy devices such as ultrasonic or bipolar energy.

Future research and developments in hysteroscopy

Hysteroscopy has become an important tool to evaluate intrauterine pathology. In most cases, the pathology can be diagnosed and treated in the office or outpatient setting. The ability to use normal saline as a distending medium allows the procedure to be performed using bipolar energy. During hysteroscopic myomectomy, visualization can remain unobstructed with the use of a hysteroscopic morcellator. Its use is also associated with decreased operating time. The use of Essure(®) to block the proximal fallopian tube by a hysteroscopic approach is an approved procedure for tubal sterilization. However, it has been increasingly used to prevent hydrosalpinx fluid from entering the uterine cavity in women undergoing invitro fertilization. The hysteroscopic approach has also been used to treat a variety of conditions such as treatment of interstitial pregnancy, caesarean scar pregnancy and retained placenta. However, the number of cases is still relatively small, and no randomized trial has ever been conducted. One of the potentially important developments is the use of falloposcopy to obtain distal tubal cytology as a screening for ovarian cancer. The technique remains to be refined.

Outpatient Hysteroscopic Polypectomy: Bipolar Energy System (Versapoint®) versus Mechanical Energy System (TRUCLEAR System®) - Preliminary Results

Hypothesis: The new hysteroscopic system with mechanical energy is an effective outpatient technique for diagnosis and treatment that has certain advantages over conventional hysteroscopy in the management of endometrial polyps. Objectives: Our primary objective was to assess the total duration of hysteroscopy and polypectomy performed in an outpatient setting comparing the new mechanical energy hysteroscopy to the bipolar energy system. Our secondary objective was to compare the level of safety of both hysteroscopic techniques using the procedure success rate, the need for subsequent referral to surgery, existing complications, and comfort experienced by the patient during the procedure. Patients and Methods: This randomized controlled trial included the first 90 patients with an ultrasound diagnosis of endometrial polyp (>1 cm) who underwent an outpatient diagnostic and operative hysteroscopy at the Igualada Hospital (Barcelona) and agreed to be included in the study by signing an informed consent. Results: We obtained a 91% success rate with the TRUCLEAR System® compared to a 69% success rate with the Versapoint® system. Total operating time was 6.36 min in the TRUCLEAR System group versus 10.82 min in the Versapoint system group (p < 0.05), with a polypectomy time of 3.06 and 7.91 min, respectively (p < 0.05). There were no significant differences between the two techniques when analyzing pain using the visual analogue scale. No complications were recorded for either technique. Conclusion: The mechanical energy system presents a significant decrease in the total duration of polypectomy and hysteroscopy when performed both by experienced staff and by staff in training, resulting in higher success rates without complications with respect to conventional hysteroscopy with bipolar energy.

579 Management of benign prostatic obstruction using bipolar plasma kinetic energy in coagulopathic patients: Initial series

579 Management of benign prostatic obstruction using bipolar plasma kinetic energy in coagulopathic patients: Initial series