Bipolar Energy Research Articles

Synergizing carbon capture and utilization in a biogas upgrading plant based on calcium chloride: Scaling-up and profitability analysis

Herein we analyze the profitability of a novel regenerative process to synergize biogas upgrading and carbon dioxide utilization. Our proposal is a promising alternative which allows to obtain calcium carbonate as added value product while going beyond traditional biogas upgrading methods with high thermal energy consumption. Recently we have demonstrated the experimental viability of this route. In this work, both the scale-up and the profitability of the process are presented. Furthermore, we analyze three representative scenarios to undertake a techno-economic study of the proposed circular economy process. The scale-up results demonstrate the technical viability of our proposal. The precipitation efficiency and the product quality are still remarkable with the increase of the reactor size. The techno-economic analysis reveals that the implementation of this circular economy strategy is unprofitable without subsidies. Nonetheless, the results are somehow encouraging as the subsides needed to reach profitability are lower than in other biogas upgrading and carbon dioxide utilization proposals. Indeed, for the best-case scenario, a feed-in tariff incentive of 4.3 €/MWh makes the approach profitable. A sensitivity study through tornado analysis is also presented, revealing the importance of reducing bipolar membrane electrodialysis energy consumption. Overall our study envisages the big challenge that the EU faces during the forthcoming years. The evolution towards bio-based and circular economies requires the availability of economic resources and progress on engineering technologies.

Comparative study of histological changes (thermal artefacts) in resected specimens of monopolar and bipolar trans-urethral resection of bladder tumours

Objective The primary aim of the study was to study the histological changes (Thermal artefacts) noted in the resected specimens between the Monopolar and Bipolar Trans-Urethral Resection of Bladder Tumours (TURBT). Patients and Methods The study was done between March 2012 and Feb 2013. This was a comparative study between Monopolar and Bipolar resection specimens studied for histological changes (Thermal artefacts). Institutional Ethics Committee approval was obtained. Informed consent was taken from all patients. Patients were randomized into two groups, Monopolar Group or Bipolar Group of 50 each to undergo TURBT. Patients either underwent Monopolar or Bipolar TURBT in Glycine and Saline respectively. Results Thermal artefacts were graded according to WHO (World Health Organization) grading system. There was no difficulty noticed during histo-pathological examination of resected specimens. In Monopolar group, there were 27 (54%) grade 2 thermal damage, 17 (34%) grade 1 thermal damage and no grade-3 thermal damage in examined specimen. In Bipolar group, there were 07 (14%) grade 2 thermal damage, 12 (24%) grade 1 thermal damage and no grade 3 thermal damage in examined specimen. Conclusion The degree of thermal damage is much lesser in histological sections of specimen resected using Bipolar energy and interpretation of the grade is easier which is one of the most important prognosticators especially in bladder tumours since high grade lesions are proven beyond doubt to progress and recur.

Electrophysiological findings after bilateral thoracoscopic atrial fibrillation ablation using irrigated bipolar radiofrequency energy

Abstract Background Thoracoscopic atrial fibrillation (AF) ablation (TARAFS) using irrigated bipolar radiofrequency energy should result in posterior left atrial (LA) wall isolation. Purpose To assess the long-term durability of this “box” lesion and the extent of additional ablation needed to achieve AF non-inducibility. Methods 22 patients with AF recurrence after bilateral TARAFS for persistent AF had a radiofrequency catheter ablation (RFA) at least three months after TARAFS. Electroanatomical voltage map was done in all patients prior to any ablation. Results Out of 22 patients, the box lesion was not completed in 15 (68.2%). In these 15 patients, 12 had no signs of any prior ablation in endocardium (voltage >0.5mV), 2 had right pulmonary veins (PVs) isolated and 1 had left PVs isolated. At the end of RFA, box lesion was finished in all 15 patients and AF non-inducibility was achieved in 18 patients. For this endpoint, besides box lesion, mitral line and extensive coronary sinus ablation was necessary in 14, extensive CFAE ablation in 7 patients. Cavotricuspid isthmus line block was done in all patients. Conclusion A minimally invasive thoracoscopic box-lesion ablation is considered to be a safe and effective method of stand-alone AF treatment. However, in a considerable amount of patients no signs of prior ablation are found on electroanatomical voltage map. Gaps thus cannot be found and a completely new complex ablation must be done. In a lot of patients, additional ablation is needed besides box lesion to achieve non-inducibility. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): University Hospital Olomouc

Effectiveness of Hysteroscopic Morcellation of Endometrial Polyps Compared to Traditional Technique: A Comparison of Disease Recurrence

Study ObjectiveTo compare the outcomes between hysteroscopic morcellation of endometrial polyps and traditional techniques such as hysteroscopic resection with monopolar or bipolar radiofrequency energy, scissors and graspers or mechanical resection with polyp forceps.DesignRetrospective chart review.SettingAcademic tertiary referral center.Patients or Participants193 patients who underwent operative hysteroscopic polypectomy between January 2015 and May 2016.InterventionsHysteroscopic polypectomy with intrauterine morcellation, monopolar or bipolar radiofrequency energy, scissors and graspers or mechanical resection with polyp forceps with evaluation and/or treatment of recurrent abnormal uterine bleeding (AUB) after operative polypectomy.Measurements and Main ResultsThere were 9 patients who underwent hysteroscopic polypectomy with monopolar radiofrequency energy, 3 patients with bipolar radiofrequency energy, 91 patients with intrauterine morcellation, 67 patients with polyp forceps and 12 patients with scissors and graspers. The recurrence rate for AUB for monopolar was 1.89%, bipolar was 1.67%, intrauterine morcellation was 1.93%, polyp forceps was 1.84% and hysteroscopic scissors and/or graspers was 1.83%. Among the recurrences the average time until recurrence was 1162 days for monopolar, 207 days for bipolar, 749.5 days for intrauterine morcellation, 477.6 days for polyp forceps and 341.5 days for hysteroscopic scissors and graspers.ConclusionThere was no significant difference in terms of recurrence of AUB following the different modalities of operative hysteroscopy. Among the patients with recurrence in order of shortest time until recurrence: bipolar, hysteroscopic scissors and graspers, polyp forceps, intrauterine morcellation and monopolar.

Abdominal Ectopic Pregnancy with Retrocervical Localization

Study Objective To present an abdominal ectopic pregnancy with a retrocervical localization and laparoscopic management performed. Design N/A Setting Private health facility. Patients or Participants 36 years old female patient with obstetric history of 4 previous miscarriages and 2 cesarean sections presented at our clinic with a chief complain of abdominal pain and 7 weeks amenorrhea. Blood hCG level was 3500 mUI/ml. Endovaginal ultrasound reveled an abnormal implantation of a gestational sac, behind the uterus, at the recto-vaginal space. The endometrial cavity was normal. Interventions Emergency laparoscopy was performed. Initial assessment of the pelvic cavity reveled blood at cul the sac and normal adnexa from both sides. Careful assessment of structures led to identify an active bleeding spot at the insertion site of the right uterosacral ligament. Trough suction organized tissue was obtained from a peritoneal defect at the bleeding site, making us suspect the gestational sac was implanted at this level. The pararectal space was developed, identifying and lateralizing the hypogastric nerve. The uterosacral ligament was detached from it´s proximal end, managing to expand the peritoneal window with the certainty that important anatomical structures were not involved. This gave access the implantation site of the gestational sac that was removed and hemostasis with bipolar energy was performed. Measurements and Main Results N/A Conclusion Knowledge of the pelvic anatomy is fundamental in the management of any pathology, especially when we encounter surprises such as an abnormal and unusual implantation site of a gestational sac, as observed in the case presented.

Laparoscopic Excision of Recurrent Pelvic Lymphocyst Following Pelvic Lymph Node Dissection for Clear Cell Carcinoma of Ovary

Study ObjectiveDemonstration of safe laparoscopic technique for definitive excision of recurrent pelvic lymphocyst developing following pelvic lymph node dissection for clear cell carcinoma of the ovary; overcoming the additional surgical challenges of close proximity to vital anatomical structures and dense post-operative adhesions.DesignSurgical video detailing a systematic approach to laparoscopic excision of pelvic lymphocyst - describing individual surgical steps and highlighting relevant anatomy.SettingSurgery was undertaken by a gynae-oncology consultant with one surgical assistant. The patient was positioned in modified Lloyd-Davis – with table height and stack adjusted for optimal ergonomics.Patients or ParticipantsA 68 year old lady underwent total abdominal hysterectomy, bilateral salpingo-oophrectomy and omentectomy in April 2018 for stage 1A clear cell carcinoma of ovary; followed by completion laparoscopic pelvic and para-aortic lymphadenectomy. The patient subsequently developed a right pelvic lymphocyst, causing pain. Pre-operative imaging described a 3.9 × 3.3 × 3 centimetre right pelvic lymphocyst, with internal septations and thick wall. Two attempts at percutaneous drainage were unsuccessful due to difficulty penetrating the cyst capsule and loculated interior.InterventionsLaparoscopic excision of pelvic lymphocyst was undertaken. Pneumoperitoneum was maintained at a pressure of 12mmHG throughout. The pelvic peritoneum overlying the lymphocyst was opened and plane developed using a combination of monopolar, bipolar and advanced energy devices. The ureter and iliac vessels were systematically identified to avoid inadvertent injury; and avascular pelvic spaces developed to aid cleavage of the capsule with minimal blood loss.Measurements and Main ResultsNo intra or post-operative complications occurred. Histopathology confirmed a benign lymphocyst. At post-operative review, the patient reported resolution of pain and improved mobility.ConclusionThis video demonstrates a safe laparoscopic approach to excision of a densely adherent pelvic lymphocyst, abutting important pelvic structures – facilitated by the step-wise identification of pelvic anatomy and relevant pelvic spaces.

Prospective, Randomized, Comparative, Multicenter Study of the Hybrid Ultrasonic Advanced Bipolar Device and the Ultrasonic Coagulating Shears in Open Thyroidectomy.

Background. The hybrid ultrasonic advanced bipolar device (HUB) that integrates ultrasonic energy and advanced bipolar energy was recently developed and applied to thyroid surgery. The purpose of this study was to compare the efficacy and safety of HUB and ultrasonic coagulating shears for open thyroidectomy. Methods. A total of 200 patients were enrolled from April to September 2017 in this prospective, randomized, multicenter study. Patients were randomly assigned to an ultrasonic group (n = 101) or a hybrid group (n = 99). Results. Operation times were similar in the 2 study groups, that is, 54.2 ± 25.2minutes in the ultrasonic group and 50.2 ± 21.6minutes in the hybrid group. Postoperative surgical results and morbidities were no different in the 2 groups. However, the total amount of bleeding was significantly less in the hybrid group (13.0 ± 17.7mg vs 8.6 ± 11.5mg; P = .042). Conclusions. Our study showed that there was no significant difference between the 2 groups in postoperative surgical results and morbidity. The total bleeding amount was significantly less in the hybrid group. The study shows that HUB is comparable to the ultrasonic coagulating shears in terms of efficacy and safety during thyroid surgery.

Feasibility of Speedboat RS2 with bipolar radiofrequency energy for peroral endoscopic myotomy in patients with achalasia (with video).

Background During peroral endoscopic myotomy (POEM), use of traditional instruments leads to an increase in overall time of procedure due to constant exchange of instruments. Speedboat-RS2 (Creo-Medical, UK) is a novel device which has shown promising results for endoscopic submucosal dissection of gastrointestinal lesions, but its feasibility, and safety for POEM is unexplored. Methods Data from patients who had undergone POEM for achalasia cardia utilizing Speedboat-RS2 was reviewed. Results Two patients with mean age of 46 years and mean symptom duration of 3 years were included. Both patients had type II achalasia diagnosed on esophageal manometry. One patient underwent anterior myotomy and the other posterior approach. Submucosal tunneling (~15 cm) was achieved in a mean of 20 minutes, myotomy (~ 9 cm) in 8 minutes and the entire procedure was completed in a mean of 30 minutes with 100 % technical success. Both patients were discharged the day after the procedure without any immediate adverse events. At 6 weeks, endoscopy was uneventful and the patients were asymptomatic. Conclusions Early experience shows that Speedboat-RS2 is feasible for performing POEM with good safety profile. Submucosal tunneling was relatively quick and coagulation was effective. Long term studies with a larger patient cohort are warranted.

THE 30 YEARS' CLINICAL EXPERIENCE IN DIAGNOSIS AND TREATMENT OF ENDOMETRIAL OVARIAN CYSTS IN PATIENTS OF REPRODUCTIVE AGE

Endometriosis occurs in 50 % of women with infertility. Ovarian endometriosis affects 55 % of women with this disease. Surgical treatment of endometrium is indicated if its size is over 3 cm. After removal of the endometriomas there are used diathermic, bipolar energy, radio wave energy, argon plasma coagulation for hemostasis of ovarian tissue. The use of argon plasma coagulation in ovarian hemostasis causes not only hemostatic but also protective effect, which is mediated by the induction of HSP27, SOD2, VEGF and iNOS, which renders an organ−preserving effect when applied to ovarian tissues. Repeated surgery for ovarian endometrium should be performed taking into account the risk of reduced levels of antimullerian hormone, which may adversely affect the further implementation of reproductive function, including the use of assisted reproductive technologies. The authors comparatively have evaluated the treatment of 900 patients of reproductive age with endometrioid cysts of the ovaries and other concomitant gynecological pathology, which were three clinical groups. The patients received radiowave energy, argonoplasmic coagulation, intraoperative use of various anti−adhesive drugs and combinations of drugs in the postoperative period. It was found that the use of argon plasma coagulation for hemostasis of ovarian tissues after removal of endometrioid cysts, polyethylene oxide gel with carboxymethylcellulose intraoperatively and gonadotropin−releasing hormone agonists, dienogest 2 mg per day for three months contributed to the pregnancy onset in post−srugery period in 56.7 % of patients. It has been noted that in women the presence of adhesions in combination with corpus luteum cysts, endometrial polyps, uterine leiomyoma reduces the onset of pregnancy by 8.0, 12, and 24 times, respectively. Key words: endometrial ovarian cysts, diagnosis, treatment, rehabilitation in the post−surgery period.

A global knowledge, attitudes and practices survey on anatomical endoscopic enucleation of prostate for benign prostatic hyperplasia among urologists.

There is an increasing use of the procedure, anatomical endoscopic enucleation of the prostate, as an alternative to conventional transurethral resection of prostate for surgical treatment of benign prostatic hyperplasia. However, barriers to adoption of this procedure remain and no prior studies explored this important aspect till date. The aim of this study is to identify the predictors and barriers of surgeon-related practices in this area. The study findings may also provide valuable insight into current practice trends worldwide. To achieve the objectives, we conducted an online, cross-sectional, questionnaire-based study between 1st September 2019 and 5th October 2019 to investigate the knowledge, attitudes and practices among urologists worldwide. Our findings showed that the main barriers for adoption of the procedure were lack of mentorship, a steep learning curve, and unavailability of morcellator, bipolar or laser energy sources. Fear of urinary incontinence, bleeding and bladder injury were not major hindrance to adoption of this technique. The results also demonstrated that there will be continued increase in utility of the procedure in the future.

Emergency laparoscopic surgery during COVID-19: What can we do and how to do it safely.

Emergency laparoscopic surgery during COVID-19: What can we do and how to do it safely.

Total laparoscopic hysterectomy with newly designed uterine manipulator (Halder’s): safety, efficacy and perforation prevention

Objective: The objective of the study is to evaluate the safety and efficacy of the new uterine manipulator (Halder’s) in performing Total Laparoscopic hysterectomy (TLH) and to determine whether it prevents perforation of uterus due to forward pushing force. Introduction: Hysterectomy is one of the most common gynaecological operation performed worldwide of which laparoscopic approach is now a days preferred alternative route compared to open abdominal hysterectomy. According to U.S. Surgical data, there is a decrease of trend of abdominal hysterectomy from 65% to 54% in favour of laparoscopic route in between 1998 to 2010. It is because laparoscopic approach is associated with shortened hospitalization and postoperative recovery times and low morbidities. But it requires specialized training and skill to perform successfully. Manipulation of uterus during TLH is a vital step to avoid inadvertent injuries of vital organs like ureter, bladder and gut. Hence the newly designed uterine manipulator (Halder’s) is developed to simplify TLH with its inherent quality of ease of use and simplicity. Special feature of this manipulator is the Cervical Guard with rotational forward and backward movement which distinguishes it from the all available manipulators in the market. Material and Methods: From March 2018 to May 2019, three hundred forty six cases were done laparoscopically following a standard and simple technique using Halder’s uterine manipulator in different centres in West-Bengal of which two hundred cases were shortlisted as they fulfilled the inclusion criteria’s of Halder’s manipulator. After introduction of Halder’s uterine manipulator through cervix, the operation was performed using bipolar or ultrasound energy for coagulation and cutting the vascular pedicles and ligaments. The entire procedure was done laparoscopically and the uterus was removed vaginally. The vaginal cuff was closed by continuous suture in single layer with polyglactin materi

Effect of the Combination of Different Electrode Spacings and Power on Bipolar Radiofrequency Fat Dissolution: A Computational and Experimental Study.

The finite element method was used, and experiments were performed to analyze the effect of different electrode spacings and power combinations on the electrical and thermal aspects of biological tissues during bipolar radiofrequency (RF) fat dissolution. Through these efforts, this study also attempted to develop a reasonable electrode spacing and power combination that can achieve fat dissolution effects,the RF energy of which will not thermally damage the tissue. COMSOL was adopted to conduct a finite element analysis for bio-thermoelectric coupling, and a two-dimensional time-domain model of biological tissue was built. A self-developed single-channel bipolar RF device was employed to load RF energy on the ex vivo porcine abdominal tissue. The thermal characteristics of the tissue were characterized and analyzed with athermal imager and thermocouple probes. Under a power of 5 W combined with the electrode spacings of 1, 2, and 3 cm, the temperature in the tissue could not reach that required for fat dissolution. Under a power of 15 W combined with the electrode spacings of 1, 2, and 3 cm, the RF energy would thermally damage part of the skin areas. Besides this, the combination of apower of 10 W and the electrode spacing of 1 cm would thermally damage the skin areas. The combination of apower of 10 W and the electrode spacing of 2 or 3 cm made part of the fat layer of the tissue satisfy the requirements of fat dissolution, and the fat dissolution area caused by the former was 118% larger than that of the latter; in the meantime, no heat damage to the skin layer was found. Different electrode spacings and power combinations significantly affect the electrical and thermal properties of bipolar RF energy loaded on biological tissue, a reasonable electrode spacing and power combination is one of the critical factors leading to the success of bipolar RF fat dissolution. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

Physics for Surgeons - Part 4: Energy Devices in Surgery

Modern surgery has advanced astoundingly in the last century owing to the advent of number of energy devices in the operation room. Surgeon in the past were only using electric current –monopolar diathermy to burn and couterize the tissue, the present day surgeons are equiped with a number of more advanced energy devices e.g. LASER, ultrasonic vibrating shears, radiofrequency, shockwaves, argon beam coagulator and advanced bipolar electric energy with hybrid systems and light energy of different wavelengths. In the present paper, we have explained the physical principles involved in the commonly used energy devices in the operation theatre.

MP25-07 EJACULATORY SPARING PHOTO SELECTIVE VAPORIZATION OF THE PROSTATE VS BIPOLAR BUTTON PLASMA VAPORIZATION OF THE PROSTATE IN THE SURGICAL MANAGEMENT OF BPH

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP25)1 Apr 2020MP25-07 EJACULATORY SPARING PHOTO SELECTIVE VAPORIZATION OF THE PROSTATE VS BIPOLAR BUTTON PLASMA VAPORIZATION OF THE PROSTATE IN THE SURGICAL MANAGEMENT OF BPH Mitali Kini*, Alexis Te, James Kashanian, Steven Kaplan, and Bilal Chughtai Mitali Kini*Mitali Kini* More articles by this author , Alexis TeAlexis Te More articles by this author , James KashanianJames Kashanian More articles by this author , Steven KaplanSteven Kaplan More articles by this author , and Bilal ChughtaiBilal Chughtai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000864.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: After transurethral prostatectomy, erectile dysfunction (ED) and ejaculatory dysfunction (EjD) are significant concerns for patients. We compared ejaculatory hood sparing technique in patients who underwent Photo Selective Vaporization of the Prostate using the Greenlight Laser (EjS-PVP) to the Bipolar Button Plasma Vaporization of the Prostate (EjS-BPVP) in the surgical management of BPH. METHODS: 27 patients were randomized to either undergo EjS-PVP or EjS-BPVP from August 2016 to March 2018. All of the patients were sexually active with antegrade ejaculation prior to prostatectomy. We evaluated International Prostate Symptom Score (IPSS), Quality of Life (QoL), peak flow rate (Qmax), post-void residual urine (PVR), International Index of Erectile Function (IIEF) and ejaculatory function by the Male Sexual Health Questionnaire (MSHQ). Men were evaluated preoperatively and at 1, 3 and 6 months postoperatively. The primary outcome was ejaculation preservation measured as no change or preservation in antegrade ejaculate at the last follow-up visit by MSHQ (6-months). RESULTS: 27 patients with a mean age of 65.6 years (±8.4) underwent either EjS-BPVP or EjS-PVP (Table 1). There were no differences in baseline characteristics between the two groups. Improvements in IPSS, QoL, Qmax and PVR were durable throughout the study period in both groups. There was no difference in outcomes between groups. Postoperatively, there was no change in ejaculatory function with ejaculatory hood sparing EjS-BPVP utilizing either 180W EjS-PVP or bipolar energy. The change in MSHQ Ejaculation Scale was -2.1 and -5.4 at 6 months in both arms. The 6-month ejaculatory preservation rate was 85% in the EjS-PVP group and 78% in the EjS-BPVP group. CONCLUSIONS: Ejaculatory Hood Sparing Greenlight photoselective vaporization and bipolar plasma button vaporization is a safe and effective method for treating men with LUTs secondary to BPH with maintenance of antegrade ejaculation. Source of Funding: Boston Scientific © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e393-e393 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mitali Kini* More articles by this author Alexis Te More articles by this author James Kashanian More articles by this author Steven Kaplan More articles by this author Bilal Chughtai More articles by this author Expand All Advertisement PDF downloadLoading ...

Modified “En Bloc” Bipolar Plasma Enucleation of Prostate: Our Technique for Treatment of Obstructive Benign Prostatic Hyperplasia

Introduction and Objectives: Although transurethral resection of prostate has been the gold-standard intervention, in recent times, endoscopic enucleation of prostate (EEP) has been introduced as safe and effective procedure for the treatment of benign prostatic enlargement. Enucleation of the adenoma can be done by any energy source such as Holmium-YAG laser, Thulium laser, or plasmakinetic energy. The acronym EEP is a coding for common ground of endoscopic enucleation techniques.1 We are presenting our modification of single-lobe technique of bipolar plasma enucleation of prostate (BPEP), which is simplified in four different steps. Materials and Patients: Thirty-nine patients were included in our study of BEEP between December 2016 and June 2018. Average volume of prostate in our study was 58.6 cc. All patients were evaluated preoperatively by International Prostate Symptom Score (IPSS), uroflowmetry, sonography of prostate and urinary tract for prostate volume and post void residue estimation, prostate-specific antigen, and quality of life score. Endoscopic enucleation was done by 26F continuous flow resectoscope and Button electrode with high-frequency bipolar generator (Olympus Medical Systems). Modified technique of single-lobe enucleation was followed as published by our group.2 Tissue morcellator (Richard Wolf) was used for removal of enucleated adenoma from the bladder. Postprocedure follow-up was done at 3, 6, and 12 months. Results: Mean enucleation time for the prostate was 33.33 minutes (10–80 minutes) and estimated blood loss during procedure was 71.81 mL (16–350 mL). No patient in our study required blood transfusions. Mean catheterization time was 49.78 hours and mean hospital stay was 73.72 hours. Clavien Grade 1 complication was seen in four patients, one patient required cystoscopy and clot evacuation. Two patients had stress urinary incontinence for 3 months. Significant improvement in IPSS and Qmax was seen on follow-up at 3, 6, and 12 months. Conclusions: Our technique of BPEP is a simplified hybrid version of “en bloc” enucleation of adenoma in the treatment of obstructive BPH. However, long-term randomized trials are required for establishing any procedure. This technique of single-lobe enucleation with button electrode and bipolar energy can be useful for overcoming the learning curve of EEP. No competing financial interests exist. Runtime of video: 8 mins 35 secs

The time-dependent effects of bipolar radiofrequency energy on bovine articular cartilage

PurposeThe purpose of this study was to compare the effect of bipolar radiofrequency energy (bRFE) on chondroplasty at the different time durations in an in vitro experiment that simulated an arthroscopic procedure.MethodsSix fresh bovine knees were used in our study. Six squares were marked on both the medical and lateral femoral condyles of each femur. Each square was respectively treated with bRFE for 0 s, 10 s, 20 s, 30 s, 40 s and 50 s. Full-thickness articular cartilage specimens were harvested from the treatment areas. Each specimen was divided into three distinct parts: one for hematoxylin/eosin staining histology, another for cartilage surface contouring assessment via scanning electron microscopy (SEM), and the last one for glycosaminoglycan (GAG) content measurement.ResultsbRFE caused time-correlated damage to chondrocytes, and GAG content in the cartilage was negatively correlated to exposure time. bRFE caused time-correlated damage to chondrocytes. The GAG content in the cartilage negatively correlated with the exposure time. The sealing effect positively correlated with the exposure time. Additionally, it took at least 20 s of radiofrequency exposure to render a smooth cartilage surface and a score of 2 (normal) in the scoring system used.ConclusionbRFE usage in chondroplasty could effectively trim and polish the cartilage lesion area; however, it induces a dose-dependent detrimental effect on chondrocytes and metabolic activity that negatively correlated with the treatment time. Therefore, cautions should be taken in the use of bRFE for treatment of articular cartilage injury.

Quantitative Analysis of Surface Contouring with Pulsed Bipolar Radiofrequency on Thin Chondromalacic Cartilage

The purpose of this study was to evaluate the quality of surface contouring of chondromalacic cartilage by bipolar radio frequency energy using different treatment patterns in an animal model, as well as examining the impact of the treatment onto chondrocyte viability by two different methods. Our experiments were conducted on 36 fresh osteochondral sections from the tibia plateau of slaughtered 6-month-old pigs, where the thickness of the cartilage is similar to that of human wrist cartilage. An area of 1 cm2 was first treated with emery paper to simulate the chondromalacic cartilage. Then, the treatment with RFE followed in 6 different patterns. The osteochondral sections were assessed for cellular viability (live/dead assay, caspase (cell apoptosis marker) staining, and quantitative analysed images obtained by fluorescent microscopy). For a quantitative characterization of none or treated cartilage surfaces, various roughness parameters were measured using confocal laser scanning microscopy (Olympus LEXT OLS 4000 3D). To describe the roughness, the Root-Mean-Square parameter (Sq) was calculated. A smoothing effect of the cartilage surface was detectable upon each pattern of RFE treatment. The Sq for native cartilage was Sq = 3.8 ± 1.1 μm. The best smoothing pattern was seen for two RFE passes and a 2-second pulsed mode (B2p2) with an Sq = 27.3 ± 4.9 μm. However, with increased smoothing, an augmentation in chondrocyte death up to 95% was detected. Using bipolar RFE treatment in arthroscopy for small joints like the wrist or MCP joints should be used with caution. In the case of chondroplasty, there is a high chance to destroy the joint cartilage.

Complete resection of the alar folds in eight standing horses with a bipolar dividing and vessel‐sealing device

ObjectiveTo describe a resection technique of the alar folds in the standing horse.Study designRetrospective case study.AnimalsEight Standardbred racing trotters.MethodsHorses in which alar fold collapse had been diagnosed between 2017 and 2018 were included in this study. All horses underwent alar fold resection under standing sedation and regional anesthesia with a bipolar electrosurgical open sealer/divider device (LigaSure). Intraoperative and postoperative complications were recorded. A Wilcoxon signed‐rank test was used to compare differences in median prize money earning pre‐surgery and post‐surgery (P < .05).ResultsThe surgical procedure was short (20‐30 min), with minimal (1/8) to no (7/8) bleeding and was well tolerated in all cases. Complete resection of the alar folds along with 3 to 5 cm of the ventral conchal cartilage was achieved. No complications were observed post‐surgery with satisfactory second intention healing, allowing return to training/racing within 3 to 6 weeks post‐surgery in all cases. Median earnings post‐surgery increased (P = .03) compared with pre‐surgery.ConclusionAlar fold resection with bipolar electrosurgical energy offered a good alternative to the traditional surgical approaches performed under general anesthesia. The surgery significantly improved race earnings and performance while avoiding the risk associated with general anesthesia and offered a short and complication‐free rehabilitation period.Clinical impactThis study describes a surgical technique offering a novel approach to resection of the alar folds in the standing horse.

GUA-02 - Anatomic endoscopic enucleation of prostate using bipolar energy and mushroom technique

GUA-02 - Anatomic endoscopic enucleation of prostate using bipolar energy and mushroom technique