Cautery Group Research Articles

Incidence of Lymphedema and Other Complications in Patients Operated on for Gynecological Cancer Including Utilization of Two Lymph Node Dissection Techniques.

Background: To assess the impact of the lymph node dissection (LND) technique on short- and long-term complications. This retrospective review included patients who underwent hysterectomy, oophorectomy, and pelvic ± para-aortic LND for gynecological malignancies (cervical, endometrial, and ovarian) from 2020 to 2022 in our Gynecological Oncology Surgery clinic. Methods and Results: Among 147 patients who underwent pelvic LND for gynecological malignancy, 48 had procedures involving scissors and 99 had procedures involving unipolar cautery. There was no significant difference in the numbers of extracted pelvic and para-aortic lymph nodes between groups. The extents of LND were comparable between the scissors and unipolar cautery groups (p = 0.945). The scissors group exhibited less fluid drainage between days 2 and 5 postoperatively (1300 [600-3100] vs 1800 [600-3400]; p = 0.038). In terms of primary early and late clinical outcomes, there were no significant differences in lymphocele (16.7% vs 15.2%; p = 0.494) and lymphedema (18.8% vs 17.2%; p = 0.491) rates between groups. Conclusions: After retroperitoneal LND for gynecological malignancy, early complications such as lymphocele and late complications such as lower extremity lymphedema did not significantly differ between procedures using cold scissors and procedures using unipolar cautery.

Impact of scleral cautery on limbal vasculature after cataract surgery assessed using optical coherence tomography angiography.

We investigate the influence of scleral cautery during cataract surgery on limbal vascular density and remodeling using anterior segment optical coherence tomography angiography (AS-OCTA). Twenty eyes of 20 patients who underwent cataract surgery with a sclerocorneal incision were included. Patients were divided into two groups: non-cautery (n = 10) and cautery (n = 10). The area around the incision site was scanned using AS-OCTA before surgery and at 1, 3, 5, 7, 14, 21, 28, and 90 days postoperatively. Images were analyzed to depict conjunctival vasculature (surface to a depth of 200μm) and intrascleral vasculature (depth of 200 to 1000μm). Vascular density was evaluated using ImageJ software. In the non-cautery group, intrascleral vascular density significantly increased during the wound-healing period up to 21 days postoperatively. Cautery application completely diminished this effect, resulting in significantly reduced intrascleral vascular density in the cautery group compared to the non-cautery group until 5 days after surgery. On the seventh day and later, intrascleral vascular density in the cautery group recovered, but the vascular pattern did not return to its preoperative state even at 90 days after surgery. Conjunctival flap vascular density was reduced for 28 days after surgery, with cautery application further decreasing conjunctival vascular density. AS-OCTA enabled separate observation of conjunctival and intrascleral vasculature. Intrascleral blood flow significantly increased after cataract surgery, but scleral cauterization markedly blocked this effect. The vascular reconstruction process following cataract surgery continued for almost a month, with cautery application leading to prolonged vascular disruption and altered vascular patterns.

Comparison of Bizact™ and Bipolar Tonsillectomy in Pediatric Patients

Background: The aim of this study is to compare the effects of Bizact™ and bipolar electrocautery on peroperative and postoperative bleeding, pain, operation time in pediatric patients. Methods: One Hundred and twenty eight (128) pediatric patients who underwent tonsillectomy were included in this prospective study. The patients were operated with indications of recurrent tonsillitis, chronic tonsillitis and obstructive sleep apnea syndrome (OSAS). Patients with a history of bleeding diathesis and peritonsillar abscess were excluded from the study. Results: While the mean peroperative bleeding amount measured in the Bizact™ tonsillectomy group was 16 ml, the mean amount of bleeding in the bipolar cautery group was 65 ml. When the mean operation times were compared, the mean operation time in the Bizact™ group was 15 minutes, and it was significantly lower than in the bipolar cautery group, which was 22 minutes. Patients' postoperative pain scores and return to normal diet were also significantly lower in the Bizact™ group than in the bipolar cautery group. Pain scores of the patients on postoperative 1st, 3rd and 5th days were significantly lower in the Bizact™ tonsillectomy group than in the bipolar cautery group. While bleeding occurred on the 4th day in 1 patient in the bipolar cautery group, no postoperative bleeding was observed in the Bizact™ group. Conclusion: Bizact™ tonsillectomy provides safe peroperative and postoperative bleeding control, less pain, and an earlier return to normal diet and social life.

Effect of Laparoscopic Suturing versus Bipolar Coagulation on Ovarian Reserve in Patients Undergoing Endometriotic Ovarian Cystectomy. A Randomized Controlled Trial

Background Women enter menarche with approximately 500000 primordial follicles, which slowly drop in number throughout their reproductive lifetimes. Aim of the Work to determine which hemostatic procedure (hemostatic suture or electrocautery) may be less harmful after laparoscopic cystectomy, based on the status of the ovarian reserve. Patients and Methods The study was conducted at Ain Shams University Maternity Hospital, Obstetric and Gynecology Department, Faculty of medicine. The study population comprised females in childbearing period undergone laparoscopic endometriotic ovarian cystectomy at Ain Shams University Maternity Hospital, Obstetric and Gynecology Department, Faculty of medicine. Results There was no statistically significant difference found between the two studied groups regarding AMH, AFC and FSH preoperative with p-value = 0.188, 0.533 and 0.812 respectively. While there was statistically significant increase in AMH and AFC in suturing group than cautery group postoperative with p-value < 0.001 and 0.005 respectively and also statistically significant decrease in FSH in suturing group than cautery group postoperative with p-value 0.004. Results of this study showed that there was statistically significant increase in the percentage of change of FSH in cautery group (61.59 ± 39.29) than suturing group (23.46 ± 17.87) with p-value < 0.001 while there was statistically significant lower rate of change in AFC and AMH in suturing group than cautery group with p-value = 0.001 and < 0.001 respectively. Conclusion laparoscopic cystectomy reduces the ovarian reserve, which is more affected by hemostatic electrocoagulation than hemostatic sutures.

Which combination cause less inflammatory response during laparoscopic hysterectomy? Ligasure plus monopolar cautery or harmonic plus bipolar cautery?

We aimed to compare the inflammatory response with alterations in hemogram parameters, in patients who underwent laparoscopic hysterectomy and bilateral salpingo-oophorectomy for benign gynecologic conditions with ligasure plus monopolar cautery or harmonic plus conventional bipolar cautery. Patients who underwent Laparoscopic hysterectomy with bilateral salpingo-oophorectomy between January 2017 and January 2022 for benign gynecologic pathology were identified. Patients were divided into two group, according to instruments used during surgery. Instruments were used according to surgeons preference. Preoperative and postoperative in the first 24 hours hematocrit (HCT), WBC, trombocyt, neutrophil- lymphocyte (NLR), platelet-lymphocyte (PLR) ratio, mean platelet volume- lymphocyte ratio (MPVLR) and red cell distribution width- platelet ratio (RPR) values were compared. During study period, a total of 462 patients underwent hysterectomy for benign gynecologic pathology. After exclusion, 212 patients were included in the study. İn the study group, 147 patients were operated with ligasure plus monopolar electrocauter and 65 with harmonic scalpel plus bipolar electrocautery. İn the postoperative period, regardless of the procedure, WBC and RPR count increase, hematocrit and trombocyt decrease in both group but the inflammatory markers lymphocyte count, neutrophyl, NLR, PLR and MPVLR count changed less in the harmonic plus bipolar cautery group which shows less inflamatuar response in this group. Ligasure plus monopolar cautery group compared with harmonic plus bipolar cautery group cause more inflammatory changes in complete blood count values. However, further studies are needed to show whether these changes in laboratory findings affect clinical situations.

Comparison of the effect of the harmonic scalpel and monopolar cautery in transaxillary endoscopic dual-plane breast augmentation

Transaxillary endoscopic dual-plane breast augmentation is becoming increasingly mature. The intraoperative separation of the implant into the space is often performed using monopolar cautery. The use of the harmonic scalpel has proved more beneficial in several surgeries. However, no study has ever addressed the effects of harmonic scalpel usage compared to monopolar cautery in transaxillary endoscopic dual-plane breast augmentation. In this randomized controlled study, we enrolled patients (n=78) who underwent breast augmentation in our hospital from January to October 2022. Participants were randomized with an intentional unequal allocation ratio (2:1 in the harmonic scalpel group: monopolar cautery group). Outcome measures included: total postoperative drainage volume, postoperative drainage volume for the first 24h, number of postoperative drainage days, daily pain scored through the visual analog scale, operative time, and reoperation rate. A total of 51 patients in the harmonic scalpel group and 24 patients in the monopolar cautery group were analyzed. Overall, in comparison to the monopolar cautery group, the harmonic scalpel group showed improved total postoperative drainage volume, postoperative drainage volume for the first 24h, number of postoperative drainage days, and postoperative pain scores. No differences were found regarding operative time and reoperation rate. Compared with monopolar cautery, harmonic scalpel usage in transaxillary endoscopic breast augmentation has evident advantages regarding postoperative drainage and patients' pain scores, making it an instrument worth of recommendation.

HAEMORRHOIDECTOMY : ULTRASONIC SCALPEL VERSUS DIATHERMY CAUTERY

INTRODUCTION Haemorrhoids are the most common anorectal disease seen in age group between 45-50 years. Milligan Morgan haemorrhoidectomy is the gold standard operative procedure for grade 3 and grade 4 haemorrhoids.In the last decade high frequency sound wave energy ultrasonic scalpel is used to cut and coagulate tissues in Milligan-Morgan haemorrhoidectomy. OBJECTIVE Our aim is to do a comparative study between the outcomes of a Milligan Morgan haemorrhoidectomy by using ultrasonic scalpel versus diathermy cautery. MATERIALS AND METHODS This is a prospective comparative randomized study done over a period of 6months (April 2022-September 2022) at GGH Vijayawada. 60 patients of age group 45-65 years. They were randomly divided into 2 groups of 30 each. Group A – Underwent haemorrhoidectomy with diathermy cautery Group B- Underwent haemorrhoidectomy with harmonic scalpel. RESULTS Patients who underwent harmonic scalpel haemorrhoidectomy have statistically signicant P value in post operative pain , post op urinary retention and anal stenosis. CONCLUSION Harmonic scalpel is better than diathermy in having relatively less post operative pain and early resumption of daily activities and less occurrence of urinary retention and anal stenosis

Does Electrocauterization of the Matrix After the Wedge Resection of the Toe-Nail Affect Recurrence in Discrete Age Groups Differently? A Retrospective Analysis

The onychocryptosis, also known as ingrown toe-nails, is a painful, common disorder which is less common in children than in adults. The purpose of the present study was to focus on the effect of electrocautery matricectomy on recurrence rate and clinical outcomes in different age groups. We performed a retrospective assessment of 189 consecutive ingrown toe-nails surgeries. Electrocautery matricectomy was performed in 68 (49.2%) of 138 (73%) adults, 25 (49%) of 51 (27%) adolescents. Recurrence was observed in 11 (21.5%) adolescent patients, while recurrence was observed in 12 (8.6%) adult patients. Recurrence was observed in 9 (9.6%) of 93 patients in whom cautery was used, while 14 (14.5%) recurrences were observed in 96 patients who did not use cautery. When the adolescent patient group was evaluated separately, recurrence was observed in 2 (8%) of 25 patients in the cautery group, while recurrence was observed in 9 (34.6%) of 26 patients in the other group. EM addition to the wedge excision does not affect the results in adult patients, but it significantly reduces recurrence in adolescent patients. Especially in younger patients, it is recommended to complete the matricectomy with electrocoagulation.

Local injection of botulinum toxin type A (BTX-A) prevents scarring esophageal stricture caused by electrocautery in rabbit models.

BackgroundBenign esophageal strictures are common in clinical practice. The commonly used methods for preventing benign esophageal strictures still have many shortcomings. In this study, we investigated the preventive effect and possible mechanism of endoscopic local injection of botulinum toxin type A (BTX-A) on scarring esophageal stricture caused by electrocautery in rabbit models, with an attempt to provide a theoretical basis for the clinical application of BTX-A in the prevention of benign esophageal stricture.MethodsAdult male New Zealand rabbits were randomly divided into 4 groups: cautery group (cauterized with 30 W electrocoagulation power without other intervention), saline group (injected with normal saline at 4 spots in the local esophagus after modeling), BTX-A I group (injected with 10 U of BTX-A after modeling), and BTX-A II group (injected with 20 U of BTX-A after modeling). Body weight was measured at postoperative weeks 1, 2, and 4. Esophagography was performed, and the internal diameter of the esophagus was measured. The esophageal tissues were harvested for hematoxylin and eosin (HE) staining and Masson staining. Type I, type III collagen levels and the mRNA expression of transforming growth factor β1 (TGF-β1) in esophageal tissues were detected.ResultsCompared with the cautery and saline groups, the BTX-A I and BTX-A II groups had significantly higher body weight, larger esophageal internal diameter, lower type I and type III collagen levels, and lower TGF-β1 mRNA expression levels in esophageal tissues at postoperative week 4. Comparisons between the BTX-A I and BTX-A II groups showed no significant differences in terms of body weight, esophageal internal diameter, and type I collagen level at postoperative week 4. However, the BTX-A II group had a significantly lower type III collagen level and TGF-β1 mRNA expression level than the BTX-A I group.ConclusionsLocal injection of BTX-A can alleviate esophageal stricture after electrocautery and has a preventive effect on benign esophageal stricture caused by electrocautery in rabbits. The mechanism may be that BTX-A down-regulates the expression of TGF-β1 in the esophageal tissue at the burn site and reduces the deposition of collagen.

Comparison of Seroma Formation with Harmonic Scalpel Versus Monopolar Electrocautery in Axillary Dissection following Modified Radical Mastectomy

Background: Breast cancer is cancer that forms in the cells of the breasts. Despite of the emergence of the breast conservation technique modified Radical Mastectomy still remains the most commonly performed surgery for CA Breast. The Harmonic scalpel is a surgical instrument used to simultaneously cut and cauterize tissue. Aim: To compare the frequency of seroma formation with harmonic scalpel versus monopolar electrocautery in axillary dissection following modified radical mastectomy. Methods: This randomized control trial was conducted in the Department of General Surgery, Lahore General Hospital and Ghurki Trust Teaching Hospital, Lahore. 60 patients were enrolled. Two groups were made by applying lottery method. One group is treated with hormonic scalpel and other with electrocautery. All surgeries were done under general anesthesia by two surgical teams. After surgery, patients shifted in post-surgical wards and will be followed- up there for 7 days. Seroma formation was noted. All the collected data was entered and analyzed on SPSS version 21. Results: The mean age in harmonic scalpel group was 49.87± 8.67 years and in electrocautery group was 49.87± 8.67 years. The seroma formation in harmonic scalpel group was noted in 5(16.7%) patients whereas the seroma formation in electro cautery group was found in 11(36.7%) patients (p-value=0.080). Conclusion: This study concluded that the harmonic scalpel group showed lower rate of seroma formation than to electrocautery group, however statistically both groups are equally effective Keywords: Harmonic Scalpel, Seroma Formation, electrocautery

Intraoperative Blood Loss, Surgical Duration and Postoperative Pain following Cold Dissection Tonsillectomy and Bipolar Electrocautery Tonsillectomy

Introduction: Tonsillectomy surgery is one of the common surgeries done in department of ENT and HNS. Over the past two centuries, indications and techniques for performing tonsillectomy has much changed. Several techniques for tonsillectomy are described, but their relative effectiveness still remains a matter of debate. To compare the intraoperative bleeding and post-operative pain following bipolar electrocautery tonsillectomy and cold dissection tonsillectomy. Methods: This prospective randomized study was conducted on 60 tonsillitis patients planned for surgery in College of Medical Sciences, Bharatpur, Chitwan during a period of one year. They were divided into two groups: one undergoing tonsillectomy by use of bipolar electrocautery and the other Cold dissection tonsillectomy by random selection. Intraoperative bleeding and postoperative pain were scored and compared. Results: In this study, the mean blood loss during cold dissection tonsillectomy was 25ml and during bipolar cautery was 12ml. The average operative time was 30 minutes for cold dissection group and 25 minutes for bipolar cautery group. The pain score for Cold dissection tonsillectomy group was significantly significant less when compared with pain scores for bipolar cautery tonsillectomy group. Conclusions: Our study shows that tonsillectomy using bipolar electrocautery causes less blood loss and decreased operative duration than cold steel dissection, however it caused relatively more postoperative pain than cold steel dissection tonsillectomy.

LigaSure versus monopolar cautery for recipient hepatectomy in liver transplantation: a propensity score-matched analysis.

BackgroundRecipient hepatectomy during liver transplantation (LT) is one of the most challenging aspects of surgery due to the possibility of massive bleeding. This study aimed to compare and analyze the effectiveness between LigaSure and monopolar cautery in recipients.MethodsWe reviewed 187 recipients who underwent LT from March 2019 to June 2020. We compared the surgical outcomes of the 69 recipients who underwent recipient hepatectomy with LigaSure (LigaSure group) and 118 recipients who underwent with monopolar cautery. Propensity score matching (PSM) was performed using the nearest-neighbor method at a ratio of 1:1 based on 14 baseline characteristics and possible factors that influence postoperative bleeding.ResultsA total of 187 adult recipients were reviewed retrospectively. In the propensity score-matched analysis, The rates of bleeding and infectious complication were significantly lower in the LigaSure group than in the monopolar cautery group (3/69, 4.35% versus 13/69, 18.8%; P=0.015 and 1/69, 1.45% versus 9/69, 13.0%; P=0.017). The length of postoperative hospital stay was shorter in the LigaSure group (mean: 23.1±16.1 versus 39.6±58.2 days; P=0.024).ConclusionsRecipient hepatectomy with LigaSure is associated with a short hospital stay due to low re-operation rates, postoperative bleeding, and secondary infection related to bleeding.

LigaSure versus monopolar cautery for recipient hepatectomy in liver transplantation: A propensity score-matched analysis

The recipient hepatectomy process during liver transplantation is one of the most challenging parts of surgery because massive bleeding may be expected. The energy device has an excellent hemostatic effect with the sealing effect compared to the monopolar cautery. The purpose of this study was to compare and analyze the usefulness of the energy device with monopolar cautery in liver transplantation. We reviewed those who underwent liver transplantation from March 2019 to June 2020. A total of 187 recipients who underwent liver transplantation were included in this study. Sixty-nine cases of recipient who underwent recipient hepatectomy with LigaSure 118 cases included as a control group. We used propensity score matching to adjust baseline characteristics and possible factor that affects postoperative bleeding. Blood loss and total amounts of RBC transfusion were not different between both groups (mean, 5,486.5 ± 9,024.6 vs. 4,754.3 ± 6,819.5 cc; p = 0.592; 11.01 ± 13.75 vs. 10.21 ± 12.52 pack; p = 0.447). The rates of bleeding and infectious complication were significantly lower in the LigaSure group than in the monopolar cautery group (3/69, 4.35% vs. 13/69, 18.8%; p = 0.015 and 1/69, 1.45% vs. 9/69, 13.0%; p = 0.017). The length of postoperative hospital stay was shorter in the LigaSure group (mean, 23.1 ± 16.1 vs. 39.6 ± 58.2 days; p = 0.024). Recipient hepatectomy using the LigaSure energy device had a shorter hospital stay due to fewer re-operations rate and postoperative bleeding. And it also had fewer secondary complications related to bleeding than the conventional monopolar cautery group.

Rapid Establishment of Tracheal Stenosis in Pigs Using Endotracheal Tube Cuff Overpressure and Electrocautery.

To apply a new airway treatment to humans, preclinical studies in an appropriate animal model is needed. Canine, porcine and leporine tracheas have been employed as animal airway stenosis models using various methods such as chemical caustic agents, laser, and electrocautery. However, existing models take a long time to develop (3-8 weeks) and the mechanism of stenosis is different from that in humans. The aim of the present study was to establish a new and fast tracheal stenosis model in pigs using a combination of cuff overpressure intubation (COI) and electrocautery. Fourteen pigs were divided into three groups: tracheal cautery (TC) group (n=3), COI group (n=3), and COI-TC combination group (n=8). Cuff overpressure (200/400/500 mmHg) was applied using a 9-mm endotracheal tube. Tracheal cautery (40/60 watts) was performed using a rigid bronchoscopic electrocoagulator. After intervention, the pigs were observed for 3 weeks and bronchoscopy was performed every 7 days. When the cross-sectional area decreased by > 50%, it was confirmed that tracheal stenosis was established. The time for tracheal stenosis was 14 days in the TC group and 7 days in the COI-TC combination group. In the COI group, no stenosis occurred. In the COI-TC group, electrocautery (40 watts) immediately after intubation for >1 h with a cuff pressure of 200 mmHg or more resulted in sufficient tracheal stenosis within 7 days. Moreover, the degree of tracheal stenosis increased in proportion to the cuff pressure and tracheal intubation time. The combined use of cuff overpressure and electrocautery helped to establish tracheal stenosis in pigs rapidly.

The addition of silver nitrate cautery to antiseptic nasal cream for patients with epistaxis: A systematic review and meta-analysis

ObjectiveTo compare the outcomes of the addition of silver nitrate cautery versus antiseptic cream alone in paediatric patients with recurrent epistaxis. MethodsA systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines and a search of electronic information was conducted to identify all Randomised Controlled Trials (RCTs) and non-randomised studies comparing the outcomes of the addition of silver nitrate cautery versus antiseptic cream alone in paediatric patients with recurrent epistaxis. Treatment success and persistence of bleeding were primary outcome measures. Secondary outcome measures included treatment side effects. Fixed effects modelling was used for the analysis. ResultsFour studies enrolling 240 patients were identified. There was no significant difference between silver nitrate cautery group and antiseptic cream alone group in terms of complete resolution (Odds Ratio [OR] = 1.07, P = 0.81), the partial resolution (OR = 1.02, P = 0.96) and persistence of bleeding (OR = 0.91, P = 0.71). For secondary outcomes, antiseptic nasal cream was associated with few side effects such as rash in one case and several complaints of bad smell or taste. ConclusionsThe addition of silver nitrate cautery is not superior to the use of antiseptic cream alone in paediatric patients with recurrent epistaxis as it does not improve treatment success or persistence of bleeding.

Scalpel can achieve better clinical outcomes compared with electric cautery in primary total knee arthroplasty: a comparison study

BackgroundWhether using the scalpel can provide better and faster recovery after the primary total knee arthroplasty (TKA) is still controversial. The aim of this research was to compare the clinical outcomes of using the scalpel and the electric cautery in primary TKA.MethodsFrom January 2016 to December 2017, a retrospective cohort study was conducted in 313 patients who underwent unilateral primary TKA by using the scalpel (group S). During this period, we selected 313 patients who underwent unilateral primary TKA by using the electric cautery (group E) for comparison. The tourniquet time, operative time, blood loss, wound complications, visual analog score for pain, range of motion, Knee Society Score were assessed between the two groups. The Forgotten Joint Score was used to analyze the ability to forget the joint.ResultsThere were no significant differences in tourniquet time, operative time, blood loss between the two groups (p > 0.05). In the group S, the visual analog score for pain, range of motion, Knee Society Score were found better results at 1 week, 1 month, 3 months, 6 months, 12 months and 24 months after surgery (p < 0.05). Besides, during the follow-up period, the Forgotten Joint Score was significantly higher compared with group E (p < 0.05).ConclusionIn this research, the patients who underwent TKA by using the scalpel could achieve better clinical outcomes. In addition, if forgotten artificial joint after TKA was the final goal, the patients who underwent TKA by using the scalpel would acquire better quality of life.

Comparison of Harmonic scalpel and monopolar cautery for capsulectomy at the second stage of expander/implant breast reconstruction.

BackgroundCapsular contracture is a common complication of two-stage expander/implant breast reconstruction. To minimize the risk of this complication, capsulectomy is performed using monopolar cautery or ultrasonic surgical instrumentation, the latter of which can be conducted with a Harmonic scalpel. To date, there is disagreement regarding which of the two methods is superior. The purpose of this study was to compare postoperative outcomes between a group of patients who underwent surgery using a Harmonic scalpel and another group treated with monopolar cautery.MethodsA retrospective chart review was conducted of patients who underwent capsulectomy as part of two-stage breast reconstruction between January 2018 and February 2019 and who received at least 1 month of follow-up after surgery. Operative time and postoperative outcomes, including drainage duration, were analyzed.ResultsIn total, 36 female patients underwent capsulectomy. The monopolar group consisted of 18 patients and 22 breasts, while the Harmonic scalpel group consisted of 18 patients and 21 breasts. There was no statistically significant difference in demographics between the two groups. The Harmonic scalpel group had a significantly shorter mean drainage duration (6.65 days vs. 7.36 days) and a smaller mean total drainage volume (334.69 mL vs. 433.54 mL) than the monopolar cautery group (P<0.05). No statistically significant difference was observed with regard to seroma or hematoma formation.ConclusionsThe Harmonic scalpel approach for capsulectomy reduced the total drainage volume and drainage duration compared to the monopolar cautery approach. Therefore, this approach could serve as a good alternative to electrocautery.

Oxidative and histopathological effects of the application of electrosurgical devices to the penile tissue of rats

This study was performed to evaluate the oxidative and histopathological changes that occur following the application of electrosurgical devices (monopolar or bipolar cautery) to penile tissue. Eighteen Wistar albino male rats were randomly distributed into three groups. In the control group (CG, n=6), all penile tissues were sampled without any additional process following the administration of anesthesia. In the monopolar cautery group (MPG, n=6), a 15-W cauterization process lasting 5s was performed on an approximately 2mm2 area of the ventral side of the penile shaft, 0.5cm proximal to the edge of the glans in the midline. Bipolar cautery was practiced in the third group (BPG, n=6) using the same techniques outlined in the previous statement. Penile tissues consisted of the cautery application area, the edge of the glans, and dorsal side of the penis and were sampled after 90min; then, histopathological evaluation and biochemical examination involving malondialdehyde (MDA), nitric oxide (NO), and superoxide dismutase (SOD) measurements were performed. Histopathologically, the MPG and BPG demonstrated increased inflammation, fibrosis, and epithelial loss in the urethra in the areas to which cautery was applied as compared to the CG (P<0.05). The vascular structures of the corpus cavernosa were significantly decreased in the cautery application area of both the MPG and the BPG as compared to the CG (P<0.05). In the Masson's trichrome stained samples, significant collagen deposition was observed in the cautery application area both in the MPG and the BPG as compared to the CG (P<0.05). However, S-100 staining was decreased in these groups as compared to the CG (P<0.05). S-100 staining was also decreased in the MPG as compared to the BPG on the edge of the glans (P<0.05). Biochemically, MDA values were significantly increased in the MPG as compared to the CG and the BPG (P<0.05). Monopolar and bipolar cautery both did cause oxidative changes and triggered inflammatory, vascular, and peripheral nerve alterations in the cautery application area while bipolar cautery did not cause any distant effects.

The use of plasmakinetic cautery compared to conventional electrocautery for dissection of abdominal free flap for breast reconstruction: single-centre, randomized controlled study.

The plasmakinetic cautery is a surgical dissection instrument that combines scalpel-like cutting precision with electrocautery-like haemostasis properties, and operates at lower temperatures (40-170 °C) than conventional electrocautery (200-350 °C). The aim of this study is to evaluate the clinical benefits of using plasmakinetic cautery in abdominal free flap dissection for breast reconstruction. Forty women undergoing abdominal-based microsurgical breast reconstruction (DIEP/MS-TRAM) were randomized to plasmakinetic cautery (n=20) or conventional electrocautery (n=20) for dissection of the abdominal free flap. Total abdominal wound drainage volume/duration, operation time and complications such as seroma and haematoma were examined. Age, body mass index, type of reconstruction and abdominal flap weight were similar in both groups. Mean abdominal drainage volume was (279±262) mL in conventional electrocautery group and (294±265) mL in plasmakinetic cautery group (P=0.853). Plasmakinetic cautery group mean drainage duration (4.3±2.2 days) was no difference compared to conventional diathermy group (3.8±2.0 days, P=0.501). Mean operation time in the conventional electrocautery group and plasmakinetic cautery group was 157±50 vs. 174±70 min respectively (P=0.195). There was more seroma detected in the conventional electrocautery group compared to plasmakinetic cautery group at days 7, 14 and 42 post-operation, but this was not statically significant. 2 haematomas in conventional diathermy group and 1 haematoms in the plasmakinetic cautery group required evacuation. This study demonstrates that there are no significant differences between the use of plasmakinetic cautery and conventional electrocautery for abdominal free flap dissection.

Long‐term olfaction outcomes in transnasal endoscopic skull‐base surgery: a prospective cohort study comparing electrocautery and cold knife upper septal limb incision techniques

Olfactory nerve fibers are at risk of injury during transnasal endoscopic skull-base approaches. Olfactory outcomes for various techniques have not been thoroughly investigated. This study aims to report long-term olfactory outcomes when a cold knife upper septal limb incision technique is used compared to monopolar cautery. A prospective cohort study was performed at a tertiary referral center. Adult patients undergoing endoscopic approaches with septal incisions were randomized to cold knife or monopolar cautery groups. Patient demographics, clinical history, surgical data, and outcomes were collected. Preoperative, 3-month, and 12-month postoperative scores on the University of Pennsylvania Smell Inventory Test (UPSIT) and 22-item Sino-Nasal Outcome Test (SNOT-22) were measured. Fisher's exact tests were performed for categorical variables and t tests were performed for continuous variables. Twenty-two (22) patients (10 cold knife, 12 cautery) were enrolled between March 2016 and August 2017. The average age ± standard deviation was 50.2 ± 14.0 years (p = 0.59), 54% (p = 0.69) were female, and the primary pathology was pituitary adenoma (73%, p = 1.00). Preoperative, 3-month, and 12-month postoperative UPSIT scores were similar between the cold knife and cautery groups (32.8 vs 32.4, p = 0.80; 33.1 vs 33.0, p = 0.96; 33.6 vs 33.3, p = 0.84). On the "sense of smell/taste" question of the SNOT-22, there was also no difference at all time points (p > 0.22). There was no significant change in patient UPSIT scores 1 year after transnasal skull-base approaches, and no short-term or long-term differences between cold knife and cautery upper septal limb incision techniques. Our study supports an individualized approach based on surgeon preference.